Sinusoidal obstruction syndrome surgery: Difference between revisions

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__NOTOC__
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{{Sinusoidal obstruction syndrome}}
{{Sinusoidal obstruction syndrome}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{HS}}
 
{{PleaseHelp}}
 
==Overview==
==Overview==
Surgical treatment of sinusoidal obstruction syndrome is reserved for patients who don't respond to supportive treatment or defibrotide. The surgical options include Transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation.
Surgical treatment of sinusoidal obstruction syndrome is reserved for patients who do not respond to supportive treatment or [[defibrotide]]. The surgical options include [[Transjugular intrahepatic portosystemic shunts|transjugular intrahepatic portosystemic shunt (TIPS)]] and [[Liver transplantation|liver transplantation.]]
 
==Surgery==
==Surgery==
The sinusoidal obstruction syndrome patients who don't respond to supportive care or defibrotide can undergo TIPS or liver transplantation.
The sinusoidal obstruction syndrome patients who don't respond to supportive care or [[defibrotide]] can undergo [[Transjugular intrahepatic portosystemic shunt|TIPS]] or [[liver transplantation]].<ref name="pmid8781329">{{cite journal |vauthors=Fried MW, Connaghan DG, Sharma S, Martin LG, Devine S, Holland K, Zuckerman A, Kaufman S, Wingard J, Boyer TD |title=Transjugular intrahepatic portosystemic shunt for the management of severe venoocclusive disease following bone marrow transplantation |journal=Hepatology |volume=24 |issue=3 |pages=588–91 |year=1996 |pmid=8781329 |doi=10.1002/hep.510240321 |url=}}</ref><ref name="pmid10800068">{{cite journal |vauthors=Azoulay D, Castaing D, Lemoine A, Hargreaves GM, Bismuth H |title=Transjugular intrahepatic portosystemic shunt (TIPS) for severe veno-occlusive disease of the liver following bone marrow transplantation |journal=Bone Marrow Transplant. |volume=25 |issue=9 |pages=987–92 |year=2000 |pmid=10800068 |doi=10.1038/sj.bmt.1702386 |url=}}</ref>
===Transjugular intrahepatic portosystemic shunting===
===Transjugular intrahepatic portosystemic shunting===
* [[Transjugular intrahepatic portosystemic shunt|Transjugular intrahepatic portosystemic shunting (TIPS)]] is bypassing the high flow rate of [[portal vein]] into the [[Systemic vein|systemic veins]].  
* [[Transjugular intrahepatic portosystemic shunt|Transjugular intrahepatic portosystemic shunting (TIPS)]] is bypassing the high flow rate of [[portal vein]] into the [[Systemic vein|systemic veins]].  
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==== Patient evaluation prior to transplantation ====
==== Patient evaluation prior to transplantation ====
Pre-transplant [[patient]] evaluation has the following objectives:   
Pre-transplant [[patient]] evaluation has the following objectives:   
* Assesment of ability of the [[patient]] to withstand [[surgery]]  
* Assesment of ability of the [[patient]] to undergo [[surgery]]  
* Assesment of ability of the [[patient]] to withstand [[immunosuppression]]   
* Assesment of ability of the [[patient]] to withstand [[immunosuppression]]   
* Assessment of [[Patient|patients]] demands of post-transplantation care  
* Assessment of [[Patient|patients]] demands of post-transplantation care  
Pre-transplant evaluation is particularly aggressive in patients prior to [[Organ transplant|transplantation]] to minimize post operative morbidity and mortality due to effects of surgery and [[Immunosuppression|immunosuppressive therapy]].The following evaluations are required:  
Pre-transplant evaluation is particularly aggressive in patients prior to [[Organ transplant|transplantation]] to minimize post operative morbidity and mortality due to effects of surgery and [[Immunosuppression|immunosuppressive therapy]].The following evaluations are required:  
* Cardiopulmonary   
* [[Cardiopulmonary]]  
* Screening for [[Cancer of unknown primary origin|occult cancer]]  
* Screening for [[Cancer of unknown primary origin|occult cancer]]  
* Screening for occult [[infection]]   
* Screening for occult [[infection]]   

Latest revision as of 16:14, 28 February 2018

Sinusoidal obstruction syndrome Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]

Overview

Surgical treatment of sinusoidal obstruction syndrome is reserved for patients who do not respond to supportive treatment or defibrotide. The surgical options include transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation.

