Liver Transplantation: Clinical Assessment and Management

Description

Cover Title Page Copyright Page Contents List of Contributors Foreword to the Second Edition Foreword to the First Edition Preface Abbreviations Part 1 When to Refer a Patient for Liver Transplantation CHAPTER 1 Overview on Organ Donation and Liver Transplantation The global burden of liver disease What causes death in patients with liver disease? A global perspective on liver transplantation The donor organ What is the goal of liver transplantation? Life after transplantation Further reading CHAPTER 2 Predicting Outcomes and Use and Abuse of Prognostic Models Background of liver allocation in the United States The MELD score for liver allocation United Kingdom Model for End-Stage Liver Disease score Acute-on-chronic liver failure Future directions Further reading Part 2 Selection, Assessment, and Management on the List CHAPTER 3 Assessment of the Potential Transplant Recipient Criteria Process References CHAPTER 4 Frailty and the Potential Liver Transplant Candidate Definition of physical frailty Causes of physical frailty Measurement of physical frailty Further reading CHAPTER 5 Alcohol Use (excluding Alcohol-Related Liver Disease), Tobacco, Marijuana, and Illicit Drugs Alcohol Tobacco Cannabis (marijuana) Opioids Other substances Further reading CHAPTER 6 The Role of the Psychiatric Consultant in the Selection, Assessment, and Management of Liver Transplant Patients Role of the transplant psychiatrist in transplant evaluation Transplant psychiatric evaluation Mistaken beliefs about transplant psychiatry Motivational interviewing Psychosocial assessment Collateral history Psychiatric contraindications for liver transplant Treatment of psychiatric disorders in patients before or after liver transplantation Role of the transplant psychiatrist in the perioperative period Special considerations Further reading CHAPTER 7 When Liver Transplant Patients Do Not Adhere to Therapeutic Plans Understanding non-compliance Liver disease and non-compliance What should you do when one of your patients does not adhere to the therapeutic plan? Further Reading CHAPTER 8 Liver Transplant Assessment for Young People: Addressing the Needs of Young People with Liver Disease Adolescent development Indications for liver transplantation in young people, including childhood liver diseases Timing of listing for liver transplantation and listing criteria Liver transplant assessment in young people with liver disease Conclusion Further reading CHAPTER 9 Assessment and Management of the Patient with Hepatitis C Screening for chronic hepatitis C virus infection Pre-therapeutic assessment Indications for hepatitis C virus treatment Further reading CHAPTER 10 Management of Hepatitis B Virus Infection Pre Transplantation Management of end-stage hepatitis B virus liver disease Conclusion Further reading CHAPTER 11 Transplantation for the Management of Malignancy Liver transplantation and hepatocellular carcinoma Liver transplantation and cholangiocarcinoma Liver transplantation for treatment of uncommon hepatic malignancies Further reading CHAPTER 12 Assessment and Management of the Liver Transplant Candidate with Acute-on-Chronic Liver Failure Definition, diagnostic criteria, and ACLF grades Epidemiology, health burden, and mortality Precipitating illness Clinical course Prognostic score Management and futility of intensive care support Liver transplantation References CHAPTER 13 Assessment and Management of the Transplant Candidate with Alcohol-Associated Liver Disease Clinical pre-transplant evaluation of patients with alcohol-related liver disease Pre-transplant evaluation of addiction in patients with alcohol-related liver disease Alcoholic hepatitis as an emerging indication for liver transplantation A team decision: an ethical perspective Further reading CHAPTER 14 Non-alcoholic Fatty Liver Disease as an Indication for Liver Transplantation Epidemiology and indication for liver transplantation in non-alcoholic fatty liver disease and non-alcoholic steatohepatitis Obstacles to the diagnosis of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in end-stage liver disease Special considerations prior to liver transplantation in patients with non-alcoholic fatty liver disease Obesity and nutrition Diabetes mellitus Cardiovascular disease Further reading CHAPTER 15 Consent The principles of consent Consent and transplantation Timing of consent What information should be given to the prospective transplant recipient? What is risk and what should be discussed? Explaining risk Research Further reading CHAPTER 16 Prehabilitation and General Management Nutrition Exercise Lifestyle and optimization of non-liver co-morbidities Psychologic support Preventing complications of end-stage liver disorder Further reading CHAPTER 17 Removal of Patients from the Liver Transplant Waiting List Hepatocellular carcinoma Hepatopulmonary syndrome Alcohol-related liver disease Hepatitis C Cumulative co-morbidity Further reading CHAPTER 18 Palliative Care and Liver Transplantation What is palliative care? Benefits of palliative care in advanced liver disease Attitudes and barriers to palliative care Palliative care and liver transplantation Special palliative care scenarios in liver transplantation Conclusion Further reading Part 3 Transplantation for Acute Liver Failure CHAPTER 19 Assessment of the Patient with Acute Liver Failure Prognosis and patient selection Proceed to liver transplantation after organ allocation? Graft allocation Auxiliary liver transplantation Further reading CHAPTER 20 Management of the Patient with Fulminant Hepatic Failure Awaiting Liver Transplantation General management Maintenance of hemodynamic stability Infection Bleeding Assessment of bleeding risk Renal function and renal replacement therapy Intracranial hypertension and cerebral edema Intracerebral pressure monitoring bolts Jugular venous bulb oxygen saturation Seizures Management of intracranial pressure and ischemia General management of patients with cerebral edema Removal from the waiting list Other measures Further reading Part 4 Donation and Allocation CHAPTER 21 Ethical and Legal Aspects of Organ Donation Legal issues in organ donation Autonomy and organ donation Beneficence and non-maleficence Deceased from circulatory death donors Hepatitis C–positive organ transplant in hepatitis C–negative patients Increased-risk organs Conclusion Further reading CHAPTER 22 Liver Allocation, Including Principles of Organ Allocation Current liver donor organ allocation and distribution system Current liver organ allocation Conclusion Further reading CHAPTER 23 Living Donor Liver Transplant in Children Historical background Importance of living donor liver transplantation in pediatrics Indications for living donor liver transplantation in children Living donor liver transplant for metabolic diseases Advantages of living donor liver transplantation in children Evaluation of the potential living donor Special considerations in the pediatric recipient of living donor liver transplant Choice of graft The surgical approach Patient survival/graft survival after living donor liver transplantation in children Considerations and potential complications related to the living donor Conclusion Further reading CHAPTER 24 Living Liver Donation in Adults History Need for living donor liver transplantation Ethical considerations Donor evaluation Donor evaluation algorithm Living donor liver transplant recipient evaluation Advances in living donor liver transplantation Conclusion Further reading CHAPTER 25 Deceased Liver Donors: Standard and Expanded Criteria A metric of donor quality: the donor risk index Donor and graft factors that pose increased risk of graft failure Further reading CHAPTER 26 Donor-Transmitted Disease Donor-transmitted cancer after liver transplantation Donor-transmitted infections Donor-transmitted metabolic disease Other donor-transmitted diseases Further reading CHAPTER 27 Liver Donation and Preservation Deceased organ donation system in the UK Donation after brain death Donation after circulatory death Organization of organ procurement in the UK Donor liver selection and evaluation Contraindications to organ donation Abdominal multi-organ retrieval and liver evaluation Organ preservation and machine perfusion Conclusion Further reading CHAPTER 28 Liver Retrieval and Preservation Multi-organ retrieval from donation after brain death donors Liver retrieval from deceased after circulatory death donors Liver preservation Further reading CHAPTER 29 Alternatives to Whole Graft Liver Transplantation Acute liver failure Heterotopic or orthotopic? This is the question Technical aspects of auxiliary partial orthoptic liver transplantation in acute liver failure Postoperative management Donor and recipient selection Auxiliary partial orthoptic liver transplantation for monogenic diseases Domino and cross-domino auxiliary liver transplantation Auxiliary liver transplantation in transplant oncology Further reading CHAPTER 30 Surgical Aspects of Deceased Donor Transplantation Preoperative workup Surgical technique Implantation technique Future horizons Further reading Part 5 Care of the Liver Transplant Recipient CHAPTER 31 Outcomes after Liver Transplantation Survival after transplantation Factors affecting outcome Reasons why survival is limited Other outcomes after transplantation Further reading CHAPTER 32 Outpatient Follow-Up of Liver Transplant Recipients Complications post liver transplant Immunosuppression post liver transplant Prophylaxis post liver transplant Cardiovascular risk and management post liver transplant Renal dysfunction post liver transplant Bone disease post liver transplant Disease recurrence post liver transplant Malignancies post liver transplant Pregnancy post liver transplant Immunization post liver transplant Proposed clinic follow-up post liver transplant and checklist Further reading CHAPTER 33 Medication Adherence Defining medication adherence Measuring adherence Risk factors for non-adherence Interventions targeting adherence Conclusion Further reading CHAPTER 34 Transitional Care What is transition and why do we do it? Principles of transition Preparation for transition Transfer of care Further reading CHAPTER 35 Managing the Liver Transplant Recipient with Abnormal Liver Blood Tests Interpretation of abnormal liver blood tests in the liver transplant recipient Differential diagnosis in the liver transplant recipient with abnormal liver blood tests Investigation of the liver transplant recipient with abnormal liver blood tests Management of specific graft-related causes of abnormal liver blood tests in the liver transplant recipient Further reading CHAPTER 36 The Immune System in Liver Transplantation: Rejection versus Tolerance Molecular mechanisms of leucocyte recruitment Antigen presentation and allorecognition T-cell activation T-cell differentiation Natural mechanisms responsible for the induction and maintenance of tolerance The liver as a tolerogenic organ: balancing immune tolerance and immune response Tolerogenic properties of liver transplants Potential barriers to developing tolerance and the immunobiology of rejection Spontaneous operational tolerance Further reading CHAPTER 37 Immunosuppressive Medications: Liver Transplantation Induction Maintenance Conclusion Further reading CHAPTER 38 Immunosuppression in Liver Transplantation Common regimens Dose of immunosuppressive agents Calcineurin inhibitors Mycophenolate mTOR inhibitors Azathioprine Corticosteroids Drug–drug interactions Disease-specific regimens Tolerance Conclusion Further reading CHAPTER 39 Patterns of Liver Allograft Rejection Pattern 1: acute T-cell–mediated rejection Pattern 2: late acute T-cell–mediated rejection Pattern 3: plasma cell hepatitis/plasma cell–rich allograft rejection Pattern 4: acute antibody-mediated rejection Pattern 5: chronic allograft rejection Pattern 6: idiopathic chronic hepatitis Pattern 7: operational tolerance Further reading CHAPTER 40 De Novo Autoimmune Hepatitis Epidemiology Diagnosis Risk factors for development of de novo autoimmune hepatitis Pathogenesis Treatment Further reading CHAPTER 41 Managing Rejection Definitions T-cell–mediated rejection Antibody-mediated rejection Chronic rejection Special cases and diagnostic challenges CHAPTER 42 Withdrawal of Immunosuppression after Liver Transplantation Tolerogenic features of the liver and first trials of immunosuppression withdrawal Definition of operational tolerance Immunosuppression withdrawal in clinical practice Conclusion Further reading CHAPTER 43 Liver Transplant Pathology Scope of liver transplant pathology Assessment of the native liver Assessment of pre-implantation donor tissue Assessment of post-implantation liver: the “time zero” allograft biopsy Liver allograft biopsy Further reading CHAPTER 44 Care of the Liver Transplant Recipient: Management of Renal Function Definitions of acute kidney injury and chronic kidney disease Renal dysfunction in liver transplant candidates and post-transplant consequences Renal dysfunction in liver transplant recipients Prevention and management of renal dysfunction in liver transplant recipients Conclusion Further reading CHAPTER 45 Managing Cardiovascular Risk in the Liver Transplant Recipient Magnitude of the problem Management of cardiovascular risk factors in the liver transplant recipient Conclusions Further reading CHAPTER 46 Bone Disease in Liver Transplantation Prevalence Pathogenesis of bone disease in liver transplantation Glucocorticoids Other immunosuppressive agents Pre-existing bone disease Other factors Diagnostic assessment Management of bone disease in liver transplantation Conclusion Further reading CHAPTER 47 Diagnosis and Management of Recurrent Autoimmune Liver Disease Recurrence of autoimmune hepatitis Recurrence of primary biliary cholangitis Recurrence of primary sclerosing cholangitis De novo autoimmune hepatitis/plasma cell–rich rejection Conclusion Further reading CHAPTER 48 NAFLD and NASH in the Patient after Liver Transplantation Recurrent and de novo non-alcoholic fatty liver disease and non-alcoholic steatohepatitis after liver transplantation Risk factors for non-alcoholic fatty liver disease and non-alcoholic steatohepatitis after liver transplantation Diagnosis of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the transplant recipient Management of non-alcoholic steatohepatitis after liver transplantation Further reading CHAPTER 49 Recurrent Metabolic Diseases Amyloid Porphyria Cholestasis Hemochromatosis Propionic acidemia Lysosomal acid lipase deficiency Further reading CHAPTER 50 Treatment of Hepatitis C in the Transplant Setting Natural history of untreated hepatitis C in the graft Prevention of recurrent hepatitis C Treatment of recurrent hepatitis C virus infection Transplantation of livers from hepatitis C virus-positive donors Further reading CHAPTER 51 Management of Hepatitis B Virus Infection Post Transplantation Diagnosis, mechanisms and risk factors for hepatitis B virus recurrence after liver transplantation Prevention of hepatitis B virus recurrence Use of liver grafts from anti-HBc-positive donors Management of hepatitis B virus infection post transplantation Conclusion Further reading CHAPTER 52 Antimicrobial Prophylaxis Following Liver Transplantation Bacterial infections Fungal infections Tuberculosis Antiviral prophylaxis Vaccination Conclusion Further reading CHAPTER 53 Cytomegalovirus and the Liver Transplant Recipient The virus Cytomegalovirus and liver transplantation Definitions Direct effects of cytomegalovirus Indirect effects of cytomegalovirus Diagnosis Preventing cytomegalovirus disease Treating cytomegalovirus disease Cytomegalovirus resistance Further reading CHAPTER 54 Post-Liver Transplant Infections Hepatitis E virus Epstein–Barr virus and post-transplant lymphoproliferative disorder Varicella zoster virus Herpes simplex virus Human adenovirus infection Human immunodeficiency virus Tuberculosis Selected fungal infections Further reading CHAPTER 55 De Novo Malignancies after Liver Transplantation De novo malignancy is increased in liver transplant recipients Impact of immunosuppression on post-transplant malignancy Screening post-transplant patients for de novo malignancy Interventions to reduce the risk of de novo malignancy in liver transplant recipients Conclusion Further reading CHAPTER 56 Post-Transplant Lymphoproliferative Disorders Background Risk factors Clinical presentation Diagnosis Prognosis Re-transplantation Further reading CHAPTER 57 Quality of Life and Employment after Liver Transplantation What is quality of life? Variables that influence quality of life Pediatric patients Employment after liver transplantation Conclusion Further reading CHAPTER 58 Sexual Function, Fertility, and Pregnancy in Liver Disease and after Liver Transplantation Overview Sexual function after liver transplantation Male recipients Female recipients Further reading CHAPTER 59 Common Drug Interactions Tacrolimus, ciclosporin, and sirolimus Tacrolimus Ciclosporin Azathioprine Mycophenolate Corticosteroids Further reading CHAPTER 60 Immunization and Liver Transplantation General principles Liver transplant candidates Liver transplant recipients Healthcare workers and close contacts Further reading Postscript Index EULA