Liver transplantation pre-surgical management: Difference between revisions
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== Overview == | == Overview == | ||
Pre-surgical management for liver transplantation includes laboratory testings such as [[ABO blood group system|ABO-Rh blood typing]], Liver biochemical and function tests ([[Alanine transaminase|alanine aminotransferase]], [[aspartate aminotransferase]], [[alkaline phosphatase]], [[bilirubin]], [[international normalized ratio]], [[Complete blood count]], [[Creatinine clearance]],[[Sodium|serum sodium]], [[Alpha fetoprotein|serum alpha-fetoprotein]], and [[Calcium]] and [[vitamin D]] levels. Cardiological testings include [[electrocardiogram]], [[cardiac stress testing]], [[Echocardiography]] , [[Pulse oximetry]] and [[ABG]]. | |||
== Liver transplantation pre-surgical management == | == Liver transplantation pre-surgical management == | ||
=== '''Laboratory testing''' === | === '''Laboratory testing''' === | ||
ABO-Rh blood typing | * [[ABO blood group system|ABO-Rh blood typing]] | ||
* Liver biochemical and function tests ([[Alanine transaminase|alanine aminotransferase]], [[aspartate aminotransferase]], [[alkaline phosphatase]], [[bilirubin]], [[international normalized ratio]] | |||
Liver biochemical and function tests (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, bilirubin, international normalized ratio | * [[Complete blood count]] | ||
* [[Creatinine clearance]] | |||
Complete blood count | * [[Sodium|Serum sodium]] | ||
* [[Alpha fetoprotein|Serum alpha-fetoprotein]] | |||
Creatinine clearance | * [[Calcium]] and [[vitamin D]] levels | ||
* Serologies for [[cytomegalovirus]], [[Epstein Barr virus|Epstein-Barr virus]], [[varicella]], [[Human Immunodeficiency Virus (HIV)|human immunodeficiency virus]], [[hepatitis A]], [[hepatitis B]], [[hepatitis C]], [[Rapid plasma reagent|rapid plasma reagin]] | |||
Serum sodium | * [[Urinalysis]] | ||
* Urine drug screen | |||
=== '''Cardiopulmonary evaluation''' === | === '''Cardiopulmonary evaluation''' === | ||
* | * [[Electrocardiogram]]<ref name="pmid14762853">{{cite journal| author=Krowka MJ, Mandell MS, Ramsay MA, Kawut SM, Fallon MB, Manzarbeitia C et al.| title=Hepatopulmonary syndrome and portopulmonary hypertension: a report of the multicenter liver transplant database. | journal=Liver Transpl | year= 2004 | volume= 10 | issue= 2 | pages= 174-82 | pmid=14762853 | doi=10.1002/lt.20016 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14762853 }}</ref> | ||
* '''Cardiac stress testing''' <ref name="pmid9346688">{{cite journal| author=Plotkin JS, Scott VL, Pinna A, Dobsch BP, De Wolf AM, Kang Y| title=Morbidity and mortality in patients with coronary artery disease undergoing orthotopic liver transplantation. | journal=Liver Transpl Surg | year= 1996 | volume= 2 | issue= 6 | pages= 426-30 | pmid=9346688 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9346688 }}</ref> | |||
* '''Cardiac stress testing''' | * [[Exercise stress testing|Noninvasive stress testing]] is suggested in liver transplantation candidates with no active cardiac conditions if there are multiple risk factors for [[Coronary heart disease|coronary artery disease]] present.<ref name="pmid22763103">{{cite journal| author=Lentine KL, Costa SP, Weir MR, Robb JF, Fleisher LA, Kasiske BL et al.| title=Cardiac disease evaluation and management among kidney and liver transplantation candidates: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. | journal=J Am Coll Cardiol | year= 2012 | volume= 60 | issue= 5 | pages= 434-80 | pmid=22763103 | doi=10.1016/j.jacc.2012.05.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22763103 }}</ref> | ||
* | * If initial noninvasive testing is abnormal, [[cardiac catheterization]] is indicated. | ||
* If initial noninvasive testing is abnormal, cardiac catheterization is indicated. | * If clinically significant [[coronary artery stenosis]] are present, patients should be evaluated for revascularization prior to transplantation. | ||
* If clinically significant coronary artery | * '''[[Echocardiography]]''' | ||
* '''Echocardiography''' | * We obtain [[Transthoracic echocardiography|transthoracic contrast-enhanced echocardiography]] to look for evidence of [[valvular heart disease]] or [[portopulmonary hypertension]]. | ||
