Acute liver failure surgery: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Acute liver failure}} | {{Acute liver failure}} | ||
{{CMG}} | {{CMG}} {{AE}} {{ADI}} {{HS}} | ||
==Overview== | ==Overview== | ||
The candidates for liver transplantation should be identified as quickly as possible because the progression to multiorgan failure results in deterioration in many patients who are awaiting liver transplantation. While many people who develop acute liver failure recover with supportive treatment, liver transplantation is often required in people who continue to deteriorate or have poor prognostic factors. The patient's candidacy for liver transplantation should be assessed based on the patient's clinical scenario, as well as upon social and financial factors. Patient evaluation for liver transplantation should be done as soon as possible and before [[encephalopathy]] occurs. The key common feature among various prognostic evaluation systems is the presence of [[encephalopathy]]. Other common features are patient's age and severity of the liver injury which is assessed by [[coagulopathy]] or [[jaundice]]. To address the limitations, a wide variety of prognostic systems have been proposed but none has universal acceptance. King's college criteria is the most well-characterized evaluation system. Common absolute contraindications for liver transplantation include untreated [[sepsis]], uncontrolled extra-hepatobiliary infection, [[alcohol]] abuse, uncontrolled cardiopulmonary disease, [[cholangiocarcinoma]], metastatic malignancy to the liver and life-threatening systemic illness. Common postoperative complications for liver transplantation include infections, graft failure, vascular compromise, biliary stricture or stenosis, anastomosis leakage, [[thrombosis]] of [[hepatic artery]] and [[portal vein]] and depression. | |||
==Liver Transplantation== | |||
* | * The candidates for liver transplantation should be identified as quickly as possible because the progression of multiorgan failure results in deterioration in many patients who are awaiting liver transplantation.<ref name="pmid18825677">{{cite journal| author=Ichai P, Samuel D| title=Etiology and prognosis of fulminant hepatitis in adults. | journal=Liver Transpl | year= 2008 | volume= 14 Suppl 2 | issue= | pages= S67-79 | pmid=18825677 | doi=10.1002/lt.21612 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18825677 }} </ref><ref name="pmid22106945">{{cite journal| author=Craig DG, Bates CM, Davidson JS, Martin KG, Hayes PC, Simpson KJ| title=Staggered overdose pattern and delay to hospital presentation are associated with adverse outcomes following paracetamol-induced hepatotoxicity. | journal=Br J Clin Pharmacol | year= 2012 | volume= 73 | issue= 2 | pages= 285-94 | pmid=22106945 | doi=10.1111/j.1365-2125.2011.04067.x | pmc=3269587 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22106945 }} </ref> | ||
* While many people who develop acute liver failure recover with supportive treatment, [[liver transplant]]ation is often required in people who continue to deteriorate or have poor [[Prognosis|prognostic]] factors. | |||
*The patient's candidacy for liver transplantation should be assessed based on the patient's clinical scenario, as well as upon social and financial factors. Patient evaluation for liver transplantation should be done as soon as possible and before [[encephalopathy]] occurs.<ref name="pmid12484709">{{cite journal |author=Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH, McCashland TM, Shakil AO, Hay JE, Hynan L, Crippin JS, Blei AT, Samuel G, Reisch J, Lee WM |title=Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States |journal=[[Annals of Internal Medicine]] |volume=137 |issue=12 |pages=947–54 |year=2002 |month=December |pmid=12484709 |doi= |url=http://www.annals.org/article.aspx?volume=137&page=947 |accessdate=2012-10-26}}</ref> | |||
=== | * The key common feature among various prognostic evaluation systems is the presence of encephalopathy. Other common features are patient's age and severity of the liver injury which is assessed by coagulopathy or jaundice. To address the limitations, a wide variety of prognostic systems have been proposed but none has universal acceptance. King's college criteria is the most well-characterized evaluation system.{{cite journal |vauthors=Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH, McCashland TM, Shakil AO, Hay JE, Hynan L, Crippin JS, Blei AT, Samuel G, Reisch J, Lee WM |title=Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States |journal=Ann. Intern. Med. |volume=137 |issue=12 |pages=947–54 |year=2002 |pmid=12484709 |doi= |url=}} | ||
===King's College Criteria=== | |||
* The King’s College criteria are from O’Grady et al. The criteria were stratified into acetaminophen and non-acetaminophen causes of acute liver failure, due to the different mechanisms of damage correlating with prognosis in each of the causes. | |||
