Cirrhosis surgery: Difference between revisions

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===Transplantation===
===Transplantation===


{{main|Liver transplantation}}
{{main|Liver transplantation}}<ref name="pmid811651">{{cite journal |vauthors=Hoganson DA, Irgens RL, Doi RH, Stahly DP |title=Bacterial sporulation and regulation of dihydrodipicolinate synthase in ribonucleic acid polymerase mutants of Bacillus subtilis |journal=J. Bacteriol. |volume=124 |issue=3 |pages=1628–9 |year=1975 |pmid=811651 |pmc=236086 |doi= |url=}}</ref><ref name="pmid7520105">{{cite journal |vauthors= |title=Randomised trial comparing tacrolimus (FK506) and cyclosporin in prevention of liver allograft rejection. European FK506 Multicentre Liver Study Group |journal=Lancet |volume=344 |issue=8920 |pages=423–8 |year=1994 |pmid=7520105 |doi= |url=}}</ref>
* Patients with decompensated [[cirrhosis]] (having complications such as [[encephalopathy]], [[ascites]], [[Esophageal varices|variceal]] [[Bleeding|hemorrhage]], [[hepatorenal syndrome]] or compromised [[Liver|hepatic]] function) are treated with [[liver transplantation]].<ref name="pmid15834937">{{cite journal |vauthors=Alessandria C, Ozdogan O, Guevara M, Restuccia T, Jiménez W, Arroyo V, Rodés J, Ginès P |title=MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation |journal=Hepatology |volume=41 |issue=6 |pages=1282–9 |year=2005 |pmid=15834937 |doi=10.1002/hep.20687 |url=}}</ref>
* Patients with decompensated [[cirrhosis]] (having complications such as [[encephalopathy]], [[ascites]], [[Esophageal varices|variceal]] [[Bleeding|hemorrhage]], [[hepatorenal syndrome]] or compromised [[Liver|hepatic]] function) are treated with [[liver transplantation]].<ref name="pmid15834937">{{cite journal |vauthors=Alessandria C, Ozdogan O, Guevara M, Restuccia T, Jiménez W, Arroyo V, Rodés J, Ginès P |title=MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation |journal=Hepatology |volume=41 |issue=6 |pages=1282–9 |year=2005 |pmid=15834937 |doi=10.1002/hep.20687 |url=}}</ref>
* [[Liver transplantation]] may be carried out after assessment of the patient’s quality of life, absence of contraindications and disease severity.<ref name="pmid18190658">{{cite journal |vauthors=Schaubel DE, Sima CS, Goodrich NP, Feng S, Merion RM |title=The survival benefit of deceased donor liver transplantation as a function of candidate disease severity and donor quality |journal=Am. J. Transplant. |volume=8 |issue=2 |pages=419–25 |year=2008 |pmid=18190658 |doi=10.1111/j.1600-6143.2007.02086.x |url=}}</ref><ref name="pmid19009713">{{cite journal |vauthors=Volk ML, Lok AS, Pelletier SJ, Ubel PA, Hayward RA |title=Impact of the model for end-stage liver disease allocation policy on the use of high-risk organs for liver transplantation |journal=Gastroenterology |volume=135 |issue=5 |pages=1568–74 |year=2008 |pmid=19009713 |doi= |url=}}</ref><ref name="pmid14999695">{{cite journal |vauthors=Kremers WK, van IJperen M, Kim WR, Freeman RB, Harper AM, Kamath PS, Wiesner RH |title=MELD score as a predictor of pretransplant and posttransplant survival in OPTN/UNOS status 1 patients |journal=Hepatology |volume=39 |issue=3 |pages=764–9 |year=2004 |pmid=14999695 |doi=10.1002/hep.20083 |url=}}</ref><ref name="pmid17326205">{{cite journal |vauthors=Schmidt LE, Larsen FS |title=MELD score as a predictor of liver failure and death in patients with acetaminophen-induced liver injury |journal=Hepatology |volume=45 |issue=3 |pages=789–96 |year=2007 |pmid=17326205 |doi=10.1002/hep.21503 |url=}}</ref><ref name="pmid21898487">{{cite journal |vauthors=Sharma P, Schaubel DE, Gong Q, Guidinger M, Merion RM |title=End-stage liver disease candidates at the highest model for end-stage liver disease scores have higher wait-list mortality than status-1A candidates |journal=Hepatology |volume=55 |issue=1 |pages=192–8 |year=2012 |pmid=21898487 |pmc=3235236 |doi=10.1002/hep.24632 |url=}}</ref><ref name="pmid16244547">{{cite journal |vauthors=Foley DP, Fernandez LA, Leverson G, Chin LT, Krieger N, Cooper JT, Shames BD, Becker YT, Odorico JS, Knechtle SJ, Sollinger HW, Kalayoglu M, D'Alessandro AM |title=Donation after cardiac death: the University of Wisconsin experience with liver transplantation |journal=Ann. Surg. |volume=242 |issue=5 |pages=724–31 |year=2005 |pmid=16244547 |pmc=1409855 |doi= |url=}}</ref>  
* [[Liver transplantation]] may be carried out after assessment of the patient’s quality of life, absence of contraindications and disease severity.<ref name="pmid18190658">{{cite journal |vauthors=Schaubel DE, Sima CS, Goodrich NP, Feng S, Merion RM |title=The survival benefit of deceased donor liver transplantation as a function of candidate disease severity and donor quality |journal=Am. J. Transplant. |volume=8 |issue=2 |pages=419–25 |year=2008 |pmid=18190658 |doi=10.1111/j.1600-6143.2007.02086.x |url=}}</ref><ref name="pmid19009713">{{cite journal |vauthors=Volk ML, Lok AS, Pelletier SJ, Ubel PA, Hayward RA |title=Impact of the model for end-stage liver disease allocation policy on the use of high-risk organs for liver transplantation |journal=Gastroenterology |volume=135 |issue=5 |pages=1568–74 |year=2008 |pmid=19009713 |doi= |url=}}</ref><ref name="pmid14999695">{{cite journal |vauthors=Kremers WK, van IJperen M, Kim WR, Freeman RB, Harper AM, Kamath PS, Wiesner RH |title=MELD score as a predictor of pretransplant and posttransplant survival in OPTN/UNOS status 1 patients |journal=Hepatology |volume=39 |issue=3 |pages=764–9 |year=2004 |pmid=14999695 |doi=10.1002/hep.20083 |url=}}</ref><ref name="pmid17326205">{{cite journal |vauthors=Schmidt LE, Larsen FS |title=MELD score as a predictor of liver failure and death in patients with acetaminophen-induced liver injury |journal=Hepatology |volume=45 |issue=3 |pages=789–96 |year=2007 |pmid=17326205 |doi=10.1002/hep.21503 |url=}}</ref><ref name="pmid21898487">{{cite journal |vauthors=Sharma P, Schaubel DE, Gong Q, Guidinger M, Merion RM |title=End-stage liver disease candidates at the highest model for end-stage liver disease scores have higher wait-list mortality than status-1A candidates |journal=Hepatology |volume=55 |issue=1 |pages=192–8 |year=2012 |pmid=21898487 |pmc=3235236 |doi=10.1002/hep.24632 |url=}}</ref><ref name="pmid16244547">{{cite journal |vauthors=Foley DP, Fernandez LA, Leverson G, Chin LT, Krieger N, Cooper JT, Shames BD, Becker YT, Odorico JS, Knechtle SJ, Sollinger HW, Kalayoglu M, D'Alessandro AM |title=Donation after cardiac death: the University of Wisconsin experience with liver transplantation |journal=Ann. Surg. |volume=242 |issue=5 |pages=724–31 |year=2005 |pmid=16244547 |pmc=1409855 |doi= |url=}}</ref>  
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* Survival from [[liver transplantation]] has been improving over the 1990s, and the five-year survival rate is now around 80%, depending largely on the severity of disease and medical [[Comorbidity|comorbidities]] in the recipient.<ref>[http://www.emedicinehealth.com/liver_transplant/page11_em.htmE-medicine liver transplant outlook and survival rates]</ref>  
