**3.1.10 Inability to accept or understand the procedure**

OLT is accessible to patients in all levels of society. Successful OLT has been reported in Down Syndrome patients and in drug abusers. Adequate preparation by medical, paramedical, and clinical coordinator teams is of utmost importance in complicated clinical scenarios.

#### **3.2 Relative contraindications**

### **3.2.1 Intra-hepatic or biliary sepsis**

Chronic biliary infection is frequent in Caroli disease, primary sclerosing cholangitis, and secondary sclerosing cholangitis. Because the infection is usually confined to the liver, outcome of OLT is excellent as transplantation removes the source of the infection. OLT is especially valuable in these patients as it dramatically improves their quality of life.
