General
Liver transplantation:
Indication of liver transplantation and graft survival:
The most frequent indications for liver transplantation are end-stage chronic hepatitis and biliary cirrhosis in adults, biliary atresia and inborn metabolic deficiencies in children. These diseases cause chronic liver failure or sometimes even an acute fulminate liver failure. One-year patient survival rate is 80% in these categories of patients.
Donor selection and liver preservation:
The liver of the cadaveric donor is matched with the recipient according to size and ABO-blood group. Elevation of hepatic enzymes, hemodynamic instability or any other liver abnormalities exclude transplantation. Hepatic preservation time for successful transplantation is limited to approximately 16-24 hours. The incidence of a reduced or non-functioning organ increases with preservation time.
Transplant procedure:
Liver transplantation is a difficult surgical procedure to perform and requires also non-surgical procedures. Recipient hepatectomy and orthotopic placement of the liver can lead to considerable blood loss and several episodes of hemodynamic instability which requires an excellent cooperation with the bloodbank and the anaesthesiology department. The transplantation is complete, if the anastomosis of supra and intra hepatic vena cava, portal vein, hepatic artery and biliary duct are connected. Split liver transplantation and living, genetically (un-)related donors have evolved as surgical alternatives and numbers have increased in recent years providing particularly young children with a chance to receive a graft in time. Both alternatives together currently account for 15-20% of all liver transplantations. Results are comparable to normal sized pediatric grafts.
Complications:
Acute and chronic rejection occurs rarely after liver transplantation. Intensive immunosupressive therapy are attempted, but fulminate rejection or even chronic symptoms are refractory to drug management. Retransplantation is the mandatory treatment. Immunosuppressive therapy includes Tacrolimus, corticosteroids and azathioprine in primary high dosage. Due to surgery, post surgical blood transfusions and immunosuppressive therapy, renal function often declines in the postoperative period.
