Liver transplantation or hepatic transplantation is the replacement of a diseased liver with a healthy liver from another person (allograft). The most commonly used technique is orthotopic transplantation, in which the native liver is removed and replaced by the donor organ in the same anatomic location as the original liver. Liver transplantation is a viable treatment option for end-stage liver disease and acute liver failure.
Indication and contraindication for Liver transplantation
Patients with end stage liver disease who have failed standard medical can be considered for liver transplantation.Signs and symptoms of end stage liver disease include jaundice, ascites(fluid in abdomen), variceal bleeding(vomiting of blood) and altered sensorium.
A number of acute and chronic diseases of the liver can result in end stage liver disease like hepatitis B, hepatitis C, alcohol, autoimmune liver disease, liver cancer and obesity related liver disease. Appropriate patient selection is paramount to the overall success of liver transplantation.
Common contraindication includes active alcohol intake, severe heart and lung disease, severe infection (sepsis), liver cancer which has gone outside liver and severe psychiatric illness.
Kind of Liver Transplantation
Living donor liver transplantation (LDLT): In a typical adult recipient LDLT, 55 to 70% of the liver (the right lobe) is removed from a healthy living donor with same blood group as that of recipient. The donor’s liver will regenerate approaching 100% function within 4–6 weeks, and will almost reach full volumetric size with recapitulation of the normal structure soon thereafter. It may be possible to remove up to 70% of the liver from a healthy living donor without harm in most cases. The transplanted portion will reach full function and the appropriate size in the recipient as well, although it will take longer than for the donor.
Disease donor liver transplantation (DDLT): Patients (with no liver problem) who were admitted in hospital and were declared brain dead, if the relatives wish to donate the liver of this patient to some needy patient who had liver disease and requires liver transplanation then it can be transplanted in the needy patients like eye,kidney and heart transplantation.
Results: are excellent with one year survival of 95%,5yr survival of 80-90% and even 15 yr post transplant survival of 50-60%.
Common Precaution to be Taken After Transplant
Most liver transplant recipients receive corticosteroids plus a calcineurin inhibitor such as tacrolimus or cyclosporin plus a purine antagonist such as mycophenolate mofetil. They need to take it regularly and for a prolonged period of time.They need regular follow up with their doctor to get tests like liver function tests (AST, ALT, GGT and prothrombin time), complete blood count and blood glucose.