Surgery

The sinusoidal obstruction syndrome patients who don't respond to supportive care or defibrotide can undergo TIPS or liver transplantation.[1][2]

Transjugular intrahepatic portosystemic shunting


{{#ev:youtube|O2u4_hF3234|500}}

Liver Transplantation

Patient evaluation prior to transplantation

Pre-transplant patient evaluation has the following objectives:

Pre-transplant evaluation is particularly aggressive in patients prior to transplantation to minimize post operative morbidity and mortality due to effects of surgery and immunosuppressive therapy.The following evaluations are required:

Laboratory investigations

Laboratory investigations essential for patient evaluation prior to liver transplantation are as follows:

General investigations

Cause specific investigations

Cardiopulmonary evaluation

Cardiopulmonary evaluation helps in the evaluation of the patient for pathologies that need to be ruled out prior to transplantation:[4][5]

Cancer screening

Prior to transplantation, screening for the following carcinomas is recommended:

Upper GI endoscopy

Bone densitometry

Vaccinations and evaluation for infection

Psychosocial evaluation and education

Techniques

{{#ev:youtube|v=hquWw4rRHh8}}

Orthotopic Liver Transplantation

Immunosuppressive management

Results

Living donor transplantation

  • Living donor liver transplantation (LDLT) has emerged in recent decades as a critical surgical option for patients with end stage liver disease, such as cirrhosis and/or hepatocellular carcinoma often attributable to one or more of the following:[20][33][34]
  • The concept of LDLT is based on:
    • Remarkable regenerative capacities of the human liver
    • Widespread shortage of cadaveric livers for patients awaiting transplant
  • In LDLT, a piece of healthy liver is surgically removed from a living person and transplanted into a recipient, immediately after the diseased liver of the recipient has been entirely removed
  • Historically, LDLT was used as a means for parents of children with severe liver disease to donate a portion of their healthy liver to replace the damaged liver of their children
  • In 1986, the first successful LDLT was performed at the Universidade de São Paulo (USP) Medical School, by Dr. Silvano Raia.
  • More technically demanding than standard, cadaveric donor liver transplantation
  • Has faced several ethical problems[35]

Complications of Liver Transplantation

    • Laboratory investigations

Imaging studies

Acute and chronic graft rejection

Acute graft rejection:[36]

Chronic graft rejection:

Infection

Infections may be classified based on the duration post transplantation.

  • After the first 6 months, risk of infection in transplant patients is equal to that of the population

Cytomegalovirus (CMV)

  • Most common viral infection (affects 25-85% patients)
  • Occurrence: Between posttransplant months 1 and 3
  • Infection may be:
    • Primary
    • Reactivated

Pneumocystis carinii pneumonia (PCP)

Other less common organisms causing infection include:

