Dileep Thakur
Introduction
1st by T. Starzl in 1963 Post transplant 1yr survival increased from 30 to 85% Refined surgery Better preservation Better immunosupression early diagnosis & management of complications
Indications
Chronic liver failure Acute liver failure Metabolic diseases Hepatic tumours
Metabolic Disease
Primary oxalosis Alpha 1 antitrypsin deficiency Hemochromatosis Wilson's Disease
Gauchers disease
Glycogen Storage disorder
Hepatic tumours
HCC Milan criteria (Mazzaferro) Size of lesion <5cm Upto 3 lesion maximum <3cm Fibrolamellar variant No microvascular invasion
Absolute Contraindications
Advanced uncorrectable cardiopulmonary disorders Severe irreversible pulmonary hypertension Hypotension requiring vasopressor support Recent intracranial hemorrhage AIDS Uncontrolled sepsis Extrahepatic malignancy Active substance abuse Irreversible neurological impairment
Relative Contraindications
HCC stage III or IV HIV positive
Coagulation profile
Biochemical studies 20 pints of blood arranged
Operative technique
Anastomotic sequence Suprahepatic IVC Infrahepatic IVC Portal vein Hepatic artery Bile ducts
Complications
Biliary anastomotic complications most common Hemorrhage Vascular complications hepatic artery thrombosis Opportunistic infections
Graft rejection
Primary graft non function
Conclusion
Routine procedure in many centres Post transplant survival improving Ultimate survival depends on underlying disease