Liver Treatment Options

Question 1

Liver Dialysis

Answer 1

Used for patients with fulminant hepatic failure awaiting transplant
A molecular absorbent recirculation system (MARS)
Clears blood of waste products metabolized by the liver
Uses an albumin containing solution and charcoal or CVVHD filter
Blood supplied by a dual lumen central catheter

Question 2

Extracorpeal Liver Assist Device (ELAD)

Answer 2

2nd phase of clinical trials
Filter for procedure uses cultured human hepatocytes as a lining
Process similar to hemodialysis filtration

Question 3

Liver Transplant

Answer 3

Practical and therapeutic option for ESLD or primary liver cancer
Leading indication for liver tx is viral hepatitis. Reinfection of liver with HBV or HCVB

Question 4

Pre-Transplant Evaluation

Answer 4

Rigorous work-up to confirm diagnosis and evaluation for other chronic conditions
Extensive diagnostic testing
Counseling regarding cigarette smoking and alcohol consumption
Ability to comply with post-tx care

Question 5

Transplant Procedure

Answer 5

Can use cadaveric or live donor livers
Live livers can be used for children and adults, in some cases (living person donates a portion of the liver)—increased risk of biliary problems, hepatic artery stenosis, infection, ileus, and pneumothorax in the donor. Or a liver can be split and placed in two recipients – success rate lower, more complications

Question 6

Post-Transplant Complications

Answer 6

Bleeding
Infection
Rejection
Less immunologic attack than other organs such as the kidney; less likely to reject

Question 7

Immunosuppressive Therapy

Answer 7

Combination therapy: corticosteroid (prednisone) a calcineurin inhibitor (cyclosporine or tacrolimus), and anti-proliferative agent (azathioprine or mycophenolate)
Tacrolimus results are superior to cyclosporine, so more commonly used
Corticosteroids can be stopped in some cases