Download Free Medical Indications For Liver Transplantation PowerPoint Presentation

Indications For Liver Transplantation PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical PowerPoint presentation titled "Indications for Liver Transplantation” by Dr.K.PANDURANGA RAO.

This medical PowerPoint presentation is about liver transplantation which is considered when a persons liver fails to perform its normal functions due to various reasons, such as chronic liver disease, acute liver failure, or liver cancer.

Some indications for liver transplantation include Chronic liver disease, Acute liver failure, Liver cancer, Inherited liver diseases, Biliary atresia and Alcoholic liver disease.

Tags : Indications for Liver Transplantation, chronic liver disease, acute liver failure, liver cancer, Inherited liver diseases, Biliary atresia, Alcoholic liver disease, Nephrology, Nephrology PowerPoint presentation

Published on : Jun 07, 2023 | Views : 1508 | Downloads : 1

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Indications for Liver Transplantation Dr.K.PANDURANGA RAO
Slide 2-

The Liver The largest single organ in the human body. In an adult, it weighs about 1.5 Kg and is roughly the size of a football. Located in the upper right-hand part of the abdomen, behind the lower ribs.
Slide 3-

Gross Anatomy The liver is divided) into four lobes: the right (the largest lobe), left, quadrate and caudate lobes. Supplied with blood via the protal vein and hepatic artery. Blood carried away by the hepatic vein. It is connected to the diaphragm and abdomainal walls by five ligaments. Gall Bladder Muscular bag for the storage, concentration, acidification and delivery of bile to small intestine The liver is the only human organ that has the remarkable property of self-regeneration. If a part of the liver is removed, the remaining parts can grow back to its original size and shape.
Slide 4-

Microscopic Anatomy
Slide 5-

What does the liver do? Temporary nutrient storage (glucose-glycogen) Remove toxins from blood Remove old/damaged RBC’s Regulate nutrient or metabolite levels in blood—keep constant supply of sugars, fats, amino acids, nucleotides (including cholesterol) Secrete bile via bile ducts and gall bladder into small intestines. Multi-function, blood-processing “factory”
Slide 6-

LIVER FUNCTION TESTS ALT AST (SGOT) ALKALINE PHOSPHATASE BILIRUBIN PROTHROMBIN TIME/INR ALBUMIN
Slide 7-

Acute and Chronic Liver Disease
Slide 8-

Acute Liver Disease Infections Viral Hepatitis A, B, C, D, E, EBV, CMV, HSV, Others – Leptospirosis, Toxoplasma, Drugs – MANY – HERBALS/OTC Alcohol Toxins Vascular obstruction (eg. Budd-Chiari)
Slide 9-

Acute Liver failure(ALF) ALF is defined as hepatic encephalopathy occurring within 24 weeks of the onset of symptoms in patients with out preexisting liver disease.
Slide 10-

Hyperacute Liver Failure 7 days or less Acute Liver Failure 8 to 28 days Subacute Liver Failure 5-24 weeks O’Grady et al. Categorization of FHF Based on the time interval between onset of jaundice and encephalopathy
Slide 11-

Aetiology of FHF in india Aetiology of FHF in india Acharaya et al Jaiswal et al (1999) (1996) No of Pt 458 95 HAV 4% 4.2% HBV 10.5% 27.3% HCV 4.4% 2.1% HDV 0% 5.2% HEV 23% 41% Mixed 6.3% 4.1% Non A, Non B 47% 15% Drugs 5% 0%
Slide 12-

Chronic Liver Disease Alcohol Viral hepatitis: B & C Autoimmune – autoimmmune hepatitis, PBC (Primary Biliary cirrhosis), PSC (Primary Sclerosing Cholangitis) Non-alcoholic fatty liver disease (NAFLD) Drugs (MTX, amiodarone) Haemochromatosis Cystic fibrosis, a1antitryptin deficiency, Wilsons disease, Vascular problems (Portal hypertension + liver disease) Cryptogenic Others: sarcoidosis, amyloid, schistosomiasis
Slide 13-

What is Cirrhosis?
Slide 14-

Definition: Hepatic necrosis and degeneration combined with hepatic regeneration and fibrosis leading to Nodular formation Cirrhosis
Slide 15-

ppt slide no 15 content not found
Slide 16-

Cirrhosis Of Liver
Slide 17-

ppt slide no 17 content not found
Slide 18-

ppt slide no 18 content not found
Slide 19-

ppt slide no 19 content not found
Slide 20-

ppt slide no 20 content not found
Slide 21-

Complications of cirrhosisVariceal haemorrhage
Slide 22-

ppt slide no 22 content not found
Slide 23-

Complications of cirrhosisAscites
Slide 24-

ppt slide no 24 content not found
Slide 25-

ppt slide no 25 content not found
Slide 26-

Hepato Renal Syndrome
Slide 27-

Complications of cirrhosisHepatic Encephalopathy
Slide 28-

ppt slide no 28 content not found
Slide 29-

ppt slide no 29 content not found
Slide 30-

ppt slide no 30 content not found
Slide 31-

ppt slide no 31 content not found
Slide 32-

ppt slide no 32 content not found
Slide 33-

ppt slide no 33 content not found
Slide 34-

Liver Transplantation Liver transplantation (LT) is now established as the only definitive treatment for end stage liver disease (ESLD) Starzl et al carried out 1st human liver transplant in 1963 Survival following liver transplant 1 year survival: 87 – 93% 3 year survival: > 75% .....(http://www.ustransplant.org The 2009 Annual Report of the OPTN and SRTR: Transplant Data 1999-2008).
Slide 35-

