Professional Documents
Culture Documents
Dileep Thakur
Introduction
• 1st by T. Starzl in 1963
• Metabolic diseases
• Hepatic tumours
Chronic liver failure
• Alcoholic liver disease (complicated)
• Biliary atresia
• Viral hepatitis
• Idiosyncratic reactions
Kings college Criteria for OLT in
ALF
Paracetamol toxicity
• pH < 7.3
• PT > 100 sec
• S. Creat > 3.4mg/dl
• Hepatic encephalopathy
No paracetamol toxicity
• PT > 50 sec
• Age < 10 yrs or >40yrs
• Duration of jaundice before encephalopathy >7days
• S. Bil > 300 micromol/dl
• Non A or B hepatitis
Metabolic Disease
• Primary oxalosis
• Hemochromatosis
• Wilson's Disease
• Gauchers disease
• HIV positive
• Cholangiocarcinoma
• Secondaries liver
Waiting list criteria
• Child Turcot Pugh
• MELD score
• PELD score
Pre operative assessment
• Already done before pt on waiting list
• Hematologic tests
• Coagulation profile
• Biochemical studies
• Infrahepatic IVC
• Portal vein
• Hepatic artery
• Bile ducts
Piggy back OLT
• Improved hemodynamic stability
• Hemorrhage
• Opportunistic infections
• Graft rejection