Liver Transplantation: Diseases Suitable For Transplantation
Liver Transplantation: Diseases Suitable For Transplantation
Liver Transplantation: Diseases Suitable For Transplantation
Liver transplantation
Approximately 700 liver transplants are performed each year in the UK, but around 14% of patients listed
die before being transplanted. The liver can be split into right and left lobes for transplantation into an
adult and child simultaneously or to allow living donor liver transplants.
Clinical indications
• Acute fulminant liver failure.
• Category 1. Expected 1y mortality >9% without liver transplant.
• Category 2. HCC within ‘Milan criteria’ (see Box 19.3).
• Category 3. Variant syndromes affecting quality of life.
If the recipient has accessory hepatic arteries, the common hepatic artery may be insufficient to perfuse
the liver and so arterial conduits can be fashioned from the donor iliac arteries retrieved with the liver.
Post-operative management
Most commonly, immunosuppression is achieved using combination of tacrolimus, azathioprine, and
steroids. The liver is less prone to acute rejection than other organs, so immunosuppression can be fairly
rapidly tapered after the immediate post-operative phase.
Monitoring disease progression using a Child–Pugh score. Patients in class C should be referred
for transplantation
• Child–Pugh class B, 5–6 points.
• Child–Pugh class B, 7–9 points.
• Child–Pugh class C, 10–15 points.
1 point 2 points 3 points
Bilirubin (μmol/L) <34 34–51 >51
Albumin (g/L) >35 28–35 <28
Prothrombin time (seconds prolungued) 1–3 4–6 >6
Ascites None Slight Moderate
Encephalopathy grade None 1–2 3–4