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Table 9.5. Cirrhosis and liver transplantation

Hepatocellular Diseases Chronic hepatitis Hepatitis B Hepatitis D Hepatitis C Autoimmune Drug-induced Steatohepatitis Alcohol Obesity Drug-induced Vascular disease

Chronic Budd-Chiari syndrome Inborn errors of metabolism

Hemochromatosis Alpha-1-antitrypsin

Wilson's disease Glycogen storage disease type I/III

Special Considerations for Liver Transplantation (OLT)

Virus should be non-replicating (HBV-DNA negative) Co- or superinfects Hepatitis B. Rare in the US Important to exclude alcohol as comorbid factor Pre-OLT medication may affect post-OLT bone disease Examples: nitrofurantoin, alphamethyldopa

Abstinence and social support critical for OLT. Increasing prevalence of cirrhosis. Rate of recurrence. Example: Amiodarone.

Acute occlusion is amenable to decompressive surgery. R/O myeloproliferative syndrome, thrombotic tendency.

Cardiac involvement results in increased OLT morbidity. Lung disease is rare in the presence of liver cirrhosis deficiency

OLT for acute disease not amenable to medical therapy Can present in early adulthood.

Cholestatic Diseases

Disease of intrahepatic bile ducts Biliary atresia

Primary biliary cirrhosis

Drug-induced disease Familial cholestasis Cystic fibrosis

Disease of extrahepatic bile ducts Primary sclerosing cholangitis Secondary biliary cirrhosis

Kasai procedure may offer relief for a few years before OLT.

Bone disease can be especially problematic post-OLT.

Examples: Chlorpromazine, tolbutamide. Byler's syndrome, arteriohepatic dysplasia. Insipissated bile syndrome leading to cirrhosis.

Secondary cholangiocarcinoma may contraindicate OLT.

Requires Roux-en-Y anastomosis at OLT.

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