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