Liver Tx

Question 1

Indications for liver Tx

Answer 1

• Acute liver failure
• Chronic liver failure
• Neoplastic liver disease
• Inborn errors of metabolism (genetic)

Question 2

MELD score and its significance

Answer 2

• MELD is based on creatinine, bilirubin, and INR and ranges from 6-30
• It indicates the likelihood of death w/o Tx w/in 3 mo
• ≥40 is almost certain 3mo mortality
• Liver donors first go to status 1A pts: those unlikely to live >1wk w/o Tx (fulminant liver failure)
• Then livers go to status 1B pts: critically ill pediatric pts and peds hepatoblastoma pts
• After that livers go to people in order of descending MELD score

Question 3

Components of the surgery and outcomes

Answer 3

• Ligation of IVC, portal vein, hepatic artery, bile duct
• Piggyback Tx: preserves IVC
• Outcomes: 64% pt survival at 15 yrs, 55% graft survival