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Figure 81-1. Indications for Liver Transplant
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4000–600 liver transplants in the US/year over the last 10 years. Only 300–400 of these are living donor transplants.

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Absolute

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Pulmonary hypertension: mean pulmonary artery pressure > 45 mm Hg

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  • Recidivism to alcohol and drug abuse
  • Extrahepatic malignancies
  • Systemic sepsis

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Relative

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  • Pulmonary hypertension: mean pulmonary artery pressure > 35 mm Hg
  • Significant cardiopulmonary disease
  • Poor psychosocial support or compliance
  • In the case of hepatocellular carcinoma (“Milan criteria”)
    • 1 tumor > 5 cm
    • >3 tumors < 3 cm
    • Presence of extrahepatic tumors
    • Presence of vascular invasion

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Table Graphic Jump Location
Table 81-1 Liver Failure and Associated Morbidities
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Routine setup of liver room at Columbia University Medical Center (courtesy of Dr. Tricia Brentjens)

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Drugs

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Induction and maintenance

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  • Propofol
  • Etomidate
  • Midazolam (have 10 mg available)
  • Fentanyl (have 3 mg available)
  • Succinylcholine
  • Cisatracurium (have 200 mg available)
  • Isoflurane (have 2 full bottles available)

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Vasoactive drugs

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  • Epinephrine 100 mcg/mL, 10 mL
  • Epinephrine 10 mcg/mL, 10 mL
  • Calcium chloride 1 g in 10 mL (have 10 vials available)
  • Phenylephrine 40 mcg/mL, 10 mL syringe, and 250 mL bag
  • Ephedrine 5 mg/mL, 10 mL
  • Atropine 100 mcg/mL, 10 mL
  • Sodium bicarbonate 50 mEq (have 10 vials available)

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Others

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  • Magnesium sulfate 2 g (4 mL of the 0.5 g/mL solution): Not drawn up!
  • Methylprednisolone sodium 500 mg
  • Mannitol 12.5 g/20 mL: Not drawn up
  • Acetylcysteine: discuss with your attending physician
    • Load: 150 mg/kg in 200 cc over 1 hour
    • Maintenance: 50 mg/kg in 500c c D5W over 4 hours
    • Then 100 mg/kg in 1 L D5W over 16 hours

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Mandatory infusions

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  • Norepinephrine 4 mg/250 mL N saline
  • Vasopressin 100 U/100 mL N saline
  • Furosemide 100 mg/100 mL N saline

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Have available

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  • Dopamine 200 mg/250 mL premix bag
  • Dobutamine 250 mg/250 mL premix bag
  • Nitroglycerin 50 mg/250 mL premix bottle
  • Aminocaproic acid (Amicar) — ...

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