Liver transplantation involves replacing a diseased liver with a healthy donor liver. It is indicated for end-stage liver disease and certain liver cancers and genetic disorders. The document outlines the history, epidemiology, immunology, indications, contraindications, surgical approach, complications, and training opportunities for liver transplantation. Living donor transplantation is also discussed.
History of liver transplant.
Why and When liver need to be transplant ?
What at basic requirements in LT.
Success and Failure %age
Global statistics of organ donation
This PPT contains only a brief summery about ATN.
for more information about the topic please refer to the book and site found the ppt, or you can get In touch with me .
History of liver transplant.
Why and When liver need to be transplant ?
What at basic requirements in LT.
Success and Failure %age
Global statistics of organ donation
This PPT contains only a brief summery about ATN.
for more information about the topic please refer to the book and site found the ppt, or you can get In touch with me .
This is a practical pocket summary for acute liver cell failure which includes the etiology, clinical picture, investigations and management. It is based on the most recent guidelines.
After study this course you learn:
1- Anatomy and physiology of UTS.
2- Disorders of UTS.
3-Kidney transplantation.
4-protocol of KT treatment.
5-Immunosuppressive drugs..
Power point presentation about general principles of organ transplantation and pioneer surgons and investigators, Specific discussion about Heart, Heart lung and Lung transplantation is given
This is a practical pocket summary for acute liver cell failure which includes the etiology, clinical picture, investigations and management. It is based on the most recent guidelines.
After study this course you learn:
1- Anatomy and physiology of UTS.
2- Disorders of UTS.
3-Kidney transplantation.
4-protocol of KT treatment.
5-Immunosuppressive drugs..
Power point presentation about general principles of organ transplantation and pioneer surgons and investigators, Specific discussion about Heart, Heart lung and Lung transplantation is given
Basics of kidney_transplant and donor_recepient evaluationJosephN7
This contains basic information on kidney transplant, benefits of transplant , donor_recepient evaluation, immunosuppressive drugs and risk factors
for update on my new presentations follow and leave a comment on any topic.
follow me on social media for related content (IG "mulebajoseph" and Pinterest "Joseph N Muleba" twitter "joseph n muleba"
Liver transplant (LT) is becoming the need of the hour and often the last ray of hope for many of our cirrhotic patients. The dearth of deceased donors, acceptance of living-related donors, better operative skills, and post transplant outcomes have played an important role is making LT accessable to more and more needy people. However, for best outcome it is important to stick to the established criteria laid down for listing a patient for LT for both best outcomes and better distribution of donor livers.
Liver transplantation current status, controversies and mythsAbhishek Yadav
Details the present status, indications, techniques about liver transplantation. Also dispels some common myths surrounding liver transplantation. #liver transplantation # living donor liver transplantation #liver cirrhosis #liver failure#transplantation#live donor#drabhishekyadav.com#liversurgeon#myths#livedonorlivertransplantation#organtransplantation#alcohololiverdisease
Anaesthesia for liver transplantation.pptxKLahari7
Introduction
Liver transplantation (LT) is the treatment of choice for end-stage liver disease regardless of its aetiology. Ever since the first transplant interventions in the 1960s, mortality rates after LT have significantly improved and have led to an increase in the number of successful procedures and improved outcomes.
Significant challenges remain for the transplant team as the procedure is performed on high-risk patients with impaired cardiovascular, pulmonary, renal and coagulation systems. Recent publications have indicated that transplant candidates are older, sicker and with multiple associate co-morbidities and organ dysfunctions compared to those treated in the past. Adequate perioperative care is essential for a prompt graft function which will improve organ system recovery and recipient’s quality of life [1].
Though there is a potential worldwide liver graft shortage, the expansion of the donor pool using marginal donors and increasing donor age has resulted, never the less, in reduced waiting list mortality [2]. A successful LT requires teams with a particular set of skills and competences, including a complete and detailed understanding of the multi-organic pathophysiology of liver failure and its implications and management during the three stages of surgery.
There have been many innovations, updates and procedural changes in the anaesthetic management of patients during this time. This article gives an overview of the current literature regarding anaesthetic management during liver transplantation and its singularities during the three stages of surgery.
Go to:
Indications for liver transplantation
The indications for LT in patients with acute and chronic liver failure should be assessed independent of the aetiology and are listed in Table 1 [3].
