LIVER TRANSPLANT Flashcards by Ila Sunio

involves the total removal of the diseased liver and replacement with a healthy liver from a cadaver donor or the right lobe from a live donor in the same anatomic location

Liver transplantation

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The success of liver transplantation depends on successful ________

Immunosuppression

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In order to prevent acute rejection in the early, high-risk months after liver
transplantation, some centers employ induction therapy. What are the medications used for this?

Basiliximab
Lymphocyte immune globulin (Atgam)

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What are the general indications for liver transplantation?

IFMH

Irreversible advanced chronic liver disease

Fulminant hepatic failure

Metabolic liver diseases

Hepatic malignancies.

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Immunosuppressant agents currently used in liver transplantation

3C PRBD

Corticosteroid
Calcineurin Inhibitors
Cell-Cycle Inhibitors

Polyclonal Antibodies (Anti-Thymocyte)
Basiliximab
Daclizumab

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Some patients are treated with “triple therapy” using

Corticosteroids
Calcineurin inhibitor
Cell-cycle Inhibitor or TOR Inhibitor

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Is an objective determination of medical need that stratifies the level of illness for patients awaiting a liver transplant, based on a formula incorporating bilirubin levels, prothrombin time, creatinine, and the cause of liver disease.

Model for End-Stage Liver Disease (MELD) classification

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Other transplant centers advocate monotherapy with what medication?

Calcineurin inhibitor

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What factors are included in calculating the MELD score?

BP CC

Bilirubin levels
Prothrombin time (INR)
Creatinine levels
Cause of liver disease.

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This classification for liver trasnplant system classifies the severity of liver disease and stratifies patients into levels for varied treatment regimens.

Child–Pugh score

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How does the MELD score differ from the Child–Pugh score?

The MELD score is an indicator of short-term mortality for patients with end-stage liver disease (ESLD), while the Child–Pugh score is used for treatment stratification.

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Before the donor liver is placed in the recipient, it is flushed with _____________solution to remove potassium and air bubbles.

Cold lactated Ringer

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is used to decompress the venous system below the diaphragm by temporarily shunting blood to the superior vena cava, minimizing complications from portal hypertension

Venovenous bypass

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What are types of biliary anastomoses performed during liver transplantation

End-to-end anastomosis

Biliary-enteric end-to-side anastomosis or Roux-en-Y procedure

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involves creating a biliary-enteric end-to-side anastomosis with a 40- to 50-cm loop of jejunum for biliary drainage.

A Roux-en-Y procedure

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Describe the criteria for considering living donor liver transplantation (LDLT).

High potential for mortality while awaiting a cadaveric liver donor

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involves the transplantation of the right hepatic lobe from an adult donor to the recipient, including a formal right hepatic lobectomy and vascular reconstruction

Living donor liver transplantation (LDLT).

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TRUE or FALSE?

After transplant, the transplanted lobe will regenerate itself, and the removed portion of the donor’s liver will also regenerate.

TRUE

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Describe the difference between living donor liver transplantation and orthotopic liver transplant.

Living donor liver transplantation involves taking a portion of the liver from a living donor, while orthotopic liver transplant involves the whole liver being taken from a recently deceased donor.

The single most common indication for liver transplantation in adults is

Viral hepatitis C

Define the groups for whom liver transplantation is not indicated.

Unlikely to survive major surgery

Cannot endure long-term immunosuppression

Patients with diseases likely to recur quickly and fatally

Individuals unwilling to comply with demanding medical regimens

What factors determine placement on the liver transplant waiting list?

Blood type

Weight

Patient urgency
- Acute liver failure being prioritized as status 1 at the top of the list

Describe the criteria for matching a donor liver to a recipient.

Blood type and body size

What screening is performed on potential liver donors?

Infectious diseases and metastatic carcinomas

*to prevent transmission to the recipient.

How can ABO incompatibility affect liver transplantation?

Cam result to post operative complication of mild hemolysis and increased incidence of acute cellular rejection.

_________can improve graft survival for patients who have ABO incompatibility with their donor liver

Plasmapheresis

The first stage, known as ___________, involves the removal of the native liver and is the longest and most difficult part of the surgery.

Recipient hepatectomy

What are the four vascular anastomoses involved in the second stage of liver transplant?

SIHP Suprahepatic inferior vena cava Infrahepatic vena cava Hepatic artery Portal vein.

__________connects the bile duct to the jejunum and is used for patients with diseased bile ducts, while _____________ connects the patient's common bile duct to the donor's bile duct and is used when the common bile duct is healthy.

(1) Choledochojejunostomy (2) Choledochocholedochostomy

is considered the most definitive diagnosis for acute rejection of allograft, showing portal and bile duct inflammation and the presence of inflammatory cells in the liver tissue.

Liver biopsy

This stage involves biliary anastomosis, which is crucial for ensuring proper bile drainage from the donor liver to the recipient.

The third stage

__________Increases the difficulty in liver transplantation

Portal HYpertension *Venovenous bypasss is used to minimize this problem

in thi transplant, a single organ is used to provide grafts for two individuals with ESLD, with the smaller patient receiving the smaller left lobe. This procedure has resulted in a higher complication rate and lower survival rate than traditional liver transplantation.

Split-liver transplant

This type of liver transplant is more common in pediatric liver transplantation from a parent to his or her infant.

Living donor liver transplantation (LDLT)

Most common type of liver transplant, the whole liver is taken from a recently deceased donor.

Orthotopic Liver Transplantation

Most common indication in pediatric patient for liver transplant is

Biliary atresia and metabolic disorders

Complication for donor, which is described as not life-threatening, do not result in permanent disability.

GRADE 1

Complication for donor, which require medications or transfusion.

GRADE 2

Complication for donor, which can be potentially life-threatening and require invasive therapy (Resurgery)

GRADE 3

Complication for donor, which can lead to disability or death

GRADE 4

Signs of Perforation

SEP F Sudden, severe abdominal pain Enlarged abdomen Presence of tenderness and rigidity of the abdominal wall Fever

To balance the importance of good cardiac function against the risk of passive congestion of the liver, the CVP is maintained at

10 mL H2O

If the stool of the patient is brown post op, the T tube should be?

Clamped *bile

If the stool of the patient is gray post op, the T tube should be?

Unclamped *Acholic

For patient who undergoes a Roux-en-Y biliary anastomosis, NGT is kept longer to prevent what?

Postoperative ileus

Late signs of rejection include:

Jaundice Malaise Dark urine Clay-colored stools.