Liver transplant
Considerations for liver transplantation
- Alcohol
- Viral - HBV
- Autoimmune - PSC, PBC
- Hereditary: Wilsons, A1-antitrypsin
Workup for transplantation
- Anatomically appropriate
- if too big can produce abdominal compartment syndrome when closing over
- ~25% well functioning liver normally required
- ABO compatibility (HLA less important)
- Cold ischaemic time: usually <12 hours (cf, 24h kidney, 4h heart)
- 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:
- "Mercedes Benz" abdominal scar: bilateral rooftop incision with sternal extension
- Look for any sites of veno-venous bypass (ie the neck and the groins)
- Features of immunosuppression / cushingoid features from excessive steroids
- Inspect scar sites for incision hernias
Post operative considerations
- Immunusuppression:
- Steroids
- Cyclosporin A
- Azathioprine
- Tacrolimus
- Rapamycin (anti-fibrinolytic agent used in drug-eluting stents))