Table 1
Indications for liver transplantation
Class Disease
Non-cholestatic liver disease HepatitisB
HepatitisC
HepatitisD
HepatitisA
Alcoholic liver disease
Autoimmune hepatitis
Cryptogenic cirrhosis
Non-alcoholic steatohepatitis
Other
Cholestatic liver disease Primary biliary cirrhosis
Secondary biliary cirrhosis (Caroli disease, choledochal cyst)
Primary sclerosing cholangitis
Other
Malignant disease Hepatocellular carcinoma
Cholangiocarcinoma
Hepatoblastoma
Other
Extrahepatic biliary atresia or hypoplasia Alagille syndrome
Other
Metabolic diseases Alpha-1 antitrypsin deficiency
Crigler-Najjar disease, Type I
Byler’s disease
Glycogen storage disease, Type I
Wilson’s disease
Hemochromatosis
Tyrosinemia
Wolman’s disease
Familial amyloidotic polyneuropathy
Primary hyperoxaluria type 1
Other
Hepatic vein thrombosis Budd-Chiari
Acute hepatic failure Hepatitis
Drugs
Unknown aetiology
Re-transplantation Primary non-function
Hepatic artery thrombosis
Acute/chronic rejection
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The US and European countries have been using the Model for End-Stage Liver Disease (MELD) score for organ allocation since 2007. This is a grading system from 6 to 40 points, which depen
The presentation highlighted the principles of blood transfusion in surgical practice. It started with the historical perspective of blood transfusion and the physiology of blood. It then discusses the types of blood products, blood transfusions, and blood administration. Finally, it discusses the immediate and delayed complications of blood transfusions and blood substitutes.
This is a lucid presentation on the management of abdominal trauma/injury in children of paediatric age. Even though it focused on paediatric trauma, the information is also relevant to adult trauma. It went ahead to discuss the definition, causes, and initial management of abdominal trauma. It further went to highlight the management algorithms and outcomes of management. Finally, the presentation ended with management of abdominal compartment syndrome
This is a presentation that discusses the principles of the use of tumour markers in surgical practice. It further discussed the advantages and disadvantages of tumour markers. Finally, the limitations of tumour markers were highlighted.
this is a detailed presentation on the principles of surgical nutrition. the presentation started with surgical metabolism and epidemiology of malnutrition in surgical patients. Furthermore, the aetiology of malnutrition was discussed in surgical patients. Finally, the various types of nutritional support, enteral and parenteral, was discussed under indications, types, access, advantages, disadvantages, complications and monitoring.
This is a detailed presentation on the management of rectal cancer. this presentation commenced with the definition of the rectum by rigid sigmoidoscopy followed by definition of high, middle and low rectum. this was follwed by the pathology and pathogenesis of colorectal cancer. I went further to discuss the various clinical presentations of rectal cancers either as emergency or elective cases. Finally, the presentation discussed on the various approaches to the treatment of rectal cancer, whether high, middle or low rectal tumor. furthermore, the discussion went to the local therapy for early rectal cancer. Finally, prognostic factors and follow up modality was discussed.
This is an overview of gallbladder stone diseases and infection of the gallbladder. I started with the surgical anatomy and physiology of gallbladder and bile secretion. furthermore, I went ahead to discuss the natural history of gallstones. then, the pathology and pathogenesis of gallstones and gallbladder infection (cholecystitis). Various investigations for Cholelithiasis and cholecystitis was discussed and the concluding part talked about various treatment modality. Finally, I went ahead to show the techniques of laparoscopic cholecystectomy.
this presentation discussed the surgical approaches to management of complications of peptic ulcer diseases. this complications include bleeding, perforation, malignant transformation and intractability. the alpathophysiology of peptic ulcer disease, principles of acid secretion and gastric pH was discussed
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Outline
• Introduction
Definition
Historical perspective
Epidemiology- Nigeria, Africa and Global
• Immunology of liver transplantation
• Indications
• Contraindications
• Source of organ
• Perioperative approach
pre-op, Intra-op and post-op
• Complications
• Training opportunities and liver transplant societies/membership
• Summary
• References
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Liver transplantation
3. Introduction- Definition
• Liver transplantation is defined as the replacement of a non-
functioning liver with a functioning one.
• Liver transplantation is a form of orthotopic transplant, i.e. the
diseased organ is removed and replaced with a functioning one at the
same site.