References

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  2. Azoulay D, Castaing D, Lemoine A, Hargreaves GM, Bismuth H (2000). "Transjugular intrahepatic portosystemic shunt (TIPS) for severe veno-occlusive disease of the liver following bone marrow transplantation". Bone Marrow Transplant. 25 (9): 987–92. doi:10.1038/sj.bmt.1702386. PMID 10800068.
  3. Lahat E, Lim C, Bhangui P, Fuentes L, Osseis M, Moussallem T, Salloum C, Azoulay D (2017). "Transjugular intrahepatic portosystemic shunt as a bridge to non-hepatic surgery in cirrhotic patients with severe portal hypertension: a systematic review". HPB (Oxford). doi:10.1016/j.hpb.2017.09.006. PMID 29110990.
  4. 4.0 4.1 4.2 Martin P, DiMartini A, Feng S, Brown R, Fallon M (2014). "Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation". Hepatology. 59 (3): 1144–65. PMID 24716201.
  5. Zoghbi GJ, Patel AD, Ershadi RE, Heo J, Bynon JS, Iskandrian AE (2003). "Usefulness of preoperative stress perfusion imaging in predicting prognosis after liver transplantation". Am. J. Cardiol. 92 (9): 1066–71. PMID 14583357.
  6. Guckelberger O, Mutzke F, Glanemann M, Neumann UP, Jonas S, Neuhaus R, Neuhaus P, Langrehr JM (2006). "Validation of cardiovascular risk scores in a liver transplant population". Liver Transpl. 12 (3): 394–401. doi:10.1002/lt.20722. PMID 16498651.
  7. 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.
  8. Colle IO, Moreau R, Godinho E, Belghiti J, Ettori F, Cohen-Solal A, Mal H, Bernuau J, Marty J, Lebrec D, Valla D, Durand F (2003). "Diagnosis of portopulmonary hypertension in candidates for liver transplantation: a prospective study". Hepatology. 37 (2): 401–9. doi:10.1053/jhep.2003.50060. PMID 12540791.
  9. Krowka MJ, Mandell MS, Ramsay MA, Kawut SM, Fallon MB, Manzarbeitia C, Pardo M, Marotta P, Uemoto S, Stoffel MP, Benson JT (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.
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  12. Raval Z, Harinstein ME, Skaro AI, Erdogan A, DeWolf AM, Shah SJ, Fix OK, Kay N, Abecassis MI, Gheorghiade M, Flaherty JD (2011). "Cardiovascular risk assessment of the liver transplant candidate". J. Am. Coll. Cardiol. 58 (3): 223–31. doi:10.1016/j.jacc.2011.03.026. PMID 21737011.
  13. Arguedas MR, Singh H, Faulk DK, Fallon MB (2007). "Utility of pulse oximetry screening for hepatopulmonary syndrome". Clin. Gastroenterol. Hepatol. 5 (6): 749–54. doi:10.1016/j.cgh.2006.12.003. PMID 17392034.
  14. Prentis JM, Manas DM, Trenell MI, Hudson M, Jones DJ, Snowden CP (2012). "Submaximal cardiopulmonary exercise testing predicts 90-day survival after liver transplantation". Liver Transpl. 18 (2): 152–9. doi:10.1002/lt.22426. PMID 21898768.
  15. Eghtesad B, Kadry Z, Fung J (2005). "Technical considerations in liver transplantation: what a hepatologist needs to know (and every surgeon should practice)". Liver Transpl. 11 (8): 861–71. doi:10.1002/lt.20529. PMID 16035067.
  16. Tuttle-Newhall JE, Collins BH, Desai DM, Kuo PC, Heneghan MA (2005). "The current status of living donor liver transplantation". Curr Probl Surg. 42 (3): 144–83. PMID 15859440.
  17. Steadman RH (2004). "Anesthesia for liver transplant surgery". Anesthesiol Clin North America. 22 (4): 687–711. doi:10.1016/j.atc.2004.06.009. PMID 15541931.
  18. Park JI, Kim KH, Lee SG (2015). "Laparoscopic living donor hepatectomy: a review of current status". J Hepatobiliary Pancreat Sci. 22 (11): 779–88. doi:10.1002/jhbp.288. PMID 26449392.
  19. Adam R, McMaster P, O'Grady JG, Castaing D, Klempnauer JL, Jamieson N, Neuhaus P, Lerut J, Salizzoni M, Pollard S, Muhlbacher F, Rogiers X, Garcia Valdecasas JC, Berenguer J, Jaeck D, Moreno Gonzalez E (2003). "Evolution of liver transplantation in Europe: report of the European Liver Transplant Registry". Liver Transpl. 9 (12): 1231–43. doi:10.1016/j.lts.2003.09.018. PMID 14625822.
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  21. Reddy S, Zilvetti M, Brockmann J, McLaren A, Friend P (2004). "Liver transplantation from non-heart-beating donors: current status and future prospects". Liver Transpl. 10 (10): 1223–32. doi:10.1002/lt.20268. PMID 15376341.
  22. Martinez OM, Rosen HR (2005). "Basic concepts in transplant immunology". Liver Transpl. 11 (4): 370–81. doi:10.1002/lt.20406. PMID 15776458.
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  26. Perry I, Neuberger J (2005). "Immunosuppression: towards a logical approach in liver transplantation". Clin. Exp. Immunol. 139 (1): 2–10. doi:10.1111/j.1365-2249.2005.02662.x. PMC 1809260. PMID 15606606.
  27. Papadopoulos-Köhn A, Achterfeld A, Paul A, Canbay A, Timm J, Jochum C, Gerken G, Herzer K (2015). "Daily low-dose tacrolimus is a safe and effective immunosuppressive regimen during telaprevir-based triple therapy for hepatitis C virus recurrence after liver transplant". Transplantation. 99 (4): 841–7. doi:10.1097/TP.0000000000000399. PMID 25208324.
  28. Chen XB, Xu MQ (2014). "Primary graft dysfunction after liver transplantation". HBPD INT. 13 (2): 125–37. PMID 24686540.
  29. Liu JH, Yan S, Zheng SS (2014). "[Application of transient elastography in early prognosis after liver transplantation]". Zhejiang Da Xue Xue Bao Yi Xue Ban (in Chinese). 43 (6): 678–82. PMID 25644567.
  30. Lindström L, Jørgensen KK, Boberg KM, Castedal M, Rasmussen A, Rostved AA, Isoniemi H, Bottai M, Bergquist A (2018). "Risk factors and prognosis for recurrent primary sclerosing cholangitis after liver transplantation: a Nordic Multicentre Study". Scand. J. Gastroenterol.: 1–8. doi:10.1080/00365521.2017.1421705. PMID 29301479.
  31. Germani G, Becchetti C (2017). "Liver transplantation for non-alcoholic fatty liver disease". Minerva Gastroenterol Dietol. doi:10.23736/S1121-421X.17.02467-9. PMID 29249127.
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  33. Nadalin S, Capobianco I, Panaro F, Di Francesco F, Troisi R, Sainz-Barriga M, Muiesan P, Königsrainer A, Testa G (2016). "Living donor liver transplantation in Europe". Hepatobiliary Surg Nutr. 5 (2): 159–75. doi:10.3978/j.issn.2304-3881.2015.10.04. PMC 4824742. PMID 27115011.
  34. Brown RS, Russo MW, Lai M, Shiffman ML, Richardson MC, Everhart JE, Hoofnagle JH (2003). "A survey of liver transplantation from living adult donors in the United States". N. Engl. J. Med. 348 (9): 818–25. doi:10.1056/NEJMsa021345. PMID 12606737.
  35. Krahn LE, DiMartini A (2005). "Psychiatric and psychosocial aspects of liver transplantation". Liver Transpl. 11 (10): 1157–68. doi:10.1002/lt.20578. PMID 16184540.
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