Liver Transplantation

Abstract

Liver transplantation has become a lifesaving procedure for patients who have chronic end-stage liver disease and acute liver failure. The satisfactory outcome of liver transplantation has led to insufficient supplies of deceased donor organs, particularly in East Asia. Hence, East Asian surgeons are concentrating on developing and performing living-donor liver transplantation (LDLT). This review article describes an update on the present status of liver transplantation, mainly in adults, and highlights some recent developments on indications for transplantation, patient selection, donor and recipient operation between LDLT and deceased-donor liver transplantation (DDLT), immunosuppression, and long-term management of liver transplant recipients. Currently, the same indication criteria that exist for DDLT are applied to LDLT, with technical refinements for LDLT. In highly experienced centers, LDLT for high-scoring (>30 points) Model of End-Stage Liver Disease (MELD) patients and acute-on-chronic liver-failure patients yields comparably good outcomes to DDLT, because timely liver transplantation with good-quality grafting is possible. With increasing numbers of liver transplantations and long-term survivors, specialized attention should be paid to complications that develop in the long term, such as chronic renal failure, hypertension, diabetes mellitus, dyslipidemia, obesity, bone or neurological complications, and development of de novo tumors, which are highly related to the immunosuppressive treatment.

Regulation of hepatocyte fate by interferon-γ

“…There are three types of liver transplantation methods: orthotopic liver transplantation (OLT) (replacement of a whole diseased liver with a healthy donor liver), heterotopic liver transplantation (addition of a donor liver at another site, leaving the diseased liver intact), and reduced-size liver transplantation (replacement of a whole diseased liver with a portion of a healthy liver) [70]. One problem that transplant recipients inevitably face is the possibility of graft rejection, which occurs in approximately 20–60% of transplant recipients [70]. Immune suppression is routinely used to induce graft acceptance and is typically aimed at suppressing the adaptive immune system, particularly the expression of Th1 cytokines such as IFN-γ [71, 72].…”

Serum Levels of Soluble Adhesion Molecules as Prognostic Factors for Acute Liver Failure

“…On the other hand, in Asian countries, the donation from deceased donors is severely limited because of various cultural and social reasons [16]. Approximately 50% of patients listed for emergency liver transplantation have died while awaiting a graft because of the lack of a timely suitable donor [17,18].…”

Transplant in the 21st century

“…If the liver is split, the smaller lobe is often transplanted into a child. 21 Extended criteria donor livers also are transplanted (Figure 6). 22 For liver transplants, ECD is defi ned as: • donors ages 70 to 80 years • donors older than age 60 years with a signifi cant medical history • donors with a history of high-risk social behaviors • donors with a history of hepatitis B or C exposure.…”