Liver transplantation pre-surgical management
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.