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Oxford Textbook of Medicine (5 ed.)

Edited by David A. Warrell, Timothy M. Cox, John D. Firth

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Latest update

The May 2013 update sees updates to chapters focusing on Respiratory Medicine and Haematology.

Respiratory Medicine updates include substantial updates to key chapters and new material on a wide range of topics including: new bronchoscopic techniques for early detection of lung cancer, specific causes of effusion and pleural disease, and chronic obstructive pulmonary disease.

Haematology updates include extensive revisions of key chapters on chronic myeloid leukaemia, aplastic anaemia and bone marrow failure disorders, and blood transfusion, with new information on a wide range of matters.

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Publisher:
Oxford University Press
Print Publication Date:
May 2010
Print ISBN-13:
9780199204854
Published to Oxford Medicine:
May 2010
DOI:
10.1093/med/9780199204854.001.1

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Disclaimer

Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Contents

Liver transplantation

Chapter:
Liver transplantation
Author(s):

Gideon M. Hirschfield,

Michael E.D. Allison,

Graeme J.M. Alexander

DOI:
10.1093/med/9780199204854.003.152205_update_001

Update:

Source of livers for transplantation—non-heart-beating donors are increasingly used, albeit with increased complication rates; living related liver donation is now widespread and routine in many centres.

Updated on 28 November 2012. The previous version of this content can be found here.

Liver transplantation is considered for patients with liver disease that is predicted to shorten life or causes symptoms that preclude an acceptable quality of life and for individuals with life-shortening genetic disease that can be cured by transplantation. One-year survival exceeds 90%, 5-year survival approaches 80%, and individual median survivals exceed 20 years.

The selection of patients and timing of transplantation is difficult, since both premature transplantation and delayed grafting can shorten life. Manifestations of chronic liver disease that should prompt referral to a transplant centre include hepatic encephalopathy, ascites, spontaneous bacterial peritonitis, jaundice, malnutrition, hepatic osteodystrophy, hepatorenal syndrome, reversed portal vein blood flow, portal vein thrombosis, and hepatocellular carcinoma. Super-urgent liver transplantation is often life saving for those with acute liver failure (encephalopathy, coagulopathy, liver disease of <6 months duration).

Liver transplantation usually involves a whole liver graft from a deceased donor, but innovations include the use of split livers, auxiliary grafts, living related transplantation, and more recently the use of non-heart-beating donors. Size matching between donor and recipient is important, but transplantation across the ABO barrier is performed in exceptional circumstances. HLA matching and pre-existing donor sensitization are not considered important. Therapeutic immunosuppression is most commonly with triple therapy: calcineurin inhibitor (tacrolimus, ciclosporin), azathioprine, and prednisolone.

In the immediate postoperative period most complications relate to the anastamoses, bleeding or poor graft function. Early postoperative complications include infection (bacterial, viral (cytomegalovirus), fungal), problems with vascular and biliary anastomoses, and acute rejection. In the longer term the consequences of immune suppression (impaired renal function, increased cardiovascular risk, infection and malignancy) remain important, alongside chronic vascular rejection and disease recurrence.

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