* We obtain transthoracic contrast-enhanced echocardiography to look for evidence of valvular heart disease or portopulmonary hypertension. | * '''[[Pulse oximetry]] and [[ABG]]''' | ||
* '''Pulse oximetry and ABG''' | * Patients should undergo pulse oximetry to screen for [[hepatopulmonary syndrome]]. | ||
* Patients should undergo pulse oximetry to screen for hepatopulmonary syndrome. | * Patients should have a blood gas obtained while breathing room air and undergo [[Transthoracic echocardiography|transthoracic contrast-enhanced echocardiography]]. | ||
* | * Testing to rule out other causes includes a [[Chest X-ray|chest radiograph]], [[pulmonary function tests]], and chest [[computed tomography]]. | ||
* Testing to rule out other causes includes a chest radiograph, pulmonary function tests, and chest computed tomography | |||
=== '''Cancer screening''' === | === '''Cancer screening''' === | ||
* | * Abdominal [[Computed tomography|CT]] scanning or [[magnetic resonance imaging]]. | ||
* Screening for cervical cancer, breast cancer, and prostate cancer should be obtained when indicated | * Screening for [[cervical cancer]], [[breast cancer]], and [[prostate cancer]] should be obtained when indicated. | ||
* | * Skin testing or [[interferon-gamma release assay]] for [[tuberculosis]] | ||
* | * Treatment may be initiated prior to transplantation or deferred until after transplantation, depending on the clinical assessment of the patient. | ||
* Patients from endemic areas should be screened for [[Coccidioidomycosis|coccidiomycosis]] or [[Strongyloidiasis|strongyloides]]. | |||
* Patients from endemic areas should be screened for coccidiomycosis or strongyloides. | * Several vaccinations are recommended prior to liver transplantation including [[hepatitis A]], [[hepatitis B]], [[pneumococcus]], [[influenza]], [[diphtheria]], [[pertussis]], and [[tetanus]]. | ||
* Several vaccinations are recommended prior to liver transplantation including hepatitis A, hepatitis B, pneumococcus, influenza, diphtheria, pertussis, and tetanus. | |||
==== '''Hepatic imaging and HCC staging''' ==== | ==== '''Hepatic imaging and HCC staging''' ==== | ||
Hepatic imaging should be obtained to assess the vasculature | * Hepatic imaging should be obtained to assess the vasculature and for tumor staging. | ||
* This is typically done with multiphase [[Contrast enhanced CT|contrast-enhanced CT]] scanning or [[MRI|contrast-enhanced MRI]]. | |||
* If cross-sectional imaging cannot be obtained, the hepatic vasculature can be assessed with transabdominal [[ultrasonography]] with Doppler imaging or contrast-enhanced ultrasonography. | |||
==== '''Upper endoscopy''' ==== | ==== '''Upper endoscopy''' ==== | ||
Upper endoscopy should be performed in patients with cirrhosis or portal hypertension to evaluate for varices. | * [[Upper endoscopy]] should be performed in patients with [[cirrhosis]] or [[portal hypertension]] to evaluate for [[varices]]. | ||
==== '''Bone density testing''' ==== | ==== '''Bone density testing''' ==== | ||
Patients should be screened for osteoporosis with bone density testing. If osteoporosis is present, treatment should be initiated prior to transplantation. Oral bisphosphonates should be used with caution in patients with esophageal varices | * Patients should be screened for [[osteoporosis]] with bone density testing. | ||
* If [[osteoporosis]] is present, treatment should be initiated prior to transplantation. | |||
* Oral [[bisphosphonates]] should be used with caution in patients with [[esophageal varices]]. | |||
==References== | |||
{{Reflist|2}} | |||
Latest revision as of 23:29, 19 December 2017
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
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Liver trasnsplantation Microchapters |
Overview
Pre-surgical management for liver transplantation includes laboratory testings such as ABO-Rh blood typing, Liver biochemical and function tests (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, bilirubin, international normalized ratio, Complete blood count, Creatinine clearance,serum sodium, serum alpha-fetoprotein, and Calcium and vitamin D levels. Cardiological testings include electrocardiogram, cardiac stress testing, Echocardiography , Pulse oximetry and ABG.
Liver transplantation pre-surgical management
Laboratory testing
- ABO-Rh blood typing
- Liver biochemical and function tests (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, bilirubin, international normalized ratio
- Complete blood count
- Creatinine clearance
- Serum sodium
- Serum alpha-fetoprotein
- Calcium and vitamin D levels
- Serologies for cytomegalovirus, Epstein-Barr virus, varicella, human immunodeficiency virus, hepatitis A, hepatitis B, hepatitis C, rapid plasma reagin
- Urinalysis
- Urine drug screen
Cardiopulmonary evaluation
- Electrocardiogram[1]
- Cardiac stress testing [2]
- Noninvasive stress testing is suggested in liver transplantation candidates with no active cardiac conditions if there are multiple risk factors for coronary artery disease present.[3]
- If initial noninvasive testing is abnormal, cardiac catheterization is indicated.
- If clinically significant coronary artery stenosis are present, patients should be evaluated for revascularization prior to transplantation.
- Echocardiography
- We obtain transthoracic contrast-enhanced echocardiography to look for evidence of valvular heart disease or portopulmonary hypertension.
- Pulse oximetry and ABG
- Patients should undergo pulse oximetry to screen for hepatopulmonary syndrome.
- Patients should have a blood gas obtained while breathing room air and undergo transthoracic contrast-enhanced echocardiography.
- Testing to rule out other causes includes a chest radiograph, pulmonary function tests, and chest computed tomography.
Cancer screening
- Abdominal CT scanning or magnetic resonance imaging.
- Screening for cervical cancer, breast cancer, and prostate cancer should be obtained when indicated.
- Skin testing or interferon-gamma release assay for tuberculosis
- Treatment may be initiated prior to transplantation or deferred until after transplantation, depending on the clinical assessment of the patient.
- Patients from endemic areas should be screened for coccidiomycosis or strongyloides.
- Several vaccinations are recommended prior to liver transplantation including hepatitis A, hepatitis B, pneumococcus, influenza, diphtheria, pertussis, and tetanus.
Hepatic imaging and HCC staging
- Hepatic imaging should be obtained to assess the vasculature and for tumor staging.
- This is typically done with multiphase contrast-enhanced CT scanning or contrast-enhanced MRI.
- If cross-sectional imaging cannot be obtained, the hepatic vasculature can be assessed with transabdominal ultrasonography with Doppler imaging or contrast-enhanced ultrasonography.
Upper endoscopy
- Upper endoscopy should be performed in patients with cirrhosis or portal hypertension to evaluate for varices.
Bone density testing
- Patients should be screened for osteoporosis with bone density testing.
- If osteoporosis is present, treatment should be initiated prior to transplantation.
- Oral bisphosphonates should be used with caution in patients with esophageal varices.
References
- ↑ Krowka MJ, Mandell MS, Ramsay MA, Kawut SM, Fallon MB, Manzarbeitia C; et al. (2004). "Hepatopulmonary syndrome and portopulmonary hypertension: a report of the multicenter liver transplant database". Liver Transpl. 10 (2): 174–82. doi:10.1002/lt.20016. PMID 14762853.
- ↑ Plotkin JS, Scott VL, Pinna A, Dobsch BP, De Wolf AM, Kang Y (1996). "Morbidity and mortality in patients with coronary artery disease undergoing orthotopic liver transplantation". Liver Transpl Surg. 2 (6): 426–30. PMID 9346688.
- ↑ Lentine KL, Costa SP, Weir MR, Robb JF, Fleisher LA, Kasiske BL; et al. (2012). "Cardiac disease evaluation and management among kidney and liver transplantation candidates: a scientific statement from the American Heart Association and the American College of Cardiology Foundation". J Am Coll Cardiol. 60 (5): 434–80. doi:10.1016/j.jacc.2012.05.008. PMID 22763103.