Upload
others
View
1
Download
0
Embed Size (px)
Citation preview
LivingDonorLiverTransplant:Pullingdownthewalltotransplant
indisadvantagedpatientsColleenJay,MD,MS
UniversityTransplantCenter
TheScopeoftheProblem…..OPTN/SRTR2015AnnualDataReport:Liver
Percentageofadultswhounderwentdeceaseddonorlivertransplantwithin5
yearsoflistingin2009,byDSA
Pretransplant mortalityratesamongadultswaitlistedforlivertransplant
in2014–2015,byDSA
DT• 46yo malewithPSCandUC• UCquiescent,nosurgery• FrequentERCPandstents• Stillworkingfulltimeascountyclerk• Labs• Current:TB1.6,AP756,INR1.1,Cr
0.5,MELD8• Prior:TB4.9,AP1118,INR1.1,Cr
0.5,MELD14• Bloodtype:B-
• Meds:propranolol,Imuran
365dayprobabilityoftransplantinSouthTexas
Allbloodtypes
Bloodtype:B
https://www.srtr.org/reports-tools/tools/
LivingDonation
Donorcriteria• Age21-55• BMI<28• Healthy• Stablepsychosocialsituation• Anatomicalevaluation• Fullcardiaceval ifage>50
AndresMuniz(stepfather,recipient)&KatieGarcia(stepdaughter,donor)2016
Katieshared,“hehasbeenafathertomesinceIwas5-years-old.Mykidslovehim,Ilovehim,andIdon’twanttobewithouthim.”AlthoughAndresinitially
wasagainstKatiedonating,shewasnotgoingtotakenoforananswer.
• 50yo male– coworker• PMH:elevatedcholesterol• MEDS:fishoil,niacin• BMI:27• Multidisciplinaryevaluation:surgery,hepatology,SW+/- psych,ILDA,nutrition.
• CTA+/- MRimaging
PotentialDonor:BO
LivingDonorLiverTransplant
Reynolds, MarkReynolds, Mark21143874211438742/25/19652/25/196550 YEAR50 YEARMM
Page: 85 of 299Page: 85 of 299
Acq no: 6Acq no: 6KVp: 120KVp: 120mA: 392mA: 392Tilt: 0Tilt: 0RD: 350RD: 350
University Hosp CT2 University Hosp CT2CT ABDOMEN 3 PHASE LIVER WOW CONTRAST 74170CT ABDOMEN 3 PHASE LIVER WOW CONTRAST 74170
THINS, iDose (3)THINS, iDose (3) 5/19/2015 1:26:29 PM 5/19/2015 1:26:29 PM
3256960532569605LOC: 157.50LOC: 157.50
THK: 2THK: 2FFSFFS------
Contrast: IVContrast: IVCV: 0CV: 0
IM:85IM:85 SE:602 SE:602
DFOV:35DFOV:35x35cmx35cmW: 400W: 400
C: 60C: 60Z: 1Z: 1
CFR:---CFR:---CC: 0CC: 0
RR LL
AA
PP
Reynolds, MarkReynolds, Mark21143874211438742/25/19652/25/196550 YEAR50 YEARMM
Page: 1 of 1Page: 1 of 1
University Hosp CT2 University Hosp CT2CT ABDOMEN 3 PHASE LIVER WOW CONTRAST 74170CT ABDOMEN 3 PHASE LIVER WOW CONTRAST 74170
L & R liver volumes (Dup)L & R liver volumes (Dup) 5/20/2015 7:30:02 AM 5/20/2015 7:30:02 AM
3256960532569605IodineIodine
------FFSFFS
IM: 1IM: 1
W: 256W: 256C: 128C: 128
Z: 1Z: 1
Totalvolume:1590ml,rightlobe:1050ml,leftlobe540ml:remnant=34%(threshold:30%)GraftWeighttoRecipientWeightratio:1.3%(threshold0.8%)
Reynolds, MarkReynolds, Mark21143874211438742/25/19652/25/196550 YEAR50 YEARMM
Page: 35 of 99Page: 35 of 99
Acq no: 5Acq no: 5KVp: 120KVp: 120mA: 471mA: 471Tilt: 0Tilt: 0RD: 350RD: 350
University Hosp CT2 University Hosp CT2CT ABDOMEN 3 PHASE LIVER WOW CONTRAST 74170CT ABDOMEN 3 PHASE LIVER WOW CONTRAST 74170
CORONAL, iDose (3)CORONAL, iDose (3) 5/19/2015 1:25:39 PM 5/19/2015 1:25:39 PM
3256960532569605------
THK: 3THK: 3FFSFFS------
Contrast: IVContrast: IVCV: 100CV: 100
IM:35IM:35 SE:503 SE:503
DFOV:35DFOV:35x30cmx30cmW: 400W: 400
C: 60C: 60Z: 1Z: 1
CFR:4CFR:4CC: 300CC: 300
RR LL
HH
FF
Vascularanatomy:1.Arterial:inthiscase,accessoryleft
hepaticartery
Vascularanatomy:1.Arterial2.Portal3.HepaticVeins
BiliaryConsiderationsReynolds, MarkReynolds, Mark21143874211438742/25/19652/25/196550 YEAR50 YEARMM
Page: 9 of 10Page: 9 of 10
--- ---XR CHOLANGIOGRAM OPERATIVE 74300XR CHOLANGIOGRAM OPERATIVE 74300
------ 6/16/2015 9:24:39 AM 6/16/2015 9:24:39 AM
3262334832623348------------------
IM: 9IM: 9
W: 65535W: 65535C: 32767C: 32767
Z: 1Z: 1
Internationaltransplant- India
• Major• PerioperativeMortality(US):0.1-0.2%• A2ALL(2007)– NorthAmerican
multicenterconsortium• Aborteddonation:earlyexperience~3%• Biliary:9%• Hernia:5%• Psych:4%• >95%ofcomplications=Grade1-2(nolong-
termdisability)
DonorOutcomes
• Hepaticregenerationwasassessedat3monthsafterdonorhepatectomy.• Pre-operativeMRIvolumetry wascomparedto3-monthvolumetry.• Regenerationreachedmean:73.4-86.8%.
DonorRegeneration
Joseph(uncle,recipient)&James(nephew,donor)
Steffanic,2009
• Relativecontraindications:• HighMELD• Priorityonlist• Renalfailure• Advancedportalhypertension,significantascites–
toosmallforsizeissues• Technicallycomplicated• Priorlivertransplant• Portal/mesentericthrombus
RecipientConsiderations
Tammy(mother,recipient)&Miranda(daughter,donor)
Green,2014
RecipientOutcomesPatientSurvival
GraftSurvival
RecipientComplications
~1/3withbiliary/infectiouscomplicationsearly,majorityresolvedwithin90days.
HannahParker(daughter,donor)&LoriHenk (mother,recipient)2014
ThankYou
Roundtable/Q&ADrs.Speeg andJay
MeetingSummaryTurninyourcompletedpost-teststoregistration
deskorstaffmember