Behind The Knife: The Surgery Podcast How to do a Liver Transplant with Dr. Shah and Dr. Dageforde
Jun 26, 2023
Join Dr. Anushi Shah, a skilled hepatobiliary and transplant surgeon, and Dr. Leanne Dageforde, a transplant expert at Massachusetts General Hospital, as they delve into the intricate world of liver transplants. They explore preoperative evaluation, including MELD scores and candidate selection. The duo discusses different surgical techniques, the pros and cons of piggyback vs. bicaval approaches, and the significance of imaging in surgical planning. Prepare for a fascinating deep dive into the challenges of managing portal vein thrombosis and ensuring graft function!
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Two Phases: Hepatectomy And Implantation
- Liver transplant has two distinct technical phases: the hepatectomy (removal) and the implantation (reconstruction).
- Understanding both phases and their vocabulary helps trainees integrate quickly on transplant rotations.
Follow Multidisciplinary Listing And MELD Rules
- Work up the transplant etiology and present patients to a multidisciplinary committee for listing decisions.
- Apply MELD and exception points (e.g., Milan criteria for HCC) when appropriate to determine listing priority.
Transplant Oncology Is Growing But Limited
- Transplant oncology is expanding but limited by organ scarcity and survival-equivalent standards.
- HCC (within Milan) remains the clearest cancer indication, with growing interest in cholangiocarcinoma and select metastases.