Liver Transplantation Issues Whether patient needs LT? When to refer or consider for LT? Is patient suitable for LT?
Slide 36-

Scoring systems CHILD-TURCOTTE - PUGH SCORE CTP score: - Disease severity for pts with ESLD - Used to predict peri-operative mortality in patients with liver disease.
Slide 37-

Shortcomings of CTP scores Subjective nature of the assessment of ascites & encephalopathy Limited discrimination into only three disease severity categories
Slide 38-

Model for End-Stage Liver Disease (MELD) MELD score = 0.957 x Loge (creatinine mg/dl) + 0.378 x Loge (bilirubin mg/dl) + 1.12 x Loge (INR) + 0.643 Multiply the score by 10 and round to the nearest whole number Established in Feb 2002 Numerical scale, from 6 (less ill) to 40 (gravely ill) This ‘score’ tells us how urgently LT is required within next 3 months Most patients on LT waiting list have MELD score between 11 and 20
Slide 39-

Upper limit of MELD.Estimated Survival A retrospective longitudinal cohort study in 232 patients The estimated survival for patients with MELD score > 25 was lower at 12 months (68.86% vs 39.13%). Ilka Fatima Ferreira Santana Boin et al, Arq Gastroenterol. 2008 Oct- ec;45(4):275-83
Slide 40-

Indications for Liver Transplantation Proportion of liver transplants for specific etiologies, 1992–2007 O’Leary et al Gastroenterology 2008
Slide 41-

Indications for Liver Transplantation
Slide 42-

Main indications for LTx: complications of ESLD GE variceal bleed- each episode of bleeding carries a 20% mortaliity rate. LT is the best way to decompress the portal system if other therapies have failed. – De Francis et al, Baveno V, J Hepatology, 2010] HE- LT remains the only permanent Rx
Slide 43-

Main indications for LTx: complications of ESLD 3. Refractory ascites- carries a mortality of >50% at 2 yrs. More prone for variceal bleed, HRS, SBP. Annual incidence of HRS in cirrhotics with ascites is 8% with median survival of 2 wks in Type I and 6 months in Type II. LT should be considered as soon as HRS is diagnosed. Planas et al, Clini gastro hepatology 2006;4:1385-94 Gines A et al, Gastroenterology 1993;105:229-36
Slide 44-

Main indications for LTx: complications of ESLD 4. HPS- [4-47% prevalence] LT is the only curative Rx for HPS 5. PPHTN- 2-8%, associated with higher post transplantation mortality Individual etiologies – viral hepatitis, ALD, NAFLD, HPB malignancy, AIH, Cholestatic disorders, ALF, HCC.
Slide 45-

Need for LT CTP and MELD most commonly used PBC/PSC have their own prognostic scores 5-year survival (CTP 7-15) with (ascites, bleeding, HE, SBP, HRS) : 20% to 50% Survival rates 1, 3, and 5 years after LT 88%, 80%, and 75% Predictive accuracy for short-term mortality -Shetty K et al Hepatology 1997 -Kamath PS et al Hepatology 2001 -Freeman RB et al Liver Transpl 2004 -H-C Huang et al. Journal of Gastroenterology and Hepatology 24 (2009) 1716–1724
Slide 46-

Comparison of mortality risk expressed as hazard ratio by MELD score for recipients of liver transplants compared to candidates on the liver transplant waiting list – Merion et al, Am J transplantation 2005;5:307-13 In pts with MELD<14, the mortality with LTx > not undergoing LTx
Slide 47-

Referred for LT when (CTP > 7 and MELD > 10) or they experience their first major complication (ascites, bleeding, or HE) - AASLD:Karen F et al Hepatology 2005 Berg CL et al Gastroenterology 2007 MELD under estimates – HCC, Cholangio Ca, HE, ascites, HPS, PPHTN, GI bleed etc
Slide 48-

Contraindication for LT x x x
Slide 49-

In US, patients name and condition is entered in National Registry CTP (CHILD-TURCOTTE - PUGH SCORE) scores in conjunction with United Network for Organ Sharing (UNOS) status determining factor was used for organ allocation in the USA until early 2002. but it did not always ensure that organs were allocated to the sickiest patients with the greatest risk of mortality. Now, Model for End-Stage Liver Disease (MELD) is used for allocating liver to recepients. In India, there is no such national registry or liver transplant centre registry. …… Liver Donor Donor Liver Allocation
Slide 50-

Thank you
Slide 51-

King’s college hospital indicators of poor prognosis in Acute Liver Failure
Slide 52-

Hyperacute Liver Failure 7 days or less Acute Liver Failure 8 to 28 days Subacute Liver Failure 5-24 weeks O’Grady et al. Categorization of FHF Based on the time interval between onset of jaundice and encephalopathy
Slide 53-

ppt slide no 53 content not found