一、禁忌证
如果病人合并有下列疾病，应视为手术禁忌证。
（1)血清中人类免疫缺陷病毒（HIV)阳性。
（2)肝外恶性肿瘤。
（3)胆管癌。
（4)严重的心肺疾病。
（5)未控制的全身性感染。
（6)其他脏器功能衰竭。
（7)心理学方面的不适应。
二、危险因素
肝移植的主要危险因素包括：年龄偏大、肌营养不良、昏迷、腹水、活动性出血和既往有腹部手术史等。表3-1为Pittsburgh的术前评估表，可用来粗略预测肝移植术后病人的存活率。
表3-1 肝移植受体术前评估表
| 分数 | 表现 | 分数 | 表现 | ||
| 昏迷 | 6 | 术中为昏迷状态 | 腹水 | 2 | 难控制型 |
| 2 | ⅢⅣ期昏迷 | 1 | 可控制型 | ||
| 1 | 间歇性意识不清 | 0 | 无 | ||
| 0 | 无肝性脑病 | 其他 | 2 | 胆红素300µmol/L | |
| 肌营养不良 | 2 | 重度肌营养不良 | 1 | 曲张静脉出血 | |
| 1 | 轻度肌营养不良 | 1 | 胆管系统感染 | ||
| 0 | 无肌营养不良 | 1 | 自发性腹膜炎 | ||
| 既往手术史 | 2 | 多次胆管再建手术 | 2 | 年龄大于40岁 | |
| 2 | 门腔静脉分流术 | 1 | 胆红素100µmol/L | ||
| 1 | 每次开腹术 | 1 | PT15 s | ||
| 0 | 无 |
本表应用比分累计法，0-3分表示低危病人，如果等于或高于7分，意味着存在着比3分病人高1倍的危险性。单一的因素如术后出血等，与术后病人的存活率也明显相关。既往腹有手术史，特别是胆管手术史，将明显增加手术的难度。
参考文献
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