{|style="padding:0.3em; float:center; margin-left:5px;border:1px solid #ffa508;" | {| style="padding:0.3em; float:center; margin-left:5px;border:1px solid #ffa508;" | ||
|-style="background-color:#FFE4E1; align:center | |- style="background-color:#FFE4E1; align:center; text-align: center" | ||
|'''King's College Hospital | |'''King's College Hospital Criteria''' <br /> | ||
'''for | '''for Liver Transplantation in Acute Liver Failure<ref>{{cite journal |author=O'Grady JG, Alexander GJ, Hayllar KM, Williams R |title=Early indicators of prognosis in fulminant hepatic failure |journal=Gastroenterology |volume=97 |issue=2 |pages=439-45 |year=1989 |pmid=2490426 |doi=}}</ref>''' | ||
|- | |- | ||
|''' | |'''Acute Liver Failure with Acetaminophen Toxicity'''<br /> | ||
pH <7.3 or<br /> | *pH <7.3 or<br /> | ||
[[Prothrombin time]] >100 seconds and<br /> [[ | *[[Prothrombin time]] >100 seconds and<br /> [[Serum creatinine]] level >3.4 mg/dL (>300 μmol/l)<br /> | ||
*Grade III or IV [[hepatic encephalopathy|encephalopathy]] | |||
|- | |- | ||
|''' | |'''Acute Liver Failure without Acetaminophen Toxicity'''<br /> | ||
Prothrombin time >100 seconds or <br /> | Prothrombin time >100 seconds or <br /> | ||
''Three of the following variables'':<br /> | ''Three of the following variables'':<br /> | ||
*Age <10 yr or >40 yr | *Age <10 yr or >40 yr | ||
*Cause: | *Cause: | ||
** | ** Non-A, non-B hepatitis | ||
** [[ | ** [[Halothane]] hepatitis | ||
** | ** Idiosyncratic drug reaction | ||
*Duration of jaundice before encephalopathy >7 days | *Duration of jaundice before encephalopathy >7 days | ||
* | *Prothrombin time >50 seconds | ||
*Serum [[bilirubin]] level >17.6 mg/dL (>300 μmol/l) | *Serum [[bilirubin]] level >17.6 mg/dL (>300 μmol/l) | ||
|} | |} | ||
=== | ===Absolute contraindications for liver transplantation=== | ||
*Untreated sepsis | |||
*Uncontrolled extrahepatobillary infection | |||
*Alcohol abuse | |||
*Uncontrolled cardiopulmonary disease | |||
*Cholangiocarcinoma | |||
*Metastatic malignancy to the liver | |||
*Life-threatening systemic illness | |||
===Relative contraindications for liver transplantation=== | |||
*Age >70 | |||
*Uncontrolled psychiatric disorder | |||
*Intrahepatic sepsis | |||
*HIV seropositivity with failure to control HIV viremia or CD4 <100/μL | |||
*Severe malnutrition/wasting | |||
*Portal vein thrombosis | |||
*Renal failure not attributable to liver disease | |||
*Severe hypoxemia secondary to right-to-left intrapulmonary shunts (Po2 <50 mmHg) | |||
===Common complications for liver transplantation=== | |||
*Infections | |||
**Bacterial: early, common postoperative infections | |||
**Fungal/parasitic: late, opportunistic infections | |||
**Viral: late, opportunistic infections, recurrent hepatitis | |||
**Infections from donor | |||
*Primary graft failure | |||
*vascular compromise | |||
*stricture, stenosis or leakage of the biliary anastomoses | |||
*Recurrence of primary hepatic disorder | |||
*Ischemic injury during harvesting | |||
*Portal vein obstruction | |||
*Hepatic artery thrombosis | |||
*Difficult psychosocial adjustment | |||
*Depression | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Hepatology]] | |||
[[Category:Gastroenterology]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 21:24, 18 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Husnain Shaukat, M.D [3]
Overview
The candidates for liver transplantation should be identified as quickly as possible because the progression to multiorgan failure results in deterioration in many patients who are awaiting liver transplantation. While many people who develop acute liver failure recover with supportive treatment, liver transplantation is often required in people who continue to deteriorate or have poor prognostic factors. The patient's candidacy for liver transplantation should be assessed based on the patient's clinical scenario, as well as upon social and financial factors. Patient evaluation for liver transplantation should be done as soon as possible and before encephalopathy occurs. The key common feature among various prognostic evaluation systems is the presence of encephalopathy. Other common features are patient's age and severity of the liver injury which is assessed by coagulopathy or jaundice. To address the limitations, a wide variety of prognostic systems have been proposed but none has universal acceptance. King's college criteria is the most well-characterized evaluation system. Common absolute contraindications for liver transplantation include untreated sepsis, uncontrolled extra-hepatobiliary infection, alcohol abuse, uncontrolled cardiopulmonary disease, cholangiocarcinoma, metastatic malignancy to the liver and life-threatening systemic illness. Common postoperative complications for liver transplantation include infections, graft failure, vascular compromise, biliary stricture or stenosis, anastomosis leakage, thrombosis of hepatic artery and portal vein and depression.
