Liver Transplantation

Overview

Liver transplantation is the 2nd most common type of solid organ transplantation.

Indications for liver transplantation include:

  • Cirrhosis (70% of transplantations in the US; 70% of these cases are attributed to hepatitis C)
  • Fulminant hepatic necrosis (about 8%)
  • Hepatocellular carcinoma (about 7%)
  • Biliary atresia and metabolic disorders, primarily in children (about 3% each)
  • Other cholestatic (eg, primary sclerosing cholangitis) and noncholestatic (eg, autoimmune hepatitis) disorders (about 8%)

Liver donors

Nearly all donated livers come from brain-dead (deceased), heart-beating donors.

Annually, about 250 transplants in US come from living donors, who can live without their right lobe (in adult-to-adult transplantation) or the lateral segment of their left lobe (in adult-to-child transplantation).

Advantages of living donation for the recipient include shorter waiting times and shorter cold ischemic times for explanted organs, largely because transplantation can be scheduled to optimize the patient’s condition.

Disadvantages to the donor include mortality risk of 1/600 and complications in up to one fourth.

A few livers come from deceased, non–heart-beating donors (called donation-after-cardiac-death donors), but in such cases, bile duct complications develop in up to one third of recipients because the liver had been damaged by ischemia before donation.

Complications

Rejection 

  • Risk factors for rejection include:
  1. Younger recipient age
  2. Older donor age
  3. Greater HLA mismatching
  4. Longer cold ischemia times
  5. Autoimmune disorders
  • Hepatitis recurrence after transplantation:

Immunosuppression contributes to recurrence of viral hepatitis in patients who had viral hepatitis-induced cirrhosis before transplantation.

  • Other complications like, primary nonfunction , biliary dysfunction,portal vein thrombosis, hepatic artery thrombosis

Prognosis

At 1 yr after liver transplantation, survival rates are:

  • Living-donor grafts: 90% (patients) and 82% (grafts)
  • Deceased-donor grafts: 90.5% (patients) and 85% (grafts)

Overall survival rates are:

  • At 3 yr: 79% (patients) and 72% (grafts)
  • At 5 yr: 73% (patients) and 65% (grafts)