• Extrahepatobiliary malignancy (not including nonmelanoma skin cancer)Q
• Metastatic malignancy to the liverQ
Relative contraindication of liver transplant?
• Age >70 yearsQ
• Prior extensive hepatobiliary surgeryQ
• Portal vein thrombosisQ
• Severe hypoxemia secondary to right-to-left intrapulmonary shunts (PO2<50 mmHg)Q
• Severe pulmonary hypertension (mean pulmonary artery pressure >35 mmHg)Q
What is Orthotopic liver transplant?
Donor liver implanted in normal anatomic position after recipient hepatectomyQ
What is Heterotopic Liver Transplant?
Donor liver implanted in alternative site rather than normal anatomic positionQ
What is Auxiliary Liver transplant?
• Native liver remains in situ and whole or partial transplant addedQ
What is Piggyback Liver transplant?
• Orthotopic transplant that preserves recipient IVCQ
What is Split Liver transplant?
• Cadaveric donor liver divided with a portion transplanted to each of two recipientsQ
What is Reduced size Liver transplant?
• Liver can be reduced to a functional unit of appropriate size for the recipientQ
What is Auxiliary partial orthotopic LT (APOLT)?
• Left lobe of recipient liver excised and donor liver occupies vacated spaceQ.
What is Auxiliary heterotopic Liver transplant?
• Whole liver or lobe placed in subhepatic space or other nonadjacent areaQ.
What are the Indications ofAuxiliary Partial Orthotopic Liver Transplantation (APOLT)?
1. Reversible fulminant hepatic failureQ
2. Small-for-size graftsQ
4. Non-cirrhotic metabolic liver diseaseQ
Methods of bile duct anastomosis in orthotropic liver transplantation?
Choledochocholedochostomy (CDCD) - end-to-end anastomosis between donor common bile duct and recipient common bile duct. This is preferred bile duct anastomosis and is used when the recipient bile duct not diseased.
Choledochojejunostomy (CDJ) - This is an alternative bile duct anastomosis and is performed when CDCD anastomosis is not feasible. This may be the case when the recipient extrahepatic bile duct is diseased or small or when there is significant recipient donor duct size mismatch.