II. Epidemiology
- Availability in Chronic Liver Failure
- Candidates: 18,000 per year for 4000 available livers
- Wait time for Liver Transplantation: 2-3 years
III. Indications: Chronic Liver Failure (Cirrhosis) - Transplant Center Referral
- MELD Score >15 (or significant complications)
- Fulminant Liver Failure
- Decompensated Cirrhosis
-
Hepatocellular Carcinoma
- No single lesion >5 cm
- No more than 3 lesions (largest 3 cm or less)
IV. Indications: Acute Liver Failure - Acetaminophen - Transplant Center Referral (King's College Criteria)
- Option 1: Lab findings after initial Resuscitation (either present)
- Arterial pH <7.3 (after Resuscitation)
- Serum Lactic Acid >3.0 mmol/L
- Option 2: Findings in first 24 hours (all 3 present)
- Hepatic Encephalopathy (Grade 3 or 4)
- INR >6.5
- Serum Creatinine >3.4 mg/dl
- MDCalc
V. Diagnosis: Acute Liver Failure - Non-Acetaminophen - Transplant Center Referral (King's College Criteria)
- Option 1
- Any encephalopathy grade AND INR >6.5
- Option 2
- Any encephalopathy grade AND
- Three of the following criteria
- Age <10 years or >40 years
- Jaundice >7 days before onset of encephalopathy
- INR >3.5
- Serum Bilirubin >=17 mg/dl
- Option 3
- Wilson Disease
- Idiosyncratic Drug Reaction
- Seronegative hepatitis
VI. Contraindications
- Hepatocellular Carcinoma >5 cm
- Other active malignancy
- Active Alcohol Abuse or other Substance Abuse
- Chronic infection
- Advanced cardiopulmonary disease
VII. Efficacy
- One year survival: 85%
- Five year survival: 75%
VIII. Management: Post-transplant care
- Expect on average up to 2 emergency department visits post-transplant (with 70% admission rate)
- Typical post-transplant ED presentations are related to gastrointestinal or infectious symptoms
- Have a low threshold for imaging (CT, Ultrasound) in post-operative transplant symptoms (esp. first year)
IX. Complications
- Transplant Rejection
- Hepatic Ischemia
- Biliary Obstruction
- Drug Reaction or Hypersensitivity
-
Immunocompromised State
- Most intense Immunosuppression in first year after transplant
- High risk for opportunistic infectious complications (e.g. Pneumocystis jiroveci)
X. References
- Swencki (2023) Crit Dec Emerg Med 37(8):4-12
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Related Studies
Definition (MSHCZE) | Přenesení části jater nebo celého orgánu z člověka nebo zvířete do druhého těla. |
Definition (MEDLINEPLUS) |
Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. You cannot live without a liver that works. If your liver fails, your doctor may put you on a waiting list for a liver transplant. Doctors do liver transplants when other treatment cannot keep a damaged liver working. During a liver transplantation, the surgeon removes the diseased liver and replaces it with a healthy one. Most transplant livers come from a donor who has died. Sometimes there is a living donor. This is when a healthy person donates part of his or her liver for a specific patient. The most common reason for a transplant in adults is cirrhosis. This is scarring of the liver, caused by injury or long-term disease. The most common reason in children is biliary atresia, a disease of the bile ducts. If you have a transplant, you must take drugs the rest of your life to help keep your body from rejecting the new liver. NIH: National Institute of Diabetes and Digestive and Kidney Diseases |
Definition (NCI) | The transfer of a healthy liver allograft from a donor to a patient. |
Definition (MSH) | The transference of a part of or an entire liver from one human or animal to another. |
Definition (CSP) | transference of the liver within an individual, between individuals of the same species, or between individuals of different species. |
Concepts | Therapeutic or Preventive Procedure (T061) |
MSH | D016031 |
ICD9 | 50.5 |
ICD10 | 90317-00 |
SnomedCT | 174429009, 149473000, 18027006 |
CPT | 1007811 |
English | Grafting, Liver, Graftings, Liver, Hepatic Transplantation, Hepatic Transplantations, Liver Graftings, Liver Transplantation, Liver Transplantations, Transplantation, Hepatic, Transplantation, Liver, Transplantations, Hepatic, Transplantations, Liver, Liver transplant, Liver Grafting, Transplantation of Liver, Transplantation of liver, Transplantation of liver NOS, liver transplantation, TRANSPL HEPATIC, HEPATIC TRANSPL, TRANSPL LIVER, LIVER TRANSPL, LTX - Liver transplant, liver transplant (treatment), liver transplant, Liver transplantation, Liver Transplant, liver transplants, livers transplants, liver transplantations, liver graft, liver transplanting, transplantation of liver, hepatic transplantation, liver transplantation procedure, Transplantation of liver NOS (procedure), Liver transplant (procedure), Liver Transplantation Procedures, Liver--Transplantation, Hepatic transplantation, Tx - Liver transplantation, LTx - Liver transplant, Transplantation of liver (procedure), Transplantation of liver, NOS, Transplant;liver |
Italian | Trapianto del fegato, Trapianto epatico, Innesto di fegato, Trapianto di fegato |
Dutch | levertransplantatie, levertransplantaat, Levertransplantatie, Transplantatie, lever- |
Portuguese | Transplantação do fígado, Transplante hepático, Enxerto de Fígado, Transplante de Fígado, Transplante Hepático, Transplantação de Fígado, Transplação Hepática |
Spanish | Trasplante de hígado, Trasplante hepático, trasplante de hígado, SAI, trasplante de hígado, SAI (procedimiento), trasplante de hígado (procedimiento), trasplante de hígado, trasplante hepático, Injerto de Hígado, Trasplantación Hepática, Trasplantación de Hígado, Trasplante Hepático, Trasplante de Hígado |
Swedish | Levertransplantation |
Japanese | カンイショク, 肝臓移植, 移植-肝, 肝移植, 移植-肝臓 |
Finnish | Maksansiirto |
French | Transplantation hépatique, Transplantation du foie, Greffe du foie, Greffe hépatique (procédure), Greffe de foie (procédure), Greffe hépatique |
Russian | PECHENI TRANSPLANTATSIIA, TRANSPLANTATSIIA PECHENI, TRANSPLANTATSIIA PECHENOCHNAIA, PERESADKA PECHENI, PECHENOCHNAIA TRANSPLANTATSIIA, ПЕРЕСАДКА ПЕЧЕНИ, ПЕЧЕНИ ТРАНСПЛАНТАЦИЯ, ПЕЧЕНОЧНАЯ ТРАНСПЛАНТАЦИЯ, ТРАНСПЛАНТАЦИЯ ПЕЧЕНИ, ТРАНСПЛАНТАЦИЯ ПЕЧЕНОЧНАЯ |
Czech | Tranplantace jater, transplantace jater, játra - transplantace, jaterní štěp |
Croatian | JETRA, TRANSPLANTACIJA |
Polish | Przeszczepianie wątroby, Przeszczep wątroby, Transplantacja wątroby |
Hungarian | Májtranszplantáció |
Norwegian | Levertransplantasjon |
German | Hepar-Transplantation, Lebertransplantation, Transplantation, Hepar-, Transplantation, Leber-, Verpflanzung, Leber- |