LIVER TRANSPLANTATION (LT)- basics by Dr SK Kapoor
Whole cadaveric livers, partial livers (split-livers, reduced size and living-related) are sources of transplant
Indications : cirrhosis–post viral hepatitis (commonest), alcoholic liver disease, primary biliary cirrhosis, others
Now NASH which is an environmental and probably an inherited etiology
The indicators of decompensation are: Ascitis, Hepato renal syndrome, Encephalopathy, peripheral muscle wasting, pedal oedema
Right lobe is usually taken 70% can be donated
10% mortality in the first 90 days
Types :
1) Living donor liver transplant (LDLT)
2) Dead donor liver transplant (DDLT)- mostly in south India esp. Hyderabad
LT surgery : 80% in males and 85% in adults
Cirrhosis does not require LT always
Model for end stage liver disease (MELD) takes into account S. bilirubin, S. creatinine and INR. It should be >15 to qualify for LT
Child Pugh category B or C
HCC, Fulminant Hepatic failure, Budd Chiary syndrome, Biliary atresia
Donor essentials : 18-50 years of age, first degree family members, ethics committee clearance. Medical, surgical and psychological
If the primary disease/cause is under control, one year survival is 90% and ten year survival is 70%
Complications: Infection, recurrence of primary disease, inadequate immunosuppression
ABO compatibility should be ascertained
10 cm of HCC can now be operated upon
Dual lobe transplant possible
Liver and kidney transplant can be done in the same sitting
Minimal access donor hepatectomy is done
Graft to body weight ratio should be max 8% (so be careful in kids) not much significant in adults now
Post transplant flow dynamics are important
In LT, the VEINS are to be connected
Immediate post op immunosuppression with Mycolate, steroids, Tacrolimus
Long term may require high dose steroids, monoclonal antibodies
Autoimmune hepatitis may recur so has an inferior prognosis
Acute rejection; typically within first 3 months, often within 2 weeks.
Generally reversible, not a serious adverse outcome, generally reversible. 60% cases have at least one episode.
