0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15
912 Liver Transplantation■mammogram for female over 45 years of age
■pelvic exam with PAP smear for female
Invasive Tests When Indicated
■liver biopsy-if diagnosis of cirrhosis is uncertain
■ERCP-rule out cholangiocarcinoma in primary sclerosing cholangi-
tis
■angiography (if vascular findings equivocal with Doppler)
■bubble echocardiography or radiolabeled albumin macroaggregate
study when hepatopulmonary syndrome is suspected
differential diagnosis
■hepatocellular disease, e.g., chronic hepatitis B and hepatitis C, alco-
holic cirrhosis
■cholestatic liver disease, e.g., primary biliary cirrhosis, primary scle-
rosing cholangitis
■inborn errors of metabolism, e.g., hemochromatosis, Wilson’s dis-
ease, alpha 1 -antitrypsin deficiency, and diseases not associated with
liver injury (e.g., primary hyperoxaluria, familial homozygous hyper-
cholesterolemia)management
What to Do First
■early referral to transplant center with first evidence of decompen-
sated cirrhosis, or biochemical impairment of liver function
➣minimal listing criteria for OLT: Child’s class B (CTP score≥7),
or any episode of variceal bleeding or SBP
General Measures
■OLT evaluation, including underlying diagnosis and disease severity,
status of complications, assessment of comorbid conditions, psy-
chosocial condition, financial and insurance status
■United Network for Organ Sharing organ allocation rules:
➣Status 1: FHF with life expectancy <7 days
➣Model for End-stage Liver Disease (MELD) score (based on biliru-
bin, INR and creatinine) determines priority for available organs
since implementation in 2002; increased MELD points given to
patients with stage 2 HCC; exceptions may be made in special
circumstances and high MELD score assignedspecific therapy
Specific Therapy of Liver Failure
Indications for OLT
■hepatocellular liver disease