Liver Transplantation
- The candidates for liver transplantation should be identified as quickly as possible because the progression of multiorgan failure results in deterioration in many patients who are awaiting liver transplantation.[1][2]
- While many people who develop acute liver failure recover with supportive treatment, liver transplantation is often required in people who continue to deteriorate or have poor prognostic factors.
- The patient's candidacy for liver transplantation should be assessed based on the patient's clinical scenario, as well as upon social and financial factors. Patient evaluation for liver transplantation should be done as soon as possible and before encephalopathy occurs.[3]
- The key common feature among various prognostic evaluation systems is the presence of encephalopathy. Other common features are patient's age and severity of the liver injury which is assessed by coagulopathy or jaundice. To address the limitations, a wide variety of prognostic systems have been proposed but none has universal acceptance. King's college criteria is the most well-characterized evaluation system.Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH, McCashland TM, Shakil AO, Hay JE, Hynan L, Crippin JS, Blei AT, Samuel G, Reisch J, Lee WM (2002). "Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States". Ann. Intern. Med. 137 (12): 947–54. PMID 12484709.
King's College Criteria
- The King’s College criteria are from O’Grady et al. The criteria were stratified into acetaminophen and non-acetaminophen causes of acute liver failure, due to the different mechanisms of damage correlating with prognosis in each of the causes.
| King's College Hospital Criteria for Liver Transplantation in Acute Liver Failure[4] |
Acute Liver Failure with Acetaminophen Toxicity
|
| Acute Liver Failure without Acetaminophen Toxicity Prothrombin time >100 seconds or |
Absolute contraindications for liver transplantation
- Untreated sepsis
- Uncontrolled extrahepatobillary infection
- Alcohol abuse
- Uncontrolled cardiopulmonary disease
- Cholangiocarcinoma
- Metastatic malignancy to the liver
- Life-threatening systemic illness
Relative contraindications for liver transplantation
- Age >70
- Uncontrolled psychiatric disorder
- Intrahepatic sepsis
- HIV seropositivity with failure to control HIV viremia or CD4 <100/μL
- Severe malnutrition/wasting
- Portal vein thrombosis
- Renal failure not attributable to liver disease
- Severe hypoxemia secondary to right-to-left intrapulmonary shunts (Po2 <50 mmHg)
Common complications for liver transplantation
- Infections
- Bacterial: early, common postoperative infections
- Fungal/parasitic: late, opportunistic infections
- Viral: late, opportunistic infections, recurrent hepatitis
- Infections from donor
- Primary graft failure
- vascular compromise
- stricture, stenosis or leakage of the biliary anastomoses
- Recurrence of primary hepatic disorder
- Ischemic injury during harvesting
- Portal vein obstruction
- Hepatic artery thrombosis
- Difficult psychosocial adjustment
- Depression
References
- ↑ Ichai P, Samuel D (2008). "Etiology and prognosis of fulminant hepatitis in adults". Liver Transpl. 14 Suppl 2: S67–79. doi:10.1002/lt.21612. PMID 18825677.
- ↑ Craig DG, Bates CM, Davidson JS, Martin KG, Hayes PC, Simpson KJ (2012). "Staggered overdose pattern and delay to hospital presentation are associated with adverse outcomes following paracetamol-induced hepatotoxicity". Br J Clin Pharmacol. 73 (2): 285–94. doi:10.1111/j.1365-2125.2011.04067.x. PMC 3269587. PMID 22106945.
- ↑ Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH, McCashland TM, Shakil AO, Hay JE, Hynan L, Crippin JS, Blei AT, Samuel G, Reisch J, Lee WM (2002). "Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States". Annals of Internal Medicine. 137 (12): 947–54. PMID 12484709. Retrieved 2012-10-26. Unknown parameter
|month=ignored (help) - ↑ O'Grady JG, Alexander GJ, Hayllar KM, Williams R (1989). "Early indicators of prognosis in fulminant hepatic failure". Gastroenterology. 97 (2): 439–45. PMID 2490426.