Fact-sheet: Liver transplant
Updated on 06/22/2020 at 9:57 AM
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Definition
Most effective treatment for chronic liver disease and acute liver failure
Indications:
- Cirrhosis following viral hepatitis
- HCC
- Cholangiocarcinoma
- Severe acute liver failure
- Sclerosing cholangitis
Contraindications:
- Active infection
- Extrahepatic tumor process
Survival rate: 93% at 1 year,
70 to 75% at 5 years
Ultrasound
Low-frequency curvilinear probe
At bedside, daily for the first 5 days, then no consensus but regular follow-up
B-mode:
- Normal graft: homogeneous echotexture
- Hyperechogenicity around the portal system: periportal edema following transplantation (normal in the first few days)
- Subcapsular hypoechoic areas: peripheral infarcts
- Perihepatic collection? measure if present, may be non-pathologic postoperatively (cholecystectomy bed ++)
- Normal IHBD < 3 mm
- Normal CBD < 8 +/- 2 mm
- Peritoneal effusion?
Color Doppler mode:
Hepatic artery
- Doppler spectrum in the common hepatic, left hepatic, and right hepatic arteries.
- Normal RI: 0.6-0.8
- Normal SAT < 80 ms
- Normal PSV: 40-80 cm/s
Main portal vein
- Normal: hepatopetal flow, velocity around 40 cm/s (20-50 cm/s)
- Stenosis: caliber variation, turbulence (aliasing), poststenotic velocity increase
- Thrombosis
Hepatic veins
Normal: patent, frequent loss of triphasic waveform
Management
Biliary tract abnormality:
Early:
Arterial etiology (ischemic cholangiopathy)
Rejection
Stenosis:
CBD dilation > 10 mm
IHBD dilation > 3 mm
Mechanical: choledocho-choledochal anastomosis
Ischemic cholangiopathy: multiple IHBD strictures
Biliary leak:
Can lead to abscess and biliary peritonitis
Hepatic artery abnormality:
Stenosis:
- RI < 0.5
- SAT > 80 ms
- PSV > 2 m/s
RI > 0.8:
common in the first days: periportal edema
Thrombosis:
- Severe, 25 to 60% mortality
- Causes biliary tract necrosis (periportal hypodensities)
Pseudoaneurysm:
look for infection
Cavo-caval anastomosis abnormality
Hepatic vein dilation
Ascites
Perfusion abnormalities
