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Home » Surgical Notes » Clinical » The Trunk » Abdominal Examination

Liver transplant

Considerations for liver transplantation

  1. Alcohol
  2. Viral - HBV
  3. Autoimmune - PSC, PBC
  4. Hereditary: Wilsons, A1-antitrypsin

 

 

 

Workup for transplantation

  1. Anatomically appropriate
    • if too big can produce abdominal compartment syndrome when closing over
    • ~25% well functioning liver normally required
  2. ABO compatibility (HLA less important)
  3. Cold ischaemic time: usually <12 hours (cf, 24h kidney, 4h heart)
  4. Physiological workup
    • Cardiovascular support required
    • Respiratory function tests
    • Bone density (steroids post surgery)
    • Renal workup (due to nephrotoxic drugs being used, cross clamping of venae cava)

Clinical features:

  1. "Mercedes Benz" abdominal scar: bilateral rooftop incision with sternal extension
  2. Look for any sites of veno-venous bypass (ie the neck and the groins)
  3. Features of immunosuppression / cushingoid features from excessive steroids
  4. Inspect scar sites for incision hernias

Post operative considerations

  1. Immunusuppression:
    • Steroids
    • Cyclosporin A
    • Azathioprine
    • Tacrolimus
    • Rapamycin (anti-fibrinolytic agent used in drug-eluting stents))
  2.  
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