Liver Transplant History
February 15th, 2021
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
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- 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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