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Post liver tx complication surgeon role
- 1. SURGICAL COMPLCATIONS IN LIVER TRANSPLANTATON S.VIVEKANANDAN HEAD, LIVER TRANSPLANT SURGERY KMCH, COIMBATORE
- 2. POST OP COMPLICATIONS IMMEDIATE vs LATE PEDIATRIC vs ADULT LDLT vs CADAVERIC
- 3. Immediate post op Bleeding Arterial complications Portal Venous Complications Hepatic Venous Complications Biliary Complications
- 4. Bleeding
- 6. Arterial Complications Hepatic artery thrombosis 4-11% Hepatic artery stenosis 5-13% HA Aneuryms 0.3-1.2% Hepatic artery rupture Median arcuate ligament syndrome 1.5- 10%
- 7. Early Vs Late HAT EARLY <2% < 30 days LATE 2-20% >30 days Transminitis Fever Bile Leaks Transminitis Liver Abscess Cholangitis PNF Liver Abscess Hepatic Necrosis Biliary Stricture
- 11. Arterial complications Resuscitation Antibiotics, antifungals Early HAT – exploration , thrombectomy, revision IR-Catheter related thrombolysis – bleeding Re Transplantation Late HAT – IR – Plasty / Stenting Retransplantation
- 14. Portal venous complications Risk factors Preexisting PVT Small portal vein Steal phenomenon Prior shunt surgery
- 15. PVT – Presentation Portal hypertension Variceal bleeding Ascitis Thrombocytopenia Acute graft failure
- 16. PVT - Treatment Surgical revision Pharmacological – Portal Flow Anticoagulation Shunt surgery Regular endoscopic surveillance
- 17. Outflow obstruction Rare but serious problem 1% - 6% Acute – technique / graft torsion Chronic – peri anastamotic fibrosis
- 18. Outflow obstruction Ascitis , congested Liver Lower limb edema Hepatic & Renal dysfunction Investigations – CT, Cavogram- Pressure Studies Trt – Stenting / plasty
- 22. Treatment Investigations – CT, MRCP, ERCP Antibiotics Antifungals Controlled Fistula Bile Recirculation
- 23. Bile Leaks Bile leaks Depends on volume ERCP- sphincterotomy, stenting Controlled fistula Consequences – infection, HAT/PA, late strictures
- 24. Anastamotic strictures Within the first year Technical issues , mismatch, fibrosis, HAT Consequences – cholangitis, sepsis ERCP / Surgery
- 25. Non anastamotic stictures + / - HAT Ischemic and necrotic biliary tree NHBD/> CIT High mortality Needs a Re transplant
- 27. Summary A high degree of suspicion is required Prevention is better – avoid technical errors Interventional Radiology plays a major role these days Multi Disciplinary team approach is required
- 31. Bile Duct Reconstruction Duct to duct – preferred , no reflux, anatomical, Roux – en-Y Hep J Insufficient length Ischemic duct PSC Pediatric Multiple ducts ( LDLT)
Editor's Notes
- Bile leak – mostly within a month, tension in anastamosis, ischemic bile ducts Anastamotic strictres – 1st year, , intially post op edema, technique, NAS – trt- repeated dilatation & stenting, retransplantation