Chapter 81. Liver Transplant

Absolute

Pulmonary hypertension: mean pulmonary artery pressure > 45 mm Hg

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

Relative

• 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

Routine setup of liver room at Columbia University Medical Center (courtesy of Dr. Tricia Brentjens)

Drugs

Induction and maintenance

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

Vasoactive drugs

• 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)

Others

• 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

Mandatory infusions

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

Have available

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