Liver Transplant

Major post-operative considerations include:

As a consequence of broader indications and fewer contraindications, the number of patients on the waiting list tends to exceed available donors. Consequently, patients are generally transplanted later when they are more unwell, which ↑ risk and peri-operative complications.

• Pre-morbid complications of liver disease:
  • Porto-pulmonary hypertension
  • Hepatopulmonary syndrome

Indications

Contraindications

Principles

Practice

Complications

• Death
• D
  • Encephalopathy
    • Pre-existing hepatic encephalopathy
    • Hepatic encephalopathy with PGD
    • Calcineurin inhibitors
• F
  • AKI
• G
  • PGD
    • Primary graft non-function occurs in 2-20% of cases and may require retransplantation
    • Major differential is hepatic artery thrombosis, ergo patients require hepatic artery ultrasound.
  • Hepatic artery thrombosis
    
  • Bile duct ischaemia
    Gastroduodenal artery usually supplies majority of bile duct blood flow, but this is not anastomosed, ↑ vulnerability of the duct.
  • Acute rejection
    Typically at 5-7 days.
• I
  • Infection
    • Bacterial most common
      • Gram positive most common
        • Enterococci
        • MRSA
        • VRE
      • ESBL
    • Fungal
      • Candidiasis

Key Studies

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References

1. Bersten, A. D., & Handy, J. M. (2018). Oh’s Intensive Care Manual. Elsevier Gezondheidszorg.