Post liver tx complication surgeon role
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Transcript of Post liver tx complication surgeon role
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SURGICAL COMPLCATIONS IN LIVER TRANSPLANTATON
S.VIVEKANANDANHEAD, LIVER TRANSPLANT SURGERY
KMCH, COIMBATORE
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POST OP COMPLICATIONS
IMMEDIATE vs LATE
PEDIATRIC vs ADULT
LDLT vs CADAVERIC
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Immediate post op
Bleeding
Arterial complications
Portal Venous Complications
Hepatic Venous Complications
Biliary Complications
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Bleeding
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Arterial Complications
Hepatic artery thrombosis 4-11%
Hepatic artery stenosis 5-13%
HA Aneuryms 0.3-1.2%
Hepatic artery rupture
Median arcuate ligament syndrome 1.5-10%
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Early Vs Late HAT
EARLY <2%< 30 days
LATE 2-20%>30 days
Transminitis Fever
Bile Leaks Transminitis
Liver Abscess Cholangitis
PNF Liver Abscess
Hepatic Necrosis Biliary Stricture
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Factors affecting HAT
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Arterial complications
Resuscitation
Antibiotics, antifungals
Early HAT – exploration , thrombectomy, revision
IR-Catheter related thrombolysis – bleeding
Re Transplantation
Late HAT – IR – Plasty / Stenting
Retransplantation
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Portal venous complications
Risk factors
Preexisting PVT
Small portal vein
Steal phenomenon
Prior shunt surgery
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PVT – Presentation
Portal hypertension Variceal bleeding Ascitis Thrombocytopenia
Acute graft failure
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PVT - Treatment
Surgical revision
Pharmacological – Portal Flow
Anticoagulation
Shunt surgery
Regular endoscopic surveillance
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Outflow obstruction
Rare but serious problem
1% - 6%
Acute – technique / graft torsion
Chronic – peri anastamotic fibrosis
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Outflow obstruction
Ascitis , congested Liver
Lower limb edema
Hepatic & Renal dysfunction
Investigations – CT, Cavogram- Pressure Studies
Trt – Stenting / plasty
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5-7%
1%-17%
5%-10%
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Treatment
Investigations – CT, MRCP, ERCP
Antibiotics
Antifungals
Controlled Fistula
Bile Recirculation
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Bile Leaks
Bile leaks Depends on volume ERCP- sphincterotomy, stenting Controlled fistula Consequences – infection, HAT/PA, late
strictures
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Anastamotic strictures
Within the first year
Technical issues , mismatch, fibrosis, HAT
Consequences – cholangitis, sepsis
ERCP / Surgery
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Non anastamotic stictures
+ / - HAT
Ischemic and necrotic biliary tree
NHBD/> CIT
High mortality
Needs a Re transplant
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Summary
A high degree of suspicion is required
Prevention is better – avoid technical errors
Interventional Radiology plays a major role these days
Multi Disciplinary team approach is required
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Bile Duct Reconstruction
Duct to duct – preferred , no reflux, anatomical,
Roux – en-Y Hep J Insufficient length Ischemic duct PSC Pediatric Multiple ducts ( LDLT)
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