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Specimen case presentation
The first liver transplant was conducted in 1963, and is one of the most successful organs transplanted since (second only to renal).
The scar normally associated with liver transplantation is well known as the “Mercedes Benz” scar due to the similarity with the car’s motif. However, in recent years, due to improved surgical techniques, this is no longer the case and now a half-Mercedes Benz scar is now used, thereby reducing further risks of post-operative complications.
Liver transplantation has become a well tolerated procedure with good outcomes for patients with end stage liver disease. The first liver transplant was in 1963, and in elective transplants, 1-year survival rates now go beyond 80-90%.
Indications for liver transplantation include:
- acute liver failure e.g. paracetamol toxicity or fulminant Wilson’s disease
- primary biliary cirrhosis
- primary sclerosing cholangitis
- autoimmune hepatitis
- alcohol liver disease (with guidelines on abstinence except maybe on younger, acute liver failure patients
- hepatitis B and C
- neuroendocrine tumours (only malignancy where transplantation occurs for palliation)
- small hepatocellular carcinomas
This patient demonstrates the classic scar of a liver transplant, termed the Mercedes-Benz scar due to its resemblance to the car’s symbol. However, newer patients due to advances in surgical techniques now have a reduced scar.
Poorer outcomes are associated with:
- extremes of age (young and elderly)
- black and oriental ethnicity
- initial liver disease
- In acute liver failure, the King’s College Hospital criteria is used as a marker:
- Paracetamol toxicity:
- pH < 7.30 prothrombin time >100 seconds
- serum creatinine >300 μmol/l – if grade III/IV encephalopathy
- Non-paracetamol acute liver failure:
- cause – indeterminate hepatitis, halothane hepatitis or an idiosyncratic drug reaction
- <10- or >40- years of age
- jaundice to encephalopathy time > 7-days
- prothrombin time >50 seconds
- serum bilirubin >300 μmol/l
The best outcomes for transplantation have been found in primary biliary cirrhosis.
The reasons for this are that poor transplant rates among patients with alcohol induced liver disease relates to the possible reversibility were the patient to cease drinking alcohol; associated alcohol dependence and risks of relapse after abstinence and finally associated co-morbidities (e.g. alcohol induced cardiomyopathy).
British Society of Gastroenterology guidelines for liver transplantation.
2013 Practice Guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation.
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Question 1 of 5
1. Question1 point(s)
What clinical sign did you identify in this video?CorrectIncorrect
Question 2 of 5
2. Question1 point(s)
Following what surgical procedure is this scar commonly encountered?CorrectIncorrect
Question 3 of 5
3. Question1 point(s)
What is the commonest indication for liver transplantation in the UK?CorrectIncorrect
Question 4 of 5
4. Question1 point(s)
Which of the following stigmata of chronic liver disease are expected to persist following liver transplantation?CorrectIncorrect
Question 5 of 5
5. Question1 point(s)
Which of the following conditions can recur post-transplant? Any number of the options may be correct.CorrectIncorrect