Transplant

Banff Score

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Q) Banff Scoring system is for

a) Acute pyelonephritis

b) Chronic glomerulonephritis

c) Acute Rejection

d) Chronic renal graft rejection

Discuss what is banff score

What is the need of banff score

What are the components

What is the significance

Complications of liver transplant

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Q) True about liver transplant complications 

a) Portal vein thrombosis is more common than Hepatic Artery thrombosis

b) Bile leak though common is not a significant problem in most

c) Any bleeding in post op period, patient should be taken to OT

d) Acute liver rejection is seen in 5-10% cases

 

Significance of MELD Scoring in Liver Transplant

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Q) The significance of MELD Scoring in Liver transplant is :

a) Less ill patients are given more priority in liver transplant

b) Set threshold for patients who are too ill to undergo transplant.

c) To access  mortality in the waiting list.

d) To list patients in cadaveric deceased donor program

d

MELD score takes into account  three factors. Bilirubin, INR and creatinine. Recently MELD Na is also included. Model for end stage Liver Disease (MELD) was initially developed to evaluate three months prognosis in patients undergoing TIPS. 
It ranges from 6 (3 months survival = 90%) to 40 (3 months survival =7%).

In countries where DDLT is more common MELD Score is used to allot grafts to people in the cadaveric list. More severe is the MELD, earlier is the allotment of cadaveric graft.

Sicker patients are given priority

 

Living Donor liver transplant

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Q) Living donor liver transplant (LDLT) is done in centers where cadaveric donations are few. Which of the following is true about it?

a) Only right lobe of the donor can be used

b) Only left lobe can be used

c) In LDLT bile leak is more than cadaveric donor

d) Small for size liver is defined as liver size less than 0.5% of recipient BSA

Answer

Contraindication of liver transplantation

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Q)Contraindications of liver transplantation have changed over the years. Which is an absolute contraindication of  liver transplantation

a) Previous breast cancer

b) Portal vein thrombosis

c) Active tuberculosis

d) Active substance abuse

d

Previous history of breast cancer if completely treated is not an contraindication of liver transplant. Portal vein thrombosis was earlier considered a relative contraindication but almost all series have shown similar results in patients with PVT than patients without PVT.

IN portal vein thrombosis, inflow to the new liver can me taken in many ways

a) thrombectomy

b) Jump grafts from Superior mesenteric vein 

c) Anastomosis have been done from big collaterals

Active tuberculosis can be managed after transplant.

Modified ATT regimens without INH and Rifampicin are being  used.  Any kind of active substance abuse alcohol,  drugs etc are absolute contraindications for liver transplant because the disease will recur.