Guidance for Timely Referral to Liver Transplantation

Morbidity and mortality from cirrhosis is increasing, and it is mainly driven by liver-associated decompensation. Liver transplantation (LT) is the only curative treatment for decompensated cirrhosis and selected liver-related complications and malignancies. Delayed referral or lack of referral in patients who will benefit from LT can impact quality of life for patients and their caregivers and lead to increased mortality. Timely identification of the clinical scenarios that will benefit from LT is key for patients not to lose their LT window. Early referral is also appropriate so that patients and providers can have access to multidisciplinary teams with dedicated expertise in managing the complications of decompensated cirrhosis. Referral for LT typically begins with primary care providers, gastroenterologists, and oncologists, who can more efficiently deliver their care through understanding of the referral process and LT framework. We aim to provide guidance to adult providers on timely referral to LT, demystify the LT evaluation process and contraindications to LT, and increase partnership between referring providers and transplant center providers caring for patients with advanced chronic liver disease.