Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ End-stage liver disease in patients who meet the minimal criteria for placement on the liver transplantation list as defined by the American Association for the Study of Liver Diseases.Fulminant acute liver failure.Hepatocellular carcinoma fulfilling Milan criteria (tumor > 2 cm but < 5 cm or up to three tumors each < 3 cm).Some pediatric metabolic liver diseases as defined by the United Network for Organ Sharing (UNOS). +++ Absolute ++ Recidivism to alcohol and drug abuse (6-month abstinence- free period essential).Significant portal venous thrombosis that precludes venous reconstruction.Extrahepatic malignancies.Systemic sepsis and certain untreated chronic infections (eg, tuberculosis, Mycobacterium avium-intracellulare).In the case of hepatocellular carcinoma: Vascular or biliary tree invasion.Tumors outside Milan criteria. +++ Relative ++ Significant cardiopulmonary disease or other medical illnesses, with the exception of liver or biliary tree specific disease and renal disease.Certain chronic infections (eg, HIV infection).Profound physical deconditioning.Advanced age (older than 70 years).Poor psychosocial support (eg, homeless).Inability to obtain immunosuppressive medications. ++ The 1-year survival following liver transplantation is 86–90% in the United States, with a death rate of approximately 5% per year death thereafter.Approximately 20% of patients will require retransplantation. +++ Expected Benefits ++ Restoration of hepatic function. +++ Potential Risks ++ Potential complications in the perioperative period are numerous given the magnitude of the procedure.Specific complications include: Infection: 66% total (bacterial, 35–70%; fungal, 20–42%; viral, 5–26%).Rejection (40–70%).Biliary complications (7–29%).Bleeding (10–25%).Primary nonfunction (7%).Hepatic artery thrombosis (2–10%).Portal vein thrombosis (1–2%). ++ Rigorous fixed retractor (mandatory to facilitate exposure of the operative field).Argon beam coagulator (useful in patients with severe coagulopathy or in retransplantation).Cell saver (reduces allogenic packed red blood cell transfusion but should not be used in patients with hepatic malignancy). ++ Patients are typically evaluated and deemed appropriate candidates for transplantation based on their preoperative transplant clinic evaluation.On the day of transplantation, laboratory values, ECG, and chest radiograph should be obtained and reviewed for potential contraindications soon after the patient is called to the hospital.Radiographic verification of portal vein patency should be up to date (within 6 months).Patients with known hepatoma should have up-to-date imaging of the chest, abdomen, and pelvis. The admission chest radiograph should be closely examined for evidence of metastatic disease.History and physical examination should specifically assess for potential contraindications to liver transplantation (eg, active infections, evidence of active alcohol or drug use). ++ The patient should be supine.The left arm is extended and the axilla prepped in the sterile field (to provide access to the left axillary vein should venovenous bypass be required).The right arm can be tucked or extended. ++ Figure 32–1: Incision and retractor placement. The chest and abdomen are prepped from the ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth