Module 3 Chapter 15: Liver Transplantation Flashcards
top 3 reasons for adult LT
HCV
EtOH
HCC
NAFLD
what has highest priority
acute liver failure, and children receive prioritization.
what criteria used to rank patients with cirrhosis
MELD-Na, but MELD exemption points are granted to HCC patients to ensure they get an organ in time.
where is the new liver anastamosed
diseased liver is removed and new liver is put in place with anastomoses or portal vein, hepatic artery, bile duct and hepatic veins.
what type of biliary anastomosis is done in a live donor liver transplant
rou-en-Y loop of vowel is Brough up to the liver.
Live donor surgery is associated
with increased risk to the recipient
(smaller connections) and also has
risks for the donor
Immunosuppression required to prevent acute cellular rejection (ACR) by targeting the ____
T cells
o Induction is given at time of LT
o Maintenance is given long-term
Drugs have many side-effects Must balance risk of rejection versus complications from immunosuppression
majority of LT immunosuppression is done through
corticosteroids
Role of calcineurin inhibitors
Tacrolimus (FK506), Cyclosporine (CyA). Good for immuosuppressoin during LT journey. HUGE concern for renal dysfunction though Renal dysfunction (50% at 5 years → can go on to dialysis or kidney transplant)
Cancer risk is increased with immunosuppression (20% at 5 years)
Non-melanoma skin cancer is very common
Throat cancer (if LT done for alcohol, especially if still smoking)
Colon cancer (if LT done for PSC)
T/F If acute liver rejection occurs, they have to take the liver out.
false. ACR has no impact on survival
20% of LT recipients develop tolerance (don’t need immunosuppression) but it is
currently impossible to identify these patients
a patient with an LT has renal dysfunction. Instead of a CNI, what should be used as an immunosuppressant
MMF + Prednisone can be used to avoid CNIs in patients with renal dysfunction
Side-effects include bone marrow suppression, nausea, diarrhea, abdominal pain