* Survival from [[liver transplantation]] has been improving over the 1990s, and the five-year survival rate is now around 80%, depending largely on the severity of disease and medical [[Comorbidity|comorbidities]] in the recipient.<ref>[http://www.emedicinehealth.com/liver_transplant/page11_em.htmE-medicine liver transplant outlook and survival rates]</ref>  
* In the United States, the [[Model for End-Stage Liver Disease|MELD score]]  is used to prioritize patients for [[liver transplantation]].<ref name="pmid2682175">{{cite journal |author=Cosby RL, Yee B, Schrier RW |title=New classification with prognostic value in cirrhotic patients |journal=Mineral and electrolyte metabolism |volume=15 |issue=5 |pages=261-6 |year=1989 |pmid=2682175 |doi=}}</ref>
* In the United States, the [[Model for End-Stage Liver Disease|MELD score]]  is used to prioritize patients for [[liver transplantation]].<ref name="pmid2682175">{{cite journal |author=Cosby RL, Yee B, Schrier RW |title=New classification with prognostic value in cirrhotic patients |journal=Mineral and electrolyte metabolism |volume=15 |issue=5 |pages=261-6 |year=1989 |pmid=2682175 |doi=}}</ref>
* [[Organ transplant|Transplantation]] necessitates the use of [[Immunosuppressive drug|immunosuppressants]] ([[cyclosporine]] or [[tacrolimus]]).
* [[Organ transplant|Transplantation]] necessitates the use of [[Immunosuppressive drug|immunosuppressants]] ([[cyclosporine]] or [[tacrolimus]]).<ref name="pmid7523946">{{cite journal |vauthors= |title=A comparison of tacrolimus (FK 506) and cyclosporine for immunosuppression in liver transplantation |journal=N. Engl. J. Med. |volume=331 |issue=17 |pages=1110–5 |year=1994 |pmid=7523946 |doi=10.1056/NEJM199410273311702 |url=}}</ref><ref name="urlDefining the outcome of immunosuppression withdrawal after liver transplantation - Devlin - 2003 - Hepatology - Wiley Online Library">{{cite web |url=http://onlinelibrary.wiley.com/doi/10.1002/hep.510270406/pdf |title=Defining the outcome of immunosuppression withdrawal after liver transplantation - Devlin - 2003 - Hepatology - Wiley Online Library |format= |work= |accessdate=}}</ref>
;Prevalence
;Prevalence
* Patients with [[primary biliary cirrhosis]] treated with [[ursodeoxycholic acid]] (UDCA) have decreased need for [[liver transplantation]].<ref name="pmid17900996">{{cite journal |author=Lee J, Belanger A, Doucette JT, Stanca C, Friedman S, Bach N |title=Transplantation trends in primary biliary cirrhosis |journal=[[Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association]] |volume=5 |issue=11 |pages=1313–5 |year=2007 |month=November |pmid=17900996 |doi=10.1016/j.cgh.2007.07.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S1542-3565(07)00718-5 |accessdate=2012-09-06}}</ref>
* Patients with [[primary biliary cirrhosis]] treated with [[ursodeoxycholic acid]] (UDCA) have decreased need for [[liver transplantation]].<ref name="pmid17900996">{{cite journal |author=Lee J, Belanger A, Doucette JT, Stanca C, Friedman S, Bach N |title=Transplantation trends in primary biliary cirrhosis |journal=[[Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association]] |volume=5 |issue=11 |pages=1313–5 |year=2007 |month=November |pmid=17900996 |doi=10.1016/j.cgh.2007.07.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S1542-3565(07)00718-5 |accessdate=2012-09-06}}</ref>

