一、禁忌證
如果病人合并有下列疾病，應視為手術禁忌證。
（1)血清中人類免疫缺陷病毒（HIV)陽性。
�。�2)肝外惡性腫瘤。
�。�3)膽管癌。
�。�4)嚴重的心肺疾病。
�。�5)未控制的全身性感染。
�。�6)其他臟器功能衰竭。
�。�7)心理學方面的不適應。
二、危險因素
肝移植的主要危險因素包括：年齡偏大、肌營養(yǎng)不良、昏迷、腹水、活動性出血和既往有腹部手術史等。表3-1為Pittsburgh的術前評估表，可用來粗略預測肝移植術后病人的存活率。
表3-1 肝移植受體術前評估表
| 分數(shù) | 表現(xiàn) | 分數(shù) | 表現(xiàn) | ||
| 昏迷 | 6 | 術中為昏迷狀態(tài) | 腹水 | 2 | 難控制型 |
| 2 | ⅢⅣ期昏迷 | 1 | 可控制型 | ||
| 1 | 間歇性意識不清 | 0 | 無 | ||
| 0 | 無肝性腦病 | 其他 | 2 | 膽紅素300µmol/L | |
| 肌營養(yǎng)不良 | 2 | 重度肌營養(yǎng)不良 | 1 | 曲張靜脈出血 | |
| 1 | 輕度肌營養(yǎng)不良 | 1 | 膽管系統(tǒng)感染 | ||
| 0 | 無肌營養(yǎng)不良 | 1 | 自發(fā)性腹膜炎 | ||
| 既往手術史 | 2 | 多次膽管再建手術 | 2 | 年齡大于40歲 | |
| 2 | 門腔靜脈分流術 | 1 | 膽紅素100µmol/L | ||
| 1 | 每次開腹術 | 1 | PT15 s | ||
| 0 | 無 |
本表應用比分累計法，0-3分表示低危病人，如果等于或高于7分，意味著存在著比3分病人高1倍的危險性。單一的因素如術后出血等，與術后病人的存活率也明顯相關。既往腹有手術史，特別是膽管手術史，將明顯增加手術的難度。
參考文獻
1.Feray C,Zignergo AL,Samuel D et al.Persistent hepatitis Bvirus infetion of mononuclear blood cells without concomitant infection.The liver transplantation model.Transplantation,1990,49:1155
2.Pemetris AJ ,Todo S, Van Thiel Dhet al.Evolution of hepatitis B virus liver disease after hepatic replacement.Practical and theoretical consideration.Am J Pathol,1990,137:667
3.O’Grady JG,Willians R.Liver transplantation for viral hepatitis .Br Med Bull.1990,46:481
4.Mazzaferro V,Regalia E,Montalto F et al.Risk of HBV reinfection afeter liver transplantation in HbsAg-positive cirrhosis.Primary hepatocellular carcinoma is not a predictor for HBV recurrence.Liver ,1996,16:117
5.Marsman WA,Wiesher RH,Batts KP et al.Fulminant hepatitis Bvirus:recurrence after liver transplantation in two patients also infected with hepatitis delta virus.Hepatology,1997,25:434
6.Hart J.Busuttil RW,Lewm KJ.Disease recurrence following liver transplantation.Am J Surg Pathol.1990,14(Suppl1):79
7.Martin P,Munoz SJ,DiBisceglia AM et al.Recurrence of hepatitis Cvirus infection after orthotopic liver transplantation.Hepatology,1991,13:719
8.Gane EJ,Portinann BC,Waoumov NV et al .Long-term outcome of hepatitis Cinfection after liver transplantation.N Engl Med,1996,334:815
9.Baber KH,Dalley G,Bahr MJ et al.Long-term outcome of hepatitis C virus infection after liver transplatation .Hepatology,1997,25 :202
10.Terrault NA,Zhou S,Combs Cet al.Prophylaxis in liver transplant recipient using a fixed dosing schedule of hepatitis Bimmunoglobulin.Hepatology,1996,24:1327
11.Van Thiel DH,Bonet H,Gavaler J et al ,Effect of alcohol use on allograft liver transplantation for alcoholic liver disease.Alcohol Chin Exp Res,1995,19:1151
12.Maddrey WC.Bone disease in patients with primary biliary cirrhosis.Prog Liver Dis,1990,9:537
13.Shapiro JM,Smith H,Schaffner F.Serum bilirubin: a prognostic factor in primary biliary cirrhosis.Gut,1979,20:137
14.Mentna G,Giostra E,Rubbia L et al .Follow-up and result of liver transplantation of primary biliary cirrhosis.Swiss Surg,1996,3:116
15.Knoop M,Bechstein Wo,Schrem H et al.Chinical significance of recurrent primary billiary cirrhosis after liver transplantation .Transpl Int,1996,9(Suppl 1):S115
16.Sternlieb I.Wilson’s disease:indication for liver transplantation.Hepatology,1984,4:155
17.Exquive CO,Marino IR,Fioravanti V et al.Liver transplantation formetabolic disease of the liver,Gastroenterol Clin N Am,1988,17:167
18. Ismail T,Angrisani L,Gunson BK et al,Primary hepatic malignancy:The role of liver transplantation,Br J Surg,1990,77:983
19.Hoofnagle JH,Carithevs RC Jr,Shapiro Cet al.Fulminant hepatic failure:summary of a workshop.Hepatology,1995,21:240
20.Williams R,Wendon J.Indication for orthotopic liver transplantation in fulminant liver failure.Hepatology,1994,20:1.
21.Ludwing J,LaRusso NF,Wiesner RH.The syndrome of primary sclerosing cholangitis.Prog Liver Dis,1990,9:555
22 .Rosen CB,Nagorney DM,Wiesner RH et al.Cholangiocarcinoma complicating primary sclerosing cholangitis .Ann Surg,1991,213:21
23.Olsson R,Panielsson ,A,Jarnerot G et al .Prevalence of primary sclerosing cholangitis in patients with ulcerative colitis.Gastroenterology,1991,11:1319
24.Higashi H,Yanaga K,Marsh JW et al.Development of colon cancer after transplantation for primary sclerosing cholangitis associated with ulcerative colitis.Hepatology,1990,11:477
25.Alayoglu M,Stratta RJ,Sollinger HW .Liner transplantation in infans and children.J Pediatr Surg,1989,24:70
26.Salerno F,Borroni G,Moser Pet al .Prognostic value of the galactose test in predicting survival of patients with cirrhosis evaluated for liver transplantation A prospective multicenter Italian study.AISF Group for the Study of Liver Transplantation.Association Italiana per lo Studio del Fegato.Hepatol.1996,25474
