When to Start the Transplant Referral Process
It is not always clear when patients should be referred for kidney or liver transplantation. Some patients
wait until it is too late to be evaluated for a transplant, and some seek evaluation as soon as a kidney or
liver problem is discovered. The criteria for referral are not very clear. However, we can provide the
following guidelines for persons seeking liver or kidney transplants.
Liver: Patients with liver disease should start referral and workup for liver transplantation if they become
symptomatic with liver disease. This would include the development of hepatic encephalopathy, ascites,
variceal bleeding, or liver dysfunction with albumin <3 and Protime >5 seconds prolonged.
If the patient is HIV positive and hepatitis C (HCV) or hepatitis B (HBV) co-infected, a hepatologist will need
to carefully watch the progression of the liver disease by monitoring liver function.
Another indicator for referral would be a Child-Turcotte-Pugh (CTP) score. Each of five parameters (see
table) is assigned a score from 1 to 3. The sum of the five scores is the CTP score. A score of 7 or greater
would be a good indicator for referral for transplant evaluation. The CTP score is no longer used for organ
allocation but does prove an excellent indicator of when to begin liver transplant evaluation.
Kidney: Patients on hemodialysis or CAPD should be referred for kidney transplant. Patients not on
dialysis but whose creatinine clearance or GFR rate is < 25 should be referred for evaluation, although
patients cannot start to accumulate time on the waiting list until their GFR is < 20%.
|Modified Child-Turcotte-Pugh (CTP) scoring system
|Prothrombin time (INR)
||<4 sec (<1.7)
||4-6 sec (1.7-2.3)
||>6 sec (>2.3)