• OLTx- Orthotopic Liver transplantation
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Liver transplantation
4. Introduction- Historical perspective
• 1952- Vittorio Staudacher described what looks like liver transplant
today
• 1955- C. Stuart Welch liver transplant in Dog
• 1956- Jack Cannon liver transplant in Dog
• 1963- Thomas Starzl started the first human liver transplant, but a
series of deaths led to a voluntary moratorium for 3.5 years
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Liver transplantation
5. Introduction- Epidemiology
• No Liver transplant services in Nigeria.
• In Africa, only 2 country has Liver transplant services: South Africa
(SA) and Egypt.
• Sudan just commenced Liver transplant services about 5month ago
• In SA, the first programme was established in 1988 at Groóte Schuur
Hospital in Cape Town and the second programme in 2004 at Wits
Donald Gordon Medical Centre (WDGMC) in Johannesburg.
1/30/2023 Liver transplantation 5
6. Introduction- Epidemiology
• Living donor liver transplant (LDLT) was first performed in Egypt in
1991 by the surgical team at the National Liver Institute (NLI),
Menoufeya University, with the help of Prof. Habib. The longest
recipient survival was 11 months
• There are thirteen LDLT centers in Egypt, including six university
centers, two military centers, three private centers and two centers in
the ministry of health hospitals.
• By the end of June 2014, the total number of cases reached 2,406.
1/30/2023 Liver transplantation 6
7. Introduction- Epidemiology
• In 2021, there were just over 9,200 liver transplant carried out in the
USA. Most liver transplants in the U.S. are among adults aged 50 to
64 years, with this age group accounting for around 45 percent of all
liver transplants in 2021.
• California had the highest number of liver transplants performed
among all U.S. states. That year, there were just over 1,000 liver
transplants performed in California. The state with the second highest
number of liver transplants was Texas.
• Liver transplants are the second most common transplant in the
United States behind kidney transplants.
1/30/2023 Liver transplantation 7
8. Immunology of liver transplantation
• Histocompatibility complex/protein
• Human leucocyte antigen (HLA)- 6q
2 types
Major- MHC- important in organ rejection
minor- miH
• HLA
• 2 types
Class I- HLA A, B and C- present in all antigen
Class II- HLA DP, DQ, DR- present in APCs
1/30/2023 Liver transplantation 8
9. Immunology of liver
transplantation
A two-signal model,
• T-cell activation begins with the
engagement of the T-cell
receptor (TCR)/CD3 complex with
the foreign molecule- signal 1.
• An additional costimulatory
signal is required. Two well-
characterized costimulatory
interactions are the CD40/CD154
and B7/CD28 pathways- signal 2
1/30/2023 Liver transplantation 9
20. Liver transplantation: Approach
• Second- to exclude any absolute or relative contraindication for Liver
transplant
Test for cardiopulmonary reserve:
CXR, FEV1, spirometry
ECG, ECHO, PAC
Tissue typing: HLA typing
other test as required
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Liver transplantation
22. Liver transplantation: Approach
• Liver allocation list by Organ Procurement Transplant Network (OPTN)
Model for End stage Liver Disease (MELD) score >12ys
Paediatric End stage Liver Disease (PELD) score <12yrs
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Liver transplantation
23. Liver transplantation: Approach
• MELD score: 3 biochemical parameter
MELD Score = 10 * ((0.957 * ln(Creatinine)) + (0.378 *
ln(Bilirubin)) + (1.12 * ln(INR))) + 6.43
Cr=4mg/dl in a patient who underwent HD in the last 7 days
any value less than 1, is given a value of 1
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Liver transplantation
24. Liver transplantation: Approach
MELD Score No of patients Mortality rate (%) Death or removal from
list because of illness
<9 124 1.9 2.9
10-19 1800 6 7.7
20-29 1098 19.6 23.5
30-39 295 52.6 60.2
≥40 120 71.3 79.3
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Liver transplantation
25. Liver transplantation: Approach
• PELD score: 3 clinical and 3 biochemical variables
PELD Score = 10 * ((0.480 * ln(Bilirubin)) + (1.857 * ln(INR)) -
(0.687 * ln(Albumin)) + 0.436(if the child is <1yr old) + 0.667(if the child
has growth failure[<2 SD])
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Liver transplantation
26. Source of organ donation
• Deceased donors
Brain death- consent from relatives
cardiac death- consent before death
• Living donors OLTx
Split liver donors- left lobe, left lateral segment/section
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Liver transplantation
27. Liver transplantation: Approach
• Living donor evaluation
laboratory:
FBC, EUC, LFT, clotting profile, a-fetoprotein, work up for
metabolic dx.
HLA typing
Imaging:
Duplex USS
CECT/MRI
Angiography
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Liver transplantation
28. Liver transplantation: Approach
• Donor surgery
Deceased donor
follow the conventional
organ procurement method
Living donor:
left lobe or left lateral
segment
piggyback donor method
After harvest, organ is perfused
with preservation solution within the
acceptable Ischaemic time for liver
tissue.
1/30/2023 Liver transplantation 28
31. Organ Package and Transportation in Liver
Graft
1/30/2023 Liver transplantation 31
• The liver is inspected in the basin.
• The first sterile bag is filled with the liver
graft and 700–1,000 mL of HTK solution
(4°C), and the bag is secured with a tie.
• It is then placed into the second sterile
bag filled with 1 L of cold normal saline
or slush ice and tied.
• The second bag is placed into the third
bag and tied. The liver in the three-
layered bag is then placed in the heat
preservation container box filled with ice
blocks for transportation.
33. Organ procurement for LDLT
• Three different types of donor hepatectomies are used for living
donor liver transplantation (LDLT), as follows:
• Left lateral hepatectomy, in which the graft consists of segments II
and III, with or without segment I
• Left hepatectomy, in which the graft consists of the whole left lobe,
segments I, II, III, and IV
• Right hepatectomy, in which the graft consists of the right lobe,
segments V, VI, VII, and VIII
1/30/2023 Liver transplantation 33
34. Liver transplantation: Approach
• Recipient hepatectomy
Bilateral subcoastal + midline extension (Mercedes-Benz incision)
all ligaments are mobilized
supra and infra hepatic vena cava is transected
hilar dissection: portal vein, HA and hepatic veins (with supra-
hepatic vena cava) and bile duct
veno-venous cannula passed from the femoral/portal to the
subclavian for those who are hemodynamically unstable
hepatectomy completed
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Liver transplantation
37. Liver transplantation:
Approach-Piggyback
technique
• IVC is not removed
• hepatic veins are divided at their
confluence before entering the
IVC.
• bypass may not be required or
partial bypass
• Adv: ↓hemodynamic instability,
good renal perfusion
• Disadv: ↑ hepatectomy time, ↑
blood loss
1/30/2023 Liver transplantation 37
39. Liver
transplantation:
Approach- LDLT
A. Hepatic transection
completed for removal of left
lateral segments (S2 and S3).
Bile ducts to segments 2 and
3 divided; vascular structures
still intact.
B. Implantation of the donor
left lobe.
1/30/2023 Liver transplantation 39
41. Post-op care
• ICU monitoring until hemodynamic stability
• Serial liver function test: transaminases
• Duplex scan to check HA, portal vein, bile flow, bleeding
• Platelet sequestration by the graft but later normalizes
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Liver transplantation
48. • Founder of Dr Rela Institute and Medical
centre in Chennei, India
• President, International Liver transplant
Society (ILTS)
• Former President, Liver Transplant society
of India (LTSI)
• www.ilts.com and become a member
• Guinness book of records
• Done over
1/30/2023 Liver transplantation 48
50. Liver transplant society
• International Liver transplantation Society
President- Prof Mohamed Rela- Owner of Rela institute &
medical centre in Chennei, India.
1/30/2023 Liver transplantation 50
51. Summary
• Liver transplantation has seen rapid development and growth from
the pioneering days of Starzl and Calne
• Today, liver transplant recipients enjoy excellent patient and graft
survival and the procedure has become routine in many centres
• Living donor LT has emerged as a viable option for patients with ESLD
• Advances in surgical technique, immunosuppression, perioperative
care have not only reduced operative morbidity/mortality, but have
also significantly improved the quality of life for the recipients
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Liver transplantation
52. References
• Charles F. Brunicardi: Schwartz’s principles of Surgery, 10th edition Chapters
33
• https://www.statista.com/statistics/954207/us-liver-transplants-by-state/
• O. James Garden and Simon Peterson-Brown: Hepatobiliary and pancreatic
surgery, a companion to specialist surgical practice, 5th edition, chapter 15
• Norman, S. W., Christopher J.K.B., and P.Ronan O’ Connell (2008). Bailey
and Love principles and practice of Surgery, 25th edition, chapter 61, 63 and
64
• Michael J Zinner and Stanley W Ashley: Maingot’s abdominal operations,
12th edition. Chapter 59
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Liver transplantation
53. • John L. R. Forsythe: Transplantation, a companion to specialist
surgical practice, 5th edition, chapter 8
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Liver transplantation