Liver Transplantation

The number of donors decreases significantly, medical teams are required to book the best indications grafts. This selection is somewhat shocking imperative. The main indications used are:

The fulminant hepatitis: liver transplantation gives 60-80% survival at 3 years. Liver transplantation is an excellent indication.

The GALL CIRRHOSIS PRIMITIVE liver transplant will be performed based on criteria that have been calculations of prognostic indices:

- Increasing increased bilirubin,

- Ascites,

- Bleeding,

- Itching,

- And fatigue.

Primary sclerosing cholangitis: liver transplantation is performed when jaundice persists and persists bilirubin above 100 to 150 micromoles / liter and in case of outbreak of cholangitis difficult to control with antibiotics.

Atresia of the extrahepatic bile ducts of the child is complete or incomplete obliteration of congenital bile tract. Must transplant these children before their nutritional status is too corrupt.

Other diseases of liver transplantation are likely to function arguments for and against:

1 - Liver cirrhosis due to hepatitis B:

otherwise questionable because the graft reinfested often due to viral persistence in the body, often more serious than the original infection reinfection. The average survival is 50% at 1 year. However, prolonged exposure to high doses of anti-HBs immunoglobulin administration greatly improves prognosis. The same concerns are to apply for the B delta virus.

2 - cirrhosis due to hepatitis C:

recurrence on the graft exists but is less severe than the original infection. 70% survival at 2 years.

3 - Alcoholic cirrhosis:

reserved for patients who despite a total abstinence of more than 6 months with severe disease. While selected, liver Transplantation is a good indication.

4 - liver cancer:

are generally a bad indication for liver transplantation. The selection criteria are very strict and liver transplantation reserved any case patients without extrahepatic metastases.

The evolution after liver transplantation is related to the underlying disease and graft quality. Monitoring to prevent recurrence must be very strict. Laboratory tests for liver function will be done once a week for two months, then once a fortnight until the sixth month, then once a month the last 6 months of the first year. The second year will be quarterly monitoring.

The anti-rejection therapy should be monitored:

- It may be too powerful and inducing ACQUIRED INFECTIONS or Opportunistic Infections (see these terms) or cancer or lymphoma.

- There may not be enough: the rejection can be suspected on the increase in bilirubin of jaundice, fever, and more importantly it will objectified by hepatic BIOPSY. The intravenous administration of cortisone to retrieve the graft almost always.

Liver transplants after viral cirrhosis B and C will also be monitored by monitoring the serum immunological profile (antibody assay).

To prevent recurrence, it may be useful to administer before liver transplantation in INTERFERON or vidarabine, and after transplantation may also be administered high doses of B virus antibody.

Finally, immunosuppressive therapy can cause cancer.

Finally, after liver transplantation for Budd Chiari syndrome should be monitored very carefully coagulation.