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Surgical Questions on liver
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Types of Transplant Rejection
Hyperacute rejection
Occurs within minutes after the transplanted organ is reperfused
There are preformed antibodies in the recipient directed against the HLA antigens or anti ABO blood groups
This type of rejection is generally not reversible.
Accelerated Acute Rejection
Involves both cellular and antibody-mediated injury.
Seen with in the first few days posttransplant
Acute rejection
It is seen within days to a few months posttransplant. It is predominantly a cell-mediated process. B cells may also be involved.
Chronic rejection
Histologically, the process is characterized by atrophy, fibrosis, and arteriosclerosis. Both immune and nonimmune mechanisms are likely involved. Clinically, graft function slowly deteriorates over months to years.
Organ Preservation Two major methods used to preserve the organs are
1. Hypothermia -- A temperature decrease from 37°C to 4°C (the temperature of most preservation solutions) slows metabolism about 12-fold. It also leads to cell swelling and accumulation of detrimental end products.
Cold storage solutions have therefore been developed to preserve the organs. They prevent cellular swelling and are composed of Low sodium and High Potassium.
The most commonly used fluid worldwide is the University of Wisconsin (UW) solution containing lactobionate, raffinose, and hydroxyethyl starch.
Comparison of cold ischaemia time for various organs
Organ Acceptable time
Kidney 36-40 hours
Pancreas 24 hours
Liver 16 hours
Heart and Lung 6 hours
2. Pharmacological interventions
Special Tests and workup
- Complete cardiovascular work up
- Pulmonary Workup
- metabolic workup for diabetes, hypercholesterolemia
- Ultrasound for cholelithiasis, Ventral hernia
- Evaluation for Gastroesophageal reflux diseases
Notes on liver transplant
