Transplant
History of Key Transplant Milestones
1. Joseph Murray
- Nobel Prize Winner in 1990 for his pioneering work in kidney transplantation.
- First successful kidney transplant performed in identical twins in 1954.
2. Thomas Starzl
- Performed the first human liver transplant in 1963.
- Known as the father of transplantation for his groundbreaking contributions to organ transplant surgery.
3. Pediatric Living Donor Liver Transplant (LDLT)
- First performed by Strong and colleagues in 1989.
- Significant breakthrough in liver transplantation for pediatric patients, offering a new lifesaving option for children with liver failure.
4. Adult Living Donor Liver Transplant (LDLT)
- First successful adult LDLT performed by Hashikura in 1993.
- Marked the beginning of adult LDLT, providing a crucial solution for liver transplantation shortages in adults.
These individuals and breakthroughs represent major milestones in the evolution of organ transplantation, leading to the advanced techniques and improved outcomes seen today.
West Haven's Criteria for Hepatic Encephalopathy:
| Grade | Description | Key Characteristics | Asterixis |
|---|---|---|---|
| Grade 0 | Normal | No detectable changes in personality or behavior | None |
| Grade I | Minimal changes | - Trivial lack of awareness - Euphoria or anxiety - Shortened attention span - Impaired performance of addition | May be present |
| Grade II | Mild confusion | - Lethargy or apathy - Disorientation for time or place - Subtle personality changes - Inappropriate behavior - Slurred speech - Impaired subtraction ability | Present |
| Grade III | Severe confusion | - Somnolence to semi-stupor but responsive - Confusion - Gross disorientation - Incoherent speech | Usually absent |
| Grade IV | Coma | - Unresponsive to verbal or noxious stimuli | Not applicable |
Liver Transplant Considerations
HIV and Liver Transplantation
- HIV is not a contraindication for liver transplantation.
- Candidates with end-stage liver disease (ESLD) can be considered if they meet the following criteria:
- Low or undetectable HIV RNA levels.
- No AIDS-defining complications.
- CD4 count > 200 cells/mm³.
Hepatopulmonary Syndrome (HPS)
- Both an indication and a contraindication for liver transplantation.
- Key features:
- Pulmonary capillary vasodilation leads to hypoxemia.
- Results in a ventilation/perfusion mismatch.
- Platypnea (shortness of breath when sitting upright) and dyspnea, with or without orthodeoxia (oxygen desaturation upon sitting upright).
- Pulse oximetry is the initial screening tool, and PaO2 < 80 mm Hg indicates significant hypoxemia.
Portopulmonary Hypertension
- Characterized by an increase in pulmonary vascular resistance, which may or may not be associated with liver disease.
- Diagnostic criteria:
- Pulmonary artery pressure (PA) > 25 mm Hg.
- Pulmonary vascular resistance (PVR) > 240 dynes/sec/cm.
- Pulmonary artery occlusion pressure < 15 mm Hg.
- Right heart catheterization required for diagnosis, with findings of:
- Mean pulmonary artery pressure (MPAP) > 35 mm Hg.
- PVR > 250.
- Pulmonary wedge pressure < 15 mm Hg.
- PA > 50 mm Hg is a contraindication for liver transplantation due to increased perioperative risks.
