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home - Liver - Treatments - Liver Transplantation Written by Dr Sebastian Zeki
Knowledge


Knows the indications for liver transplantation appropriate timing of
referral for assessment and outcomes after transplantation

Understands the long-term management of liver transplant recipients
including complications of immunosuppression and management of
recurrent disease

Skills
Can identify potential candidates for liver transplantation as well as
demonstrating an understanding of why patients with end-stage liver
disease are not appropriate candidates for liver transplantation

Has detailed understanding of the transplant process will
be required while training in specialist units and their satellites

Behaviours
Displays confidence that they can identify all potential candidates for
liver transplantation refer at the appropriate time and contribute to
life-long follow-up of liver recipients

Liver Transplantation

Liver transplantation Long term transplant period (more than 4 weeks) Watch for malignancies Kaposi's sarcoma BCC Burkitt's. DDX HA/PV thrombosis Biliary leak, cholangitis Drug toxicity, recurrent viral Early transplant period (1 to 4 weeks) Regime Tacrolimus with Prednisolone/MMF - Cyclosporine with Prednisolone/AZA/MMF (Stop steroids at 6 months) Raised LFTs - 50% get rejection in first 3 months Prognostic predictors of survival post transplant - Pre treatment creatinine - Age - Re transplantation - Extensive stage HCC - HCV Relative contra indications PV/MB thrombosis Cholangiocarcinoma Age more than 65 Pulmonary hypertension HIV infection Absolute contra indication Extra hepatic malignancy Uncontrolled sepsis Active ETOH/drug use Inadequate Social support More than T3 HCC Advanced cardiopulmonary disease Kings Paracetamol + normal Paracetamol referral criteria NB/fulminant hepatic failure = encephalopathy within 8 weeks of onset of symptoms in Pre-existing liver disease MELD = way of prioritising liver transplantation = 0.957 x log e (creatinine conc in mg/dl) + 0.378 x log e (bilirubin in mg/dl) + 1.120 x log e(INR) + 0.643 x 10 Refer when MELD is more than 14 Diseases for which liver transplantation performed Chronic liver disease (90%) Hepatic adenoma/carcinoid - 2% Acute liver failure 8% Disadvantages Risk to donor No long term data More biliary complication in recipients Living donor liver transplantation (LDLT) Advantages Decreased waiting time to transplantation Decreased cold ischaemic time Written by Dr Sebastian Zeki

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