{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 24, Ep 4 of 4: Liver Transplant Scoring to Recurrence","html":"","width":"100%","height":180,"duration":1082,"description":"Episode four follows a patient across the whole transplant arc, organized by two clocks: the allocation score that triages who is sickest, and time itself, which orders both the drop in immunosuppression intensity and the shift from acute risk to cumulative toxicity. The calculated score does the primary triage with its sex and albumin corrections fixing real undervaluation, the workup confirms the operation can succeed medically, infectiously, and psychosocially, and the exception points cover the diseases the labs cannot see. Donor type then sets the complication profile, immunosuppression intensity organizes the early timeline of rejection and opportunistic infection with CMV dominant, and cumulative toxicity organizes the late timeline. The original disease returns in a pattern specific to its cause, which is why surveillance continues indefinitely.\n \nTopics covered\n\nAllocation score components and corrections\nReferral triggers and the score-of-fifteen threshold\nThe three-question workup\nException points for undervalued diseases\nDonor types and their complication signatures\nImmunosuppression stepping down over time\nThe complication timeline by era\nAcute and antibody-mediated rejection\nCMV and recurrent disease patterns\n \n \nKey decisions\n\nThe allocation score uses capped creatinine, bilirubin, INR, and sodium, adds points for female sex to correct the lower creatinine of lower muscle mass, and subtracts points across the low albumin range to capture catabolic decompensated disease.\nList for transplant on decompensation, meaning variceal bleeding, ascites, encephalopathy, HCC, or hepatorenal dysfunction, or on a score of fifteen or higher, the point where the operation stops being a net loss versus medical management.\nException points cover diseases the score misses: HCC within criteria gets a regional median score after a six-month wait, hepatopulmonary syndrome qualifies at an arterial oxygen under sixty, and portopulmonary hypertension qualifies with a mean...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}