Liver Transplantation

Question 1

what are the indications for liver transplant?

Answer 1

advanced cirrhosis secondary to - alcoholic liver disease, hepatitis (B, C, autoimmune), primary biliary cirrhosis, Wilson’s disease, alpha1-atintrypsin deficiency, primary sclerosing cholangitis. hepatocellular cancer.

Question 2

what are the contraindications for liver transplant?

Answer 2

extrahepatic malignancy, multiple tumours, severe cardiorespiratory disease, systemic sepsis, HIV infection, non-compliance (drug therapy or alcohol abstinence)

Question 3

what immunosuppression would a liver transplant patient be put on?

Answer 3

ciclosporin or tacrolimus + azathioprine.

Question 4

what’s the difference between hyperacute and acute transplant rejection?

Answer 4

hyperacute - due to ABO incompatibility. acute - T cell mediated, 5-10d post-op, patient feels unwell with pyrexia and tender hepatomegaly - managed by altering immunosuppressives.

Question 5

what changes would you see on a liver biopsy of an alcoholic hepatitis patient?

Answer 5

fatty change and infiltration by polymorphonuclear leucocytes and hepatocytes in zone 3. Mallory bodies - dense cytoplasm and giant mitochondria.

Question 6

what would you see on biopsy in primary biliary cirrhosis?

Answer 6

bile duct granuloma