Management of the Cirrhotic Patient Before Liver Transplantation: The Role of the Referring Gastroenterologist.

The referral of a patient with cirrhosis to a liver transplant center for evaluation is usually made by a local gastroenterologist. The role of the referring gastroenterologist begins with early identification and modification of high-risk behaviors, which may delay listing a patient for liver transplantation. The local gastroenterologist must also fully appreciate what constitutes a timely referral of a patient to a liver transplant center and the consequences of late referral. Although patients experience the inevitable deterioration of their liver function, which in turn advances their priority on the liver transplant waiting list, the referring gastroenterologist must also anticipate medical complications of cirrhosis, and should initiate appropriate surveillance and prophylaxis programs to detect and prevent these complications. Finally, the referring gastroenterologist constitutes a vital link of information between the patient and the transplant center. Adherence to these guidelines will increase the probability that a patient with chronic liver failure will undergo successful liver transplantation and will decrease post-transplant morbidity.