Presentation on theme: "Pediatric Liver Disease Alyssa Brzenski. Pediatric Liver Disease Keely DA, Hartley. End Stage Liver Disease."— Presentation transcript:
Pediatric Liver Disease Alyssa Brzenski
Pediatric Liver Disease Keely DA, Hartley. End Stage Liver Disease.
Chronic Liver Disease
Acute Liver Disease
Biliary Atresia Biliary Atresia. The Lancet.
Most common in southeast Asia 1: 15,000 born in the US 2.5 times more common in african american mothers Most common cause of pediatric liver transplant 10-20% associated with congenital anomalies Biliary atresia splenic malformation Polysplenia (90%) Situs invertus (50%) Vascular anomalies (70%) Intestinal malrotation (60%) Cardiac anomalies- VSD, ASD, HLHS (50%) The Statistics
Jaundice Pale Stools Dark Urine Failure to Thrive Coagulopathy Presentation
Routine Monitors +/- A-line 2 PIV Balanced Anesthetic +/- Epidural Anesthesia for a Kasai
Prognosis Previously unpublished data, based on UK Biliary Atresia Registry (1999–2008).93 BASM=biliary atresia splenic malformation syndrome.
Statistics 16,414- currently on the Liver Transplant waitlist (as of March 9, 2013) 475 of which are children 3 children listed at Radys In 2011, there were 536 pediatric recipients in US Within 2 years of being listed for a liver transplant, % of patients had not been transplanted
LI 8.1 Pediatric patients waiting for a liver transplant
LI 8.2 Distribution of pediatric patients waiting for a liver transplant
LI 8.7 Pre-transplant mortality rates among pediatric patients wait-listed for a liver transplant, by age
LI 8.8 Pediatric liver transplants, by donor type
LI 8.12 Use of DCD donors in pediatric liver transplant recipients
LI 8.18 Survival among pediatric liver transplant recipients, 2002–2006, by age
Split Liver Transplant
Full stomach- RSI Large bore Upper extremity IV access 1 central line Large bore PIV Arterial Line Anesthesia Considerations
Surgical Stages Yudkowitz FS, Chietero M. Anesthesia Issues in Pediatric Liver Transplants. Pediatric Transplant. 2005; 9;
Hematocrit less than 30 Attempt to avoid platelet transfusion Avoid hypercoagulable state Dextran used by some centers Hepatic Artery Thrombosis
Hartley JL, Davenport M, Kelly DA. Biliary Atresia. Lancet 2009; 374: Scientific Registry of Transplant Recipients Liver OPTN/SRTR annual report. Hendrickson R et al. Pediatric Liver transplantation. Current Opin Pediatr 2004; 16: Hartley J and Kelly D. End stage liver failure. Paediatrics and Child Health 2009; 20: Sources