gs

1. General considerations of liver
transplantation

2. Liver Transplantation
 1963 : First human LT attempt by Starzl.
 1967 : First successful LT by Starzl.
 Early 1980’s: LT became clinical reality.
 1983 : Defin 1960 :Initial Liver Transplant ( LT)
techniques done using dogs. itive therapy for end-
stage liver disease (ESLD).
 1988: Development of the University of Wisconsin
(UW) solution ( graft preservation).
 1992: First Liver xenotransplants x 2 (baboon) by AG
Tzakis

3. Indications
• ADULTS
Non cholestatic cirrhosis
.Viral Hepatitis B&C
.Alcoholic
.Cryptogenic
Cholestatic
.Primary biliary cirrhosis
.Primary sclerosing cholangitis
Autoimmune
Malignant Neoplasm
Miscallaneous

4. • CHILDREN
.Biliary Atresia
.Inborn Errors of metabolism
.Cholestatic
.Primary Sclerosing Cholangitis
.Alagille syndrome
.Autoimmune
.Viral Hepatitis
.Miscallaneous

5. Indications for LT
HCV, 28
ETOH, 18
Cryptogenic, 11
PBC, 9
PSC, 8
FulminantAutoimmune
HBV
Metabolic Other
HCC, 2
0
5
10
15
20
25
30
%
HCV
ETOH
Cryptogenic
PBC
PSC
Fulminant
Autoimmune
HBV
Metabolic
Other
HCC
HCV
ETOH
PBC
PSC
Fulminant
AI
HBV
Meta
bolic
HCC

6. Fulminant Hepatic Failure
• Acute onset liver failure with absence of
previous liver disease.
• Entity defined as presence of encephalopathy
within 8weeks of jaundice.
• Encephalopathy,jaundice,coagulopathy,metab
olic acidosis,renal insufficiency and even coma
• Common causes are Acetaminophen
overdose,Viral hepatitisB
• Early recognition and liver transplantation

8. Hepatitis C And Liver Transplantation
• Most common indication for liver
transplantation in the western countries
• High chance of recurrance following
transplantation
• Depends on
. Donor age(>40yrs high chance)
. Treatment of acute rejection
. Hepatitis C viremia at time of LT

9. Hepatitis B
• Most common cause of chronic liver disease in
endemic regions of Asia and Africa
• Reinfection of graft
• Treatment with antiviral agents and hyper
immune globulin eradicate disease recurrance
after transplantation

13. Contraindications to LT
ABSOLUTE
 Active infection
 SBP
 Pulmonary HTN
 Extrahepatic
malignancy
 Active alcoholism
 Active substance abuse
 Non compliance
RELATIVE
 CRF
 Advanced cachexia
 Large HCCs
 Multisystem organ
failure states
 HIV ?

14. MILAN CRITERIA
• Milan criteria for liver transplantation in HCC
• Single nodule<5cm
• Less than three nodules largest <3cm
• Patients satisfying criteria <20%risk of
recurrance

15. Model for End Stage Liver Disease
• MELD Score=[0.957loge creatinine(mg/dl)]+
[0.378loge bilirubin(mg/dl)]+
[1.120loge INR]+0.643
Highly predictive 3-month mortality of
patients with ESLD
Minimum score for LT: 15 points
Maximum score: 40 points