23 y/o with PSC/AIH overlap p/w cholangitis now s/p Liver Transplant
Dr. Lorna Dove | Morning Report | 11/28/2016
Autoimmune Hepatitis and Primary Sclerosing Cholangitis- not common to have both, usually overlap type syndrome that pathology is not able to clearly differentiate. This makes treatments difficult.
Patients are placed on the transplant list when they begin losing synthetic liver function
PSC patients can get priority on the list because they have high mortality even if synthetic function is intact (they are prone to cholangitis)
Posted 11/28/16 11:00:32 AM by Adam Faye
MELD Score - Initially used to predict 90-day mortality post-TIPS (Transjugular intrahepatic Portosystemtic Shunt) MELD-Na - MELD scores now incorporate Na- shown to be an independent predictor of mortality.
Posted 11/28/16 11:16:19 AM by Adam Faye
MELD >40, post-transplant have worse outcomes
Pancytopenia in Liver disease- often from Hypersplenism
Post-op intra-abdominal hematoma more likely in patients with portal HTN (higher bleed risk)
PSC can recur post-transplant (~20%)
AIH does not recur after transplant but has increased rejection risk
Liver transplation confers low risk for rejection - interestingly, combined liver/kidney transplant has lower rejection risk than kidney alone