**3.2.2 Advanced liver disease in abstinent alcoholic patients**

The Model for End-Stage Liver Disease (MELD) scoring system aims to reduce liver waitlist mortality by transplanting sicker patients more rapidly. Abstinent alcoholics frequently belong to the sickest patient groups. Nowadays, OLT is a very good indication in such patients if the recipient remains abstinent and is compliant. If the recipient remains abstinent, alcoholic cirrhosis is one of the best indications for OLT as this is the only disease that does not recur in the allograft. Moreover, abstinent alcoholics that receive OLT offer a unique opportunity to study the effect of immunosuppression withdrawal without primary disease involvement in the allograft.

#### **3.2.3 Previous abdominal surgery**

Many transplant recipients have undergone previous abdominal and right upper quadrant surgery. These interventions can compromise the transplant procedure. Thus, exploratory or staging laparotomies as well as unnecessary cholecystectomies and cyst fenestrations should be avoided in future OLT patients. Interventional radiology procedures such as the Transjugular Intrahepatic Portosystemic Shunt (TIPSS) are preferred in potential OLT recipients instead of portal hypertension surgery. In cases where portal hypertension surgery cannot be avoided, meso-caval or spleno-renal shunts are the preferred options leaving the hilar region intact.

#### **3.2.4 HIV infection**

HIV patients that are well controlled on Highly Active Antiretroviral Therapy (HAART) are generally not contraindicated for OLT. The indication for OLT relates more so to concomitant HCV and/or HBV infection. Co-infected patients are at higher post-OLT infectious risk. Particular attention should be given to the interaction between anti-viral drugs and calcineurin inhibitors.

#### **3.2.5 Positive HBsAg status**

See above.
