Succinct guide to liver transplantation for medical students
Cheng, Wing Tung
- Publisher: Elsevier
Annals of Medicine and Surgery,
(issn: 2049-0801, eissn: 2049-0801)
Medical education | PTLD, post-transplant lymphoproliferative disease | GRWR, graft-recipient-weight ratio | HBV, hepatitis B virus | MELD, model for end stage liver disease | INR, international normalized ratio | HCV, Hepatitis C virus | UCSF, University of California San Francisco | Review | HCC, hepatocellular carcinoma | Liver transplantation | Guide | SFSS, small for size syndrome
Literature on liver transplantation for use in medical education is limited and as yet unsatisfactory. The aim of this article is to help medical students gain enough insight into the reality of being a liver transplant recipient. This is crucial so in the future they can feel confident in approaching these patients with adequate knowledge and confidence. The knowledge-tree based learning core topics are designed for a 2-h class including indication/contraindication in the real-world setting, model for end stage liver disease scoring and organ allocation policy, liver transplantation for hepatic malignancy, transplantation surgery, immunosuppression strategy in practical consideration, and management of viral hepatitis. The rationales of each topic are discussed comprehensively for better understanding by medical students. Recipient candidates may have reversible contraindications that halt the surgery temporarily and therefore, it warrants re-evaluation before transplant. Organ allocation policy is primarily based on disease severity instead of waiting time. Transplant surgery usually involves resection of the whole liver, in situ implantation with reconstruction of the hepatic vein, the portal vein, the hepatic artery and the biliary duct in sequence. The primary goal of artificial immunosuppression is to prevent graft rejection, and the secondary one is to reduce its complication or side effects. Life-long oral nucleoside/nucleotide analogues against hepatitis virus B is needed while short course of direct acting agents against hepatitis viral C is enough to eradicate the virus. Basic understanding of the underlying rationales will help students prepare for advanced learning and cope with the recipients confidently in the future.