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1. Liver Transplantation & its Anaesthetic Management Dr.
Swadheen kumar Rout 2nd year P.G Dept. of Anaesthesiology M.K.C.G
College & hospital
2. Introduction:- Liver transplantation is the only life saving
procedure in pts. with end stage liver disease & some cases of
acute liver failure. Orthotopic Heterotopic First orthotopic liver
transplant was performed by Dr Thomas Starzl in 1963. Patient was a
3 year old child with biliary atresia, who died in the operating
room from massive haemorrhage caused by venous collaterals &
uncontrollable coagulopathy. However with continued improvements in
Organ preservation technique, Surgical technique, Immunosuppressive
agents, Management of Has become highly successful in prolonging
survival & improving coagulopathy,in affected patients. quality
of life Treatment of
3. Data from the United Network for Organ Sharing (UNOS) on
24,900 ad patients undergoing liver transplantation in a 10 year
study showed tha yr, 4-yr, and 10-yr patient survival rates were
85%, 76%, and 61%, respectively, Survival (%) after adult liver
transplantation by thus confirming that liver transplantation
results in prolongation of life. diagnosis* Diagnosis 1-yr 4-yr
10-yr Primary sclerosing cholangitis 91 84 78 Primary biliary
cirrhosis 89 84 79 Autoimmune hepatitis 86 81 78 Chronic hepatitis
C 86 75 67 Alcoholic liver disease 85 76 63 Cryptogenic cirrhosis
84 76 67 Chronic hepatitis B 83 71 63 Malignancy 72 43 34 Liver
transplantation can be performed in patients of all ages.
Paediatric liver transplantation has a better survival rate (10-yr
= 80
4. Indications for liver transplantation: Acute liver failure
Acute hepatitis A,B,C infection Drug/toxin hepato-toxicity
Cirrhosis from chronic liver diseases Chronic hepatitis B virus and
chronic hepatitis C virus infection Alcoholic liver disease
Autoimmune hepatitis Cryptogenic liver disease Primary biliary
cirrhosis and primary sclerosing cholangitis Metabolic Disorders
Alpha-1 antitrypsin deficiency Hereditary haemochromatosis Wilsons
disease Glycogen-storage disorders Type 1 hyperoxaluria Familial
homozygous hypercholesterolemia Malignancy Primary hepatic cancer:
hepatocellular carcinoma and cholangiocarcinoma Metastatic:
carcinoid tumors and islet cell tumours Miscellaneous Polycystic
liver disease Budd-Chiari syndrome
5. The decision to list a patient for transplantation is based
more on the severity of hepatic dysfunction than the underlying
aetiology. Determining the need for liver transplantation must take
into account the natural history of the patients disease and
carefully compare it to the anticipated survival after liver
transplantation. Priority is based on specific prognostic criteria
using a number of scoring systems devised by United Network for
Organ Sharing (UNOS) for optimal use of the limited number of
available organs. In the past Childs-Turcotte-Pugh (CTP) score plus
the amount of time on the waiting list. For listing purposes, a
patient must have at least 7 points (i.e, be at least a Childs
class B),
6. However this did not always ensure that organs were
allocated to the sickest patients with the greatest risk of
mortality. In 2002, model for end-stage liver disease (MELD) ,
based on the patients risk of dying while awaiting transplantation.
The MELD risk score is a mathematical formula based on the
following factors: 1) Creatinine 2) Bilirubin (mg/dL) 3)
International normalized ratio Most patients on the liver
transplant waiting list have a MELD score between 11 & 20.
7. Pediatric End-Stage Liver Disease (PELD) scoring system
incorporates the following criteria(