Liver transplant

Question 1

Outline the indications for liver transplantation

Answer 1

Acute: Fulminant hepatic failure of any cause
Chronic: Complications of cirrhosis that are no longer responding to therapy, hepatopulmonary syndrome, porto-pulmonary HTN

Question 2

Who should be referred to a transplant centre for liver transplant?

Answer 2

All patients with end-stage cirrhosis (Child’s grade C)

Debilitating symptoms of liver disease

Question 3

Name the complications for liver disease

Answer 3

Hepatic failure:

• Coagulopathy
• Hepatic encephalopathy
• Hypoalbuminaemia
• Sepsis
• Spontaneous bacterial peritonitis
• Hypoglycaemia

Portal HTN:

• Ascites, splenomegaly
• Portosystemic shunting: oesophageal varices, caput medusae

Increased risk of hepatocellular carcinoma

Question 4

Define fulminant hepatic failure

Answer 4

Severe hepatic failure in which encephalopathy develops in under 2 weeks in a patient with a previously normal liver.

Question 5

Outline the Child-Pugh classification of Cirrhosis

Answer 5

Child-Pugh classification
The following are each scored out of 3
-Albumin
-Bilirubin
-Encephalopathy
-Ascites
-Prothrombin Time

Grade A (<7)
Grade B (7-9)
Grade C (10+) ➔ Liver transplant referral

*Variceal bleeding risk increases significant if score >8

Question 6

What are the contraindications for liver transplant?

Answer 6

Absolute: Active sepsis outside hepatobiliary tree, extra-hepatic malignancy, liver metastases (except neuroendocrine), patient not psychologically committed

Relative: Extensive splanchnic venous thrombosis, 70+yr, HCC unless fewer than 3 small lesions or 1 medium nodule.

Question 7

What types of liver transplant rejection can occur?

Answer 7

Acute or cellular rejection (5-10d post): responds to immunosuppressive therapy
Chronic ductopenic rejection (6wk-9m post): may respond to immunosuppression, often require retransplant
Graft vs host disease: extremely rare