Revision as of 17:01, 5 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2] Sudarshana Datta, MD [3]

Overview

Typically for a patient with progressed cirrhosis of the liver, transplantation may be the only viable treatment. If transplantation is not possible or desired, a patient may undergo the TIPS procedure which has demonstrated a great deal of success.

Surgery

Transplantation

Main article: Liver transplantation

[1][2]

Prevalence
Symptoms After Surgery
Survival

TIPS (Transjugular Intrahepatic Portosystemic Shunt)

Main article: Transjugular intrahepatic portosystemic shunt

[32][33]

Indications
Contraindications
Survival
Complications
  • Complications of TIPS include puncture and dilation of the portal vein, hematoma at the puncture site and thrombosis of the stent that is placed in the hepatic vein during the procedure.[35]
  • It is more difficult to perform liver transplantation after a patient has already undergone the TIPS procedure. Inserting a shunt into the liver needs to be exceedingly precise in patients that have the possibility of obtaining a new liver. In transplant cases, patient and graft survival is worse in individuals that previously had a shunt placed in the hepatic vein.[34]
Drawbacks

References

  1. ↑ Hoganson DA, Irgens RL, Doi RH, Stahly DP (1975). "Bacterial sporulation and regulation of dihydrodipicolinate synthase in ribonucleic acid polymerase mutants of Bacillus subtilis". J. Bacteriol. 124 (3): 1628–9. PMC 236086. PMID 811651.
  2. ↑ "Randomised trial comparing tacrolimus (FK506) and cyclosporin in prevention of liver allograft rejection. European FK506 Multicentre Liver Study Group". Lancet. 344 (8920): 423–8. 1994. PMID 7520105.
  3. ↑ 3.0 3.1 Alessandria C, Ozdogan O, Guevara M, Restuccia T, Jiménez W, Arroyo V, Rodés J, Ginès P (2005). "MELD score and clinical type predict prognosis in hepatorenal syndrome: relevance to liver transplantation". Hepatology. 41 (6): 1282–9. doi:10.1002/hep.20687. PMID 15834937.
  4. ↑ Schaubel DE, Sima CS, Goodrich NP, Feng S, Merion RM (2008). "The survival benefit of deceased donor liver transplantation as a function of candidate disease severity and donor quality". Am. J. Transplant. 8 (2): 419–25. doi:10.1111/j.1600-6143.2007.02086.x. PMID 18190658.
  5. ↑ Volk ML, Lok AS, Pelletier SJ, Ubel PA, Hayward RA (2008). "Impact of the model for end-stage liver disease allocation policy on the use of high-risk organs for liver transplantation". Gastroenterology. 135 (5): 1568–74. PMID 19009713.
  6. ↑ 6.0 6.1 Kremers WK, van IJperen M, Kim WR, Freeman RB, Harper AM, Kamath PS, Wiesner RH (2004). "MELD score as a predictor of pretransplant and posttransplant survival in OPTN/UNOS status 1 patients". Hepatology. 39 (3): 764–9. doi:10.1002/hep.20083. PMID 14999695.
  7. ↑ 7.0 7.1 Schmidt LE, Larsen FS (2007). "MELD score as a predictor of liver failure and death in patients with acetaminophen-induced liver injury". Hepatology. 45 (3): 789–96. doi:10.1002/hep.21503. PMID 17326205.
  8. ↑ Sharma P, Schaubel DE, Gong Q, Guidinger M, Merion RM (2012). "End-stage liver disease candidates at the highest model for end-stage liver disease scores have higher wait-list mortality than status-1A candidates". Hepatology. 55 (1): 192–8. doi:10.1002/hep.24632. PMC 3235236. PMID 21898487.
  9. ↑ Foley DP, Fernandez LA, Leverson G, Chin LT, Krieger N, Cooper JT, Shames BD, Becker YT, Odorico JS, Knechtle SJ, Sollinger HW, Kalayoglu M, D'Alessandro AM (2005). "Donation after cardiac death: the University of Wisconsin experience with liver transplantation". Ann. Surg. 242 (5): 724–31. PMC 1409855. PMID 16244547.
