Liver transplantation- indications criteria

Pankaj Singodia

What is a liver transplant?

A liver transplant is a surgical procedure performed to replace a diseased liver with a healthy liver from another person. The liver may come from a deceased organ donor or from a living donor. Family members or individuals who are unrelated but make a good match may be able to donate a portion of their liver. This type of transplant is called a living transplant. Individuals who donate a portion of their liver can live healthy lives with the remaining liver.

History
1st experimental liver transplant-1950 1st liver transplant in human- 1963 (Thomas Starzl) 1st successful liver transplant- 1967 Major breakthrough- 1980s(advent of Cyclosporin)

Types
Living donor liver transplant Deceased donor Split liver transplant

Indications
a. b. c. d. Acute & chronic liver disease Fulminant hepatic failure (Acute liver ds) PCM toxicity Acute Hep B Hepatoxic drugs & toxins Wilsons disease

Chronic liver disease

a. Cholestatic liver disease 1. Primary biliary cirrhosis 2. Primary sclerosing cholangitis 3. Biliary atresia b. Chronic hepatitis 1. Hep-B&C 2. Autoimmune hepatitis

Chronic liver disease

c. Alcoholic liver disease
d. Metabolic diseases Haemochromatosis Wilsons disease Alpha1 antitrypsin def Tyrosinemia Cystic fibrosis e. Primary Hepatic malignancy

Contraindications
Sepsis Extrahepatic malignancy Ongoing substance abuse Hepato-pulmonary syndrome

Criteria- Acute liver failure

a. b. c. In PCM toxicity PH <7.3 P-time> 100 sec(INR>6.5) Serum creatinine>3.4 mg/dL

Criteria- Acute liver failure

In non-PCM toxicity age<10 or > 40 yrs P-time> 100 sec(INR>6.5) Serum creatinine>3.4 mg/dL NANB Hepatitis Duration of jaundice befor onset of encephalopathy>7 days

Criteria- Chronic liver failure

1. 2. 3. 4. 5. 6. Hepatic encephalopathy Ascitis SBP Variceal bleeding Hepatorenal syndrome Others- severe weakness & fatigue- mal nutrition

Most common indications

Alcoholic liver disease Viral hepatitis Primary hepatic malignancy