4. Clinical Guidelines for Liver Transplantation (PDF) - British ...

Guidebook for the Solid Organ Transplant Programme Chapter 4
4.3.2 EARLY COMPLICATIONS CONT.
To date, Sirolimus has been used when immunosuppression is required with low-dose
Tacrolimus levels. The circumstances in which this drug may be used would be in patients
who are suffering from ongoing renal dysfunction or calcineurin inhibitor toxicity and
Mycophenolate Mofetil use alone is inadequate either because the patient cannot tolerate
MMF or because of the risk of ongoing rejection
(See Appendix F: Application for Sirolimus) (Also in Chapter 7, Section 7.9)
4.3.3 Exceptional Distribution - Follow-up of Recipients
It is recognized that in exceptional circumstances and compassionate reasons, a liver may be
transplanted even when there may be a contraindication during donor assessment (e.g.,
incomplete donor screening). If these conditions exist, an organ may be released for transplant
only under exceptional distribution as per Health Canada requirements. The process is
documented on an Exceptional Distribution Form by the BCT Organ Donation Coordinator.
The transplanting physician must authorize the exceptional distribution including obtaining
informed consent of the recipient. Copies of the exceptional distribution form are to be
included in the Recipient chart.
It is important that in all cases, appropriate follow-up of recipients is performed by the posttransplant
medical care team. Each exceptional distribution is to be reviewed and assessed by
the team for any follow-up treatment and diagnosis.
Risk for Viral Mediated Disease Transmission
In Exceptional Distribution cases involving risk for viral mediated disease transmission, the
following will be faxed from BCT Quality Assurance to the transplant hospital or outpatient
location:
1) Fax Coversheet - Required Medical Follow-up for Transplant Recipient(s)
(See Appendix S)
2) Copy of the Exceptional Distribution Form
3) Reference - Recommended Follow-up Testing for Recipients Transplanted under
Risk for Viral Mediated Disease Transmission (See Appendix S)
The post transplant Coordinator at VGH will ensure the above documents are reviewed by the
post-transplant medical care team and the recommended follow-up is performed at the required
intervals.
Chapter 4 – Clinical Guidelines for Liver Transplantation – July, 2010 Page 15
See Page 1 for disclaimer