Question

How do we improve post-transplant Liver survival? What do we look for on ultrasound? What are the complication? Which one is the most serious complication?

Answer 1

Post liver transplantation survival

1)It depends on many factors like selection and optimisation of candidates, preservation of organ ,Donor selection postoperative care immunosuppression and management of recurrent disease and complicati on.

2) Infections like hepatitis B and Hepatitis C virus can occur and prophylaxis have to be given to prevent these viral illnesses. Antiviral agents like tenofovir and entecavir for hepatitis B. has increased the survival.

3) Nowadays post transplant recurrence of nonalcoholic steatohepatitis(NASH) is an emerging issue .there is no specific treatment as for NASH.Lifestyle changes have to be made .

4) Tobacco use along with metabolic syndrome is a predisposing factor for cardiovascular diseases post-transplant so, stopping the smoking is strongly recommended.

5) Long term immunosuppression also predisposes the patient to malignancy so minimising immunosuppression is also recommended tacrolimus is a risk factor for denovo solid cancer. M tor inhibitors are alternatives for calcineurin inhibitors to prevent rejection after transplantation and M tor inhibitors also have anti tumoral properties. So this way we can improve the post survival survival of the patients.

What to look on USG ?

In the post transplant USG, we have to look for the complications following transplantation like
1)chronic vanishing duct syndrome,
2)reappearance of any malignancy or de novo malignancies
3)post transplant lymphoproliferative disorder
4)vascular complications like hepatic artery thrombosis which is better seen by doppler USG.

Complications following liver transplant.

1)Rejection is a complication
hyperacute rejection is not seen
acute rejection is seen within 6 months and presents as liver failure.
chronic rejection is manifested as vanishing duct syndrome

2)Infections with hepatitis B and C virus can also occur . Infection may be also due to reinfection following immunosuppression.

3) malignancy , PTLD -post transplant lymphoproliferative disorder

4)vascular complications like hepatic artery thrombosis

5)biliary structures

most serious complication is hepatic artery thrombosis