CCTC CERTIFICATION REVIEW

CCTC CERTIFICATION REVIEW Absolute Contraindications for liver transplant - Severe cardiopulmonary disease, uncontrolled HIV, poorly controlled Psych illness, noncompliance, anatomical abnormalities precluding adequate surgical reconstruction Reason for not accepted for liver TX - Hepatocellular Carcinoma (HCC) outside Milan Criteria What is NAFLD? - Nonalcoholic Fatty Liver Disease- caused by obesity, hyperglycemia, elevated serum lipids, and high BP What is NASH? - Non-alcoholic steatohepatitis. Can lead to cirrhosis 3rd common indication for liver TX. What is the MELD score? - MELD(Model for End Stage Liver Disease) is a predictive model of death within a 3 month period. Ranks your degree of sickness, shows how much you need a liver transplant. The higher the number, the more urgent case is. Score ranges from 6-40. *Score for HCC capped at 34. Calculated using: -INR -Bilirubin -Creatinine -Sodium MELD > 14 needed for liver transplant What can green drainage post liver TX indicate? - Bile leakage What can a rise in ALP post liver tx indicate? - Can be a sign of biliary complications or cholestasis Lab changes are indicate of graft dysfunction. Which values will be elevated for liver tx? - Elevated AST and ALT Target levels for immunosuppressants are based on a number of factors including: - Indication for tx, use of induction therapy, kidney function, overall condition of pt. What can lead to metabolic encephalopathy post liver transplant? - Renal failure or sepsis What can lead to hypoxic ischemic encephalopathy post liver transplant? - Significant peri- operative hypotension De Novo seizures can occur post liver transplant and can be caused by what? - Electrolyte imbalances, reaction to cyclosporine or tacrolimus, intracranial hemorrhage or cerebral infarction and intracerebral abscesses What can cause a post liver transplant patient whose initial postop neurological course is normal to develop sudden deterioration in neurological status? - Intracranial bleed Risk of primary non-function after liver transplant is: - 4-6% Factors related to primary nonfunction of new liver include: - Donor age, prolonged cold ischemic time, prolonged donor hospital stay with periods of hypotension, preservation injury during donor surgery, and donor steatosis(fat in liver) Early Indicators of non functioning liver: - decrease in bile production extreme edema of organ Abnormal color of organ upon reperfusion(mottled, gray, pale) lack of reperfusion in OR urine output <30ml/hr hemodynamically unstable