liver transplantation

Question 1

what are the indications for liver transplantation ?

Answer 1

end stage liver disease
hepatocellular carcinoma
budd-chiari syndrome

Question 2

which child score is an absolute indication for transplant ?

Answer 2

Child C (above 9)

Question 3

what does the MELD score indicate ?

Answer 3

measures creatinine
bilirubin
INR
mortality in 3 months

Question 4

what is the range for transplantation using the MELD score ?

Answer 4

<14 no need for transplantation
>14 prepare the patient for transplantation
a patient with a MELD score of 15 is an absolute indication

Question 5

what type of patients are the exceptions of MELD score ?

Answer 5

patients with refractory ascites 
repeated encephalopathy 
porto-pulmonary hypertension 
metabolic liver disease 
HCC

Question 6

what are the contraindications for liver transplantation ?

Answer 6

advanced age >70 yo
uncontrolled active sepsis 
advanced CVD
Alcoholic 
BMI >30 
HIV infection 
extra hepatic malignancy

Question 7

what are the criteria for suitable donor ?

Answer 7

age should be less than 45 
no chronic diseases 
compatible blood group 
BMI less than 28 
sero negative 
no drug abuse 
psychologically stable 
no pregnancy or hormonal therapy

Question 8

what does the graft to weight ratio explain ?

Answer 8

the amount of liver tissue transplanted should ideally be 1% of the recipients weight and a minimum of 0.8%

Question 9

what is the minimum amount of liver tissue can the donor live with ?

Answer 9

35%

Question 10

what are the early complications of liver transplantation ?

Answer 10

primary non functioning graft 
delayed graft function 
technical errors 
acute rejection 
infection

Question 11

what are the long term complications of liver transplantation?

Answer 11

associated with problems of immunosuppression

recurrence of primary disease
hypertension
renal failure
dyslipidemia
DM
~~~

Question 12

what are the late complications mainly related to ?

Answer 12

immunosuppression

Question 13

what are the early complications mainly related to ?

Answer 13

surgical complications

Question 14

what are the donor post op complications ?

Answer 14

pulmonary embolism
portal vein thrombosis
bile duct injury
liver insufficiency

Question 15

what are the immunosuppression combinations ?

Answer 15

calcineurin inhibitor ( cyclosporin )
steroids ( methylprednisolone )
antiproliferative agent ( mycophenolate mofetil )
sirolimus rapamycin inhibitor - immunosuppressive + antineoplastic

Question 16

what are the phases of immunosuppression ?

Answer 16

induction
maintenance
rescue

maintenance

Question 17

what are the side effects of immunnosuppression ?

Answer 17

opportunistic infections :
bacterial infections 
viral infections 
fungal infections 
malignancy 
metabolic

Question 18

what is the side effewct of cyclosporin ?

Answer 18

renal complications

Question 19

what could be done for immunosuopressed infections to avoid infections ?

Answer 19

chemoprophylaxis

Question 20

what is an allograft ?

Answer 20

from one indvidual to another

Question 21

what is a xenograft ?

Answer 21

between different species

Question 22

orthotropic graft ?

Answer 22

graft placed in its normal anatomical site

Question 23

heterotrophic graft ?

Answer 23

graft placed in a site different from that where organ is normally located

Question 24

what malignancies are commonly seen as a side effect of immunosuppression ?

Answer 24

• Posttransplant lymphoproliferative disease (PTLD)
• Skin cancer
• Kaposi’s sarcoma