Thursday, February 27, 2014

Liver Transplant | Precautions, Rejection, Failure Rate

Liver Transplant | Precautions, Rejection, Failure Rate .

Liver Transplant

First successful liver transplantation was done in 1967 at Denver, USA by Professor Thomas Starzl.

To date, a number of liver transplants have been performed, so far with a average number of long term survivors.

Indications for Liver Transplantationclass="unIndentedList">
  • Post necrotic cirrhosis.
  • Primary biliary cirrhosis.
  • Sclerosing cholangitis with cirrhosis.
  • Or end stage liver diseases with portal hypertension.
  • Fulminating hepatic failure.
  • in born errors of metabolism-
    • Wilson’s disease.
    • Alpha-1-antitrypsin deficiency.
    • Glycogen storage disease.
    • Hemophilia.
  • Alcoholic cirrhosis
  • Hepatitis-B induced cirrhosis.
  • Hepatic malignancies.
  • Liver Transplant Donor Typesclass="unIndentedList">
  • Cadaver donor (brain dead heart beating donor)-
    • In this liver is obtained after declaring a patient as brain dead.

      Posted by http://signs-causes-treatment-prevention.blogspot.com Prevention And Detection Of Diseases At An Early Stage When The First Signs To Get The Most Effective Treatment.

      This also allows harvesting of other organs like kidneys, lungs, pancreas for transplantation.
  • Living related donor
    • This involves partial hepatectomy in a living relative; the liver lobe usually left lobe or left hemi-liver is then transplanted in a pediatric recipient.
  • Xenotransplantation
    • In future, use of animal livers may become possible. Fear of rejection of transplant and transmission of viruses remains.
  • Selection criteria for cadaveric donortype="disc">
  • Age between 2-60yrs.
  • No pre-existing bacterial, viral or fungal infections.
  • No history of liver disease.
  • No history of drug addiction.
  • Absence of intra-abdominal injuries.

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  • Normal liver and renal function.
  • No malignancy.
  • Contra-indications of liver transplanttype="disc">
  • Pre-existing sepsis.
  • Presence of extra-hepatic malignancies.
  • Presence of serious diseases of other organs.
  • HIV positive status.
  • Immunology of Liver Transplantationclass="unIndentedList">
  • Success of liver transplant is not dependent on extensive HLA typing and cross matching between donor and recipient as is needed in renal and cardiac transplantation.
  • Only blood group cross-matching i.e. ABO compatibility is sufficient. This unique behavior by liver is not well understood.
  • Another peculiarity of liver is its resistance to cytotoxic anti-graft antibodies, which are known to cause hyper-acute rejection in renal and cardiac grafts.
  • Liver Transplant Rejection or Failureclass="unIndentedList">
  • Rejection is the most frequent cause of post-operative grafts dysfunction and morbidity.
  • Acute rejection occurs within 1st 3-6wks of transplant.
  • It is manifested by rise in bilirubin, potassium and alkaline phosphate.
  • Liver biopsy usually confirms the diagnosis.
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