Liver Transplantation

Liver transplantation is a surgical procedure to replace a patient's diseased liver with a whole or partial healthy liver from another person, called a donor.

Indications for Liver Transplantation

• End-stage liver disease (ESLD) due to various causes such as hepatitis B and C, alcoholic liver disease, non-alcoholic fatty liver disease, primary biliary cirrhosis, primary sclerosing cholangitis, and autoimmune hepatitis.
• Acute liver failure due to drug overdose, viral infections, or other causes.
• Liver cancer, such as hepatocellular carcinoma.
• Metabolic disorders, such as Wilson's disease and tyrosinemia.

Types of Liver Transplantation

• Orthotopic liver transplantation (OLT): The most common type, where the diseased liver is removed and replaced with a donor liver in the same location.
• Heterotopic liver transplantation: A less common type, where the donor liver is implanted in addition to the recipient's native liver, usually in a different location.
• Living donor liver transplantation: A procedure where a portion of the liver is donated by a living person, usually a family member or close relative.
• Split-liver transplantation: A procedure where a single donor liver is split into two grafts, each transplanted into a separate recipient.

Surgical Procedure

The surgical procedure for liver transplantation typically involves:

• Incision and exposure of the abdominal cavity.
• Dissection and removal of the diseased liver.
• Implantation of the donor liver, including connection of blood vessels and bile ducts.
• Closure of the incision site.

Post-Operative Care

After liver transplantation, patients require close monitoring and care to prevent complications, such as:

• Rejection of the transplanted liver.
• Infections, such as pneumonia or urinary tract infections.
• Bleeding or thrombosis.
• Adverse reactions to immunosuppressive medications.

Immunosuppression

To prevent rejection of the transplanted liver, patients must take immunosuppressive medications for the rest of their lives. These medications may include:

• Corticosteroids, such as prednisone.
• Calcineurin inhibitors, such as cyclosporine or tacrolimus.
• Antiproliferative agents, such as mycophenolate mofetil.

Risks and Complications

Liver transplantation carries risks and complications, including:

• Surgical complications, such as bleeding or infection.
• Rejection of the transplanted liver.
• Adverse reactions to immunosuppressive medications.
• Increased risk of certain cancers, such as lymphoma or skin cancer.

Outcomes and Prognosis

The outcomes and prognosis for patients undergoing liver transplantation vary depending on the underlying disease, overall health, and other factors. Generally:

• The 1-year survival rate is around 85-90%.
• The 5-year survival rate is around 70-80%.
• Patients who undergo liver transplantation can expect to lead active and productive lives, with many returning to work and normal activities within several months after surgery.