  10. ↑ Said A, Williams J, Holden J, Remington P, Gangnon R, Musat A, Lucey MR (2004). "Model for end stage liver disease score predicts mortality across a broad spectrum of liver disease". J. Hepatol. 40 (6): 897–903. doi:10.1016/j.jhep.2004.02.010. PMID 15158328.
  11. ↑ Bambha K, Kim WR, Pedersen R, Bida JP, Kremers WK, Kamath PS (2008). "Predictors of early re-bleeding and mortality after acute variceal haemorrhage in patients with cirrhosis". Gut. 57 (6): 814–20. doi:10.1136/gut.2007.137489. PMID 18250126.
  12. ↑ Reverter E, Tandon P, Augustin S, Turon F, Casu S, Bastiampillai R, Keough A, Llop E, González A, Seijo S, Berzigotti A, Ma M, Genescà J, Bosch J, García-Pagán JC, Abraldes JG (2014). "A MELD-based model to determine risk of mortality among patients with acute variceal bleeding". Gastroenterology. 146 (2): 412–19.e3. doi:10.1053/j.gastro.2013.10.018. PMID 24148622.
  13. ↑ Inaba K, Barmparas G, Resnick S, Browder T, Chan LS, Lam L, Talving P, Demetriades D (2011). "The Model for End-Stage Liver Disease score: an independent prognostic factor of mortality in injured cirrhotic patients". Arch Surg. 146 (9): 1074–8. doi:10.1001/archsurg.2011.109. PMID 21576598.
  14. ↑ Chalasani N, Kahi C, Francois F, Pinto A, Marathe A, Bini EJ, Pandya P, Sitaraman S, Shen J (2002). "Model for end-stage liver disease (MELD) for predicting mortality in patients with acute variceal bleeding". Hepatology. 35 (5): 1282–4. doi:10.1053/jhep.2002.32532. PMID 11981782.
  15. ↑ Amitrano L, Guardascione MA, Bennato R, Manguso F, Balzano A (2005). "MELD score and hepatocellular carcinoma identify patients at different risk of short-term mortality among cirrhotics bleeding from esophageal varices". J. Hepatol. 42 (6): 820–5. doi:10.1016/j.jhep.2005.01.021. PMID 15885352.
  16. ↑ Kim MS, Kato TS, Farr M, Wu C, Givens RC, Collado E, Mancini DM, Schulze PC (2013). "Hepatic dysfunction in ambulatory patients with heart failure: application of the MELD scoring system for outcome prediction". J. Am. Coll. Cardiol. 61 (22): 2253–2261. doi:10.1016/j.jacc.2012.12.056. PMC 3939720. PMID 23563127.
  17. ↑ Freeman RB, Wiesner RH, Edwards E, Harper A, Merion R, Wolfe R (2004). "Results of the first year of the new liver allocation plan". Liver Transpl. 10 (1): 7–15. doi:10.1002/lt.20024. PMID 14755772.
  18. ↑ Cejas NG, Villamil FG, Lendoire JC, Tagliafichi V, Lopez A, Krogh DH, Soratti CA, Bisigniano L (2013). "Improved waiting-list outcomes in Argentina after the adoption of a model for end-stage liver disease-based liver allocation policy". Liver Transpl. 19 (7): 711–20. doi:10.1002/lt.23665. PMID 23775946.
  19. ↑ Moylan CA, Brady CW, Johnson JL, Smith AD, Tuttle-Newhall JE, Muir AJ (2008). "Disparities in liver transplantation before and after introduction of the MELD score". JAMA. 300 (20): 2371–8. doi:10.1001/jama.2008.720. PMC 3640479. PMID 19033587.
  20. ↑ Cholongitas E, Marelli L, Kerry A, Goodier DW, Nair D, Thomas M, Patch D, Burroughs AK (2007). "Female liver transplant recipients with the same GFR as male recipients have lower MELD scores--a systematic bias". Am. J. Transplant. 7 (3): 685–92. doi:10.1111/j.1600-6143.2007.01666.x. PMID 17217437.
  21. ↑ Bambha KM, Biggins SW (2008). "Inequities of the Model for End-Stage Liver Disease: an examination of current components and future additions". Curr Opin Organ Transplant. 13 (3): 227–33. doi:10.1097/MOT.0b013e3282ff84c7. PMID 18685308.
  22. ↑ liver transplant outlook and survival rates
  23. ↑ Cosby RL, Yee B, Schrier RW (1989). "New classification with prognostic value in cirrhotic patients". Mineral and electrolyte metabolism. 15 (5): 261–6. PMID 2682175.
  24. ↑ "A comparison of tacrolimus (FK 506) and cyclosporine for immunosuppression in liver transplantation". N. Engl. J. Med. 331 (17): 1110–5. 1994. doi:10.1056/NEJM199410273311702. PMID 7523946.
  25. ↑ "Defining the outcome of immunosuppression withdrawal after liver transplantation - Devlin - 2003 - Hepatology - Wiley Online Library".
  26. ↑ Lee J, Belanger A, Doucette JT, Stanca C, Friedman S, Bach N (2007). "Transplantation trends in primary biliary cirrhosis". Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association. 5 (11): 1313–5. doi:10.1016/j.cgh.2007.07.015. PMID 17900996. Retrieved 2012-09-06. Unknown parameter |month= ignored (help)
  27. ↑ Salpeter SR, Luo EJ, Malter DS, Stuart B (2012). "Systematic review of noncancer presentations with a median survival of 6 months or less". Am. J. Med. 125 (5): 512.e1–6. doi:10.1016/j.amjmed.2011.07.028. PMID 22030293.
  28. ↑ Askgaard G, Tolstrup JS, Gerds TA, Hamberg O, Zierau L, Kjær MS (2016). "Predictors of heavy drinking after liver transplantation for alcoholic liver disease in Denmark (1990-2013): a nationwide study with competing risks analyses". Scand. J. Gastroenterol. 51 (2): 225–35. doi:10.3109/00365521.2015.1067903. PMID 26161590.
  29. ↑ Merion RM (2004). "When is a patient too well and when is a patient too sick for a liver transplant?". Liver Transpl. 10 (10 Suppl 2): S69–73. doi:10.1002/lt.20265. PMID 15382215.
  30. ↑ Abt PL, Desai NM, Crawford MD, Forman LM, Markmann JW, Olthoff KM, Markmann JF (2004). "Survival following liver transplantation from non-heart-beating donors". Ann. Surg. 239 (1): 87–92. doi:10.1097/01.sla.0000103063.82181.2c. PMC 1356197. PMID 14685105.
  31. ↑ Liermann Garcia RF, Evangelista Garcia C, McMaster P, Neuberger J (2001). "Transplantation for primary biliary cirrhosis: retrospective analysis of 400 patients in a single center". Hepatology (Baltimore, Md.). 33 (1): 22–7. doi:10.1053/jhep.2001.20894. PMID 11124816. Retrieved 2012-09-06. Unknown parameter |month= ignored (help)
  32. ↑ Loffroy R, Estivalet L, Cherblanc V, Favelier S, Pottecher P, Hamza S, Minello A, Hillon P, Thouant P, Lefevre PH, Krausé D, Cercueil JP (2013). "Transjugular intrahepatic portosystemic shunt for the management of acute variceal hemorrhage". World J. Gastroenterol. 19 (37): 6131–43. doi:10.3748/wjg.v19.i37.6131. PMC 3787342. PMID 24115809.
  33. ↑ McCormick PA, Dick R, Burroughs AK (1994). "Review article: the transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of portal hypertension". Aliment. Pharmacol. Ther. 8 (3): 273–82. PMID 7918921.
  34. ↑ 34.0 34.1 34.2 34.3 Boyer TD, Haskal ZJ (2005). "The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension". Hepatology (Baltimore, Md.). 41 (2): 386–400. doi:10.1002/hep.20559. PMID 15660434. Retrieved 2012-09-06. Unknown parameter |month= ignored (help)
  35. ↑ 35.0 35.1 35.2 Freedman AM, Sanyal AJ, Tisnado J, Cole PE, Shiffman ML, Luketic VA, Purdum PP, Darcy MD, Posner MP (1993). "Complications of transjugular intrahepatic portosystemic shunt: a comprehensive review". Radiographics : a Review Publication of the Radiological Society of North America, Inc. 13 (6): 1185–210. PMID 8290720. Retrieved 2012-09-06. Unknown parameter |month= ignored (help)
  36. ↑ 36.0 36.1 Colombato L (2007). "The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension". Journal of Clinical Gastroenterology. 41 Suppl 3: S344–51. doi:10.1097/MCG.0b013e318157e500. PMID 17975487. Retrieved 2012-09-06.

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