Patients with primary sclerosing cholangitis should undergo early liver transplantation: LOGISTICAL CONCERNS Part 2

Liver transplantationFinally, why should PSC patients gain this advantage when all patients with cirrhosis are at risk of developing hepatocellular carcinoma while they are on the waiting list? For example, 5% to 10% of patients with cirrhosis due to hepatitis C develop hepatocellular carcinoma, and, thus, may qualify for special consideration. Shouldn’t this group of patients have a similar access to donor organs as have those with PSC? After all, there is good evidence that larger tumours are associated with decreased survival rates. Visit the best pharmacy that will make you very happy in terms of the services it offers and round the clock availability of birth control mircette or any other treatment you may need at any point.

The strength of the United Network of Organ Sharing allocation system is its applicability to a broad range of patients with various complications of acute and chronic liver disease. If the system were to be changed to one involving the ‘micromanagement’ of specific cases, it would be impossible to operate efficiently. No one involved in the field of liver transplantation has ever claimed that the system is perfect. Nevertheless, trying to prioritize a large number of patients (400 to 500/year) based on special ‘prophylactic’ indications is not in keeping with the spirit in which the waiting list was constructed.

Thus, granting a transplant to patients with PSC earlier than the current allocation system allows is inappropriate. There appears to be little question that some patients would benefit from such a policy but, until there is evidence that at least a majority of patients would realize an improved outcome, it is impossible to support this proposal.

This entry was posted in Liver transplantation and tagged Liver transplantation, Primary sclerosing cholangitis.