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Liver Transplantation - part 3

Dạ dày variceal cổ trướng tái phát xuất huyết chịu nhiệt tự phát vi khuẩn viêm phúc mạc gan nặng bệnh não gan thận hội chứng sâu sắc không đáp ứng ngứa gan ứ bệnh gan nặng tăng tế bào gan xương Progressive ung thư trong huyết thanh | Assessment for Liver Transplantation 19 aspartate transaminase and a history of variceal hemorrhage have been constructed into a prognostic instrument. Although the allocation priority scheme in the United States does not incorporate prognostic scoring schemes specific to either primary biliary cirrhosis or primary sclerosing cholangitis these scoring schemes allow transplant physicians to recognize patients with poor prognosis. 3 Table 2. Indications for consideration of liver transplantation in patients with chronic liver disease Recurrent gastroesophageal variceal hemorrhage Refractory ascites Spontaneous bacterial peritonitis Severe hepatic encephalopathy Hepatorenal syndrome Profound non-responsive pruritus of cholestatic liver disease Severe hepatic osteopathy Hepatocellular carcinoma Progressive rise in serum alpha-fetoprotein without mass Refractory bacterial cholangitis Severe coagulopathy due to liver failure Severe sustained fatigue and weakness Severe malnutrition Hepatopulmonary syndrome Timing of Placement on the Waiting List A useful approach to the often difficult questions regarding timing of placement of a patient with liver disease on the transplant waiting list is to consider compensated or stable and decompensated cirrhosis. Stable cirrhosis is defined as cirrhosis in a patient who has never experienced any one of the four cardinal features of decompensation variceal hemorrhage accumulation of ascites jaundice associated with cirrhosis or encephalopathy. Decompensated cirrhosis cirrhosis and the onset of at least one of these clinical phenomena is defined as decompensated cirrhosis. The onset of decompensation is associated with significantly impaired survival and indicates the need to evaluate for liver transplantation. Spontaneous bacterial peritonitis and or hepatorenal failure are indicators of significantly worsened prognosis and should prompt transplantation evaluation. Indications for evaluation of liver transplantation are shown in .