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Gastrointestinal History
 
Gastrointestinal History
 

Liver Transplant History

 
 
 
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Overview

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  • Pretransplant history - cause and complications of chronic liver disease, past transplant, medical and social considerations
  • Peritransplant history - timing, indication, donor, graft type, anastomosis
  • Complications - past rejection episodes, infections, cardiovascular, metabolic, malignancy
  • Post-transplant management - immunosuppression, infective prophylaxis, cancer screening

Pretransplant History

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  • Chronic liver disease - underlying cause, complications
  • Past liver transplant
  • Medical comorbidities - particularly cardiovascular and respiratory
  • Psychological factors - depression / anxiety
  • Social situation - family, living arrangement, occupation
  • Adherence - to management plan, dialysis, medications

Peritransplant History

  • Ask About

  • When
  • Indication for liver transplant
  • Graft type - orthotopic vs split graft
  • Anastomosis - duct to duct (recipient to donor) vs roux-en-y (no recipient bile duct)

Complications

  • Complications of Liver Transplant

  • Surgical

  • Wound - bleeding, infection, poor healing
  • Biliary - stricture, leak, haematoma, collection
  • Vascular - hepatic artery stenosis, hepatic vein stenosis, thrombosis
  • Immunologic

  • Rejection - T-cell mediated, antibody-mediated
  • Infectious

  • Fungal infections - candida, aspergillus, cryptococcus
  • Viral infections - herpes simplex, varicella, CMV, EBV, influenza
  • Bacterial infections - mycobacterial, pneumococcal
  • Protozoal infections - pneumocystis, toxoplasmosis
  • Other

  • Cardiovascular disease
  • Diabetes mellitus
  • Osteoporosis
  • Malignancy - skin, bowel, gynaecologic, post-transplant lymphoproliferative disease
  • Disease recurrence

Post-Transplant Management

  • Management Strategy

  • Immunosuppression

  • Induction - steroids, basaliximab
  • Maintenance - steroids, tacrolimus / cyclosporine, mycophenolate mofetil
  • Prophylaxis & Screening

  • Infection prophylaxis - valaciclovir / valganciclovir, bactrim
  • Cancer screening - skin checks, pap smears, colorectal cancer screening
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