Liver Transplantation

From Anvita Health Wiki

Contents 1 Introduction 2 Indications 3 Contraindications 4 Laboratory 5 Complications 6 Management 7 More General Terms 8 Additional Terms 9 References

Introduction

• Cadaveric & living donor liver* transplants.
  

• * Transplant of left lateral segment, left lobe or right lobe of the liver obtained from a living donor (> 90% of donors are relatives)

Indications

• patients with complications from end-stage liver disease

• hepatic encephalopathy
• hepatorenal syndrome
• variceal hemorrhage
• uncontrolled ascites
• spontaneous bacterial peritonitis
• unresponsive coagulapathy
• profound fatigue
• hepatic osteodystrophy
• recurring bacterial cholangitis

• diseases

• fulminant hepatic failure

• drug or toxin-induced
• viral hepatitis

• end-stage liver disease

• cirrhosis of any cause
• cystic fibrosis
• arteriohepatic dysplasia
• Budd-Chiari syndrome
• veno-occlusive disease
• polycystic liver disease
• congenital hepatic fibrosis
• metabolic disorders

• tyrosinemia
• glycogen storage disease

• hemochromatosis

• selected malignant disorders

• hepatocellular carcinoma
• cholangiocarcinoma
  

• * Early referral

Contraindications

• AIDS, not list in [1]
• continuing alcohol or drug abuse
• severe, uncontrolled cardiac or pulmonary disease
• most extra-hepatic malignancies

• some islet cell tumors & carcinoid tumors can be exceptions
• advanced hepatocellular carcinoma
• cholangiocarcinoma

• uncontrolled sepsis
• morbid obesity
  

• Advanced age is NOT a contraindication

Laboratory

• MELD score predicts prognosis, urgent need for transplantation

Complications

• systemic hypertension
• obesity
• azotemia from immunosuppressive agents
• infection
• allograft rejection
• recurrence of original disease

• for example: hepatitis C

• malignancies

• squamous cell carcinomas

• skin
• lip
• cervix
• vulva
• perineum

• adenocarcinomas

• breast
• colon

• lymphoproliferative disorders

• B-cell lymphoma

• lung cancer [6]

Management

• post liver transplant
• prophylaxis for:

• Pneumocystis carinii pneumonia ( PCP)
• Herpes simplex virus ( HSV)

• immunosuppression for transplant rejection

• use of tacrolimus associated with improved outcomes

• avoid excessive sun exposure; use sun screen (risk of skin cancer)
• cancer screening

• annual fecal occult blood
• flexible sigmoidoscopy
• mammography
• Pap smear

More General Terms

• organ/tissue transplantation

Additional Terms

• model for end-stage liver disease (MELD)

References

1. Medical Knowledge Self Assessment Program (MKSAP) 11, 15, American College of Physicians, Philadelphia 1998, 2009
2. Journal Watch 21(20):62, 2001 Miller CM et al, One hundred nine living donor liver transplants in adults and children: a single-center experience. Ann Surg 234:301, 2001 PMID: [1]
3. Engels EA et al. Spectrum of cancer risk among US solid organ transplant recipients. JAMA 2011 Nov 2; 306:1891. PMID: &dopt=Abstract
4. Liver Transplantation: NIH Institute and Center Resources [2]
5. National Guideline Clearinghouse
   - Neurological problems in liver transplantation. European Federation of Neurological Societies ngc-guideline: [3]

liver transplantation