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Management of Complications of Chronic Liver Disease: “When to Refer to Transplant?” Philip Rosenthal, M.D. Professor of Pediatrics & Surgery University of California, San Francisco THE LIVER • • • • Largest organ in body RUQ of abdomen Sheltered by rib cage In adult, weighs 3 lbs. LIVER: GROSS ANATOMY • Separated into 2 lobes: Right and Left • Right lobe is ~6X larger than the left • Porta hepatis is entry site for blood vessels and exit site for bile ducts Liver Transplantation • • • • Anatomical segments Living-related Split Reduced-sized Split liver HEPATIC CIRCULATION • A dual blood supply • Portal vein drains intestines and spleenprovides 75% of liver’s blood supply • Hepatic artery supplies oxygenated blood from aorta-provides 25% of blood supply CELLULAR ARCHITECTURE • Portal vein and hepatic artery branch within the lobes to form sinusoids that run parallel to rows of hepatocytes (liver cells) • Sinusoids allow exchange of substances to liver cells CELLULAR ARCHITECTURE • Hepatocytes are most abundant and metabolically active • Kupffer cells in the sinusoids are scavenger cells for foreign matter, wornout blood cells and bacteria CELLULAR ARCHITECTURE • The liver is organized into polyhedral unitslobules • On cut section, a lobule is hexagonal with 6 portal triads at the periphery • Portal triad-branch of hepatic artery, portal vein, bile duct REGENERATIVE ABILITY • Hepatocytes rarely divide but have the capacity to reproduce in response to appropriate stimuli • This process can restore the liver to within 5-10% of its original weight • Liver regeneration plays an important role after surgical resection or after injury that destroys portions of the liver LIVER FUNCTIONS • Purification, transformation and clearance of: – – – – – ammonia bilirubin hormones drugs toxins