Liver transplantation

Liver transplantation is one of the more common forms of organ transplantation. It may be performed from living or deceased donors. It’s performed in an orthotopic fashion, i.e. the native liver is removed and the donor liver is placed in its place.

Indications

• HCC within the Milan criteria
• Decompensated cirrhosis from any cause, if MELD score is > 15
• Liver related diseases with systemic manifestations
  • Crigler-Najjar syndrome
  • Glycogen storage disorder

The MELD (Model for End-Stage Liver Disease) score assesses the risk of dying from chronic liver disease based on serum bilirubin, INR, and creatinine. When the score is > 15, the risk