Transplant Flashcards
Year of first liver TXP
1963; 1967 (first 1 year survival);
1980: CsA
2 classifications of ALF
Fulminant: Encephalopathy within 8 weeks of jaundice
Sub-fulminant: Encephalopathy up to 26 weeks
Most common cause of ALF in the US and W. Europe
Drug-induced (50%); Tylenol (EtOH, malnutrition, CYP 450 inducers –> phenytoin, cabamazepine, rifampin)
Major causes of ALF (aside from Tylenol)
Indeterminate; idiosyncratic drug-induced; HBV; ischemic hepatitis; autoimmune; HAV; Wilson’s; Budd-Chiari; pregnancy; malignancy
Complications of acute liver failure that need to be immediately addressed
Cerebral edema, HD abnormalities, coagulopathy, renal failure, infection/sepsis, acid-base, pulmonary dysfunction
MCC death in acute liver failure
Cerebral edema (increased ICP; deceased CPP)
Does lactulose work in ALF?
Not really; need to raise HOB and minimize patient stimulation thorugh sedation/paralysis
Most widely applied criteria for TXP in ALF
King’s College Criteria
For acetaminophen induced ALF; what are King’s College criteria?
pH < 7.3 or INR > 6.5 and serum Cr > 3.4
For non-tylenol induced ALF; what are King’s College criteria?
INR > 6.5 or any 3 of the following: INR > 3.5; bili > 17.6; Age < 10 or > 40; cause drug toxicity; time from onset of jaundice to encephalopathy > 7 days
Most common causes of chronic ESLD and need for txp?
EtOH, HCC, PSC, Cryptogenic, HCV, Cholangio, PBC, AI, NASH, HBV
MELD of 40 is what % 3-month mortality?
90%
Milan criteria
T1; 1 lesion < 2cm
T2; one lesion >2cm < 5cm, or 3 lesions < 3cm
How many exception points for HCC?
22 points
MELD originally developed to…
Predict survival in patients with complications of portal HTN undergoing TIPS
