Liver Transplantation

A major new reference work on Liver Transplantation written by the transplantation team of one of Asia’s leading transplant centres with a foreword by Prof. Sir Roy Calne the liver transplantation pioneer and expert in immunosuppressant techniques. The book begins with an overview of transplantation team composition, international donor selection guidelines and donor management and goes on to discuss technique and management of DDLT, LDLT, Pediatric, Split, Domino and ABO-incompatible liver transplantation. Post-transplant management, immuno-suppression, follow-up, short and long-term complications and their outcomes, as well as recent advances in liver transplantation such as stem cell, hepatocyte and xenotransplantation, are also discussed. CONTENTS 1. History of Liver Transplantation .................................................................................................................... 1 2. Anatomy of Liver ............................................................................................................................................... 8 3. UNOS, Organ Allocation Policy and MELD Score .................................................................................. 24 4. Indications and Contraindications of Liver Transplantation ................................................................ 32 5. Liver Transplantation Team ........................................................................................................................... 39 6. Evaluation of Live Donor ............................................................................................................................... 41 7. Graft Volume Estimation and Donor with Fatty Liver .......................................................................... 54 8. Liver Donation after Brain Death and Cardiac Death ............................................................................ 58 (A) Heart-beating Donors/Donation After Brain Death (B) Donation after Cardiac Death (DCD) 9. Marginal Donor and Donor Risk Index ..................................................................................................... 67 10. Donor Surgery .................................................................................................................................................. 70 (A) Right Lobe Graft (B) Left Lateral Segment (C) Right Posterior Segment or Right Lateral Sector Graft (D) Left Lobes Graft (E) Deceased Donor Hepatectomy 11. Graft Preservation and Bench Procedure.................................................................................................... 90 12. Recipient Surgery ............................................................................................................................................ 97 (A) Live Donor Liver Transplantation: Recipient Hepatectomy (B) Right Lobe Graft (C) Left Lobe Graft (D) Left Lateral Segment Graft (E) Recipient Surgery for Deceased Donor Liver Transplantation 13. Reperfusion Syndrome and Preservation Injury .................................................................................... 118 14. Technical Modifications in Recipient Surgery........................................................................................ 120 15. Small for Size Syndrome .............................................................................................................................. 127 16. Split Liver Transplantation .......................................................................................................................... 131 17. Dual Grafts ...................................................................................................................................................... 140 18. Auxiliary Partial Orthotopic Liver Transplantation (APOLT) ............................................................ 144 19. Domino Liver Transplantation .................................................................................................................... 149 20. Postoperative Care and Immunosuppression .......................................................................................... 155 21. Immunosuppression Drugs .......................................................................................................................... 166 Contents xviii Liver Transplantation 22. Hepatic Hemodynamics and Role of Doppler Ultrasonography ........................................................ 181 (A) Hepatic Hemodynamics (B) Doppler Ultrasonography in Liver Transplantation 23. ABO-Incompatible Liver Transplantation ................................................................................................ 191 24. Electrolyte Abnormalities in ESLD ............................................................................................................ 197 25. Immunology of Transplantation ................................................................................................................. 204 26. Early Complications of Liver Transplantation ........................................................................................ 213 (A) Primary Nonfunction (B) Allograft Rejection (C) Biliary Complications (D) Vascular Complications (E) Post-transplant Infections 27. Role of Liver Biopsy in Transplantation .................................................................................................. 275 28. Renal Dysfunction in Liver Transplantation ........................................................................................... 282 29. Long-term Care of Recipient....................................................................................................................... 288 30. Pregnancy after Liver Transplantation ...................................................................................................... 298 31. Recurrent Diseases after Liver Transplantation ..................................................................................... 301 32. Retransplantation ........................................................................................................................................... 310 33. Pediatric Liver Transplantation ................................................................................................................... 312 34. Anesthesia in Liver Transplantation ......................................................................................................... 320 35. Extracorporeal Liver Supporting Systems ................................................................................................ 329 36. Health-related Quality of Life ..................................................................................................................... 335 37. Liver Transplantation in Asia and Western Countries ......................................................................... 340 38. Hepatocellular Carcinoma and Liver Transplantation .......................................................................... 347 39. Hepatitis B Virus and Liver Transplantation .......................................................................................... 358 40. Hepatitis C Virus and Liver Transplantation.......................................................................................... 370 41. Alcoholism and Liver Transplantation ..................................................................................................... 378 42. Autoimmune Liver Diseases ........................................................................................................................ 383 43. Acute Liver Failure ........................................................................................................................................ 388 44. Metabolic Liver Diseases .............................................................................................................................. 397 45. Non-alcoholic Fatty Liver Disease .............................................................................................................. 402 46. Wilson’s Disease ............................................................................................................................................ 407 47. Budd-Chiari Syndrome ................................................................................................................................. 411 48. Recent Advances in Liver Transplantation .............................................................................................. 415 (A) Hepatocyte Transplantation (B) Xenotransplantation (C) Stem Cell Transplantation 49. Complications of ESLD ................................................................................................................................ 429 (A) Ascites (B) Portal Hypertension and Variceal Bleeding (C) Hepatorenal Syndrome (D) Hepatic Encephalopathy (E) Hepatopulmonary Syndrome (F) Spontaneous Bacterial Peritonitis (G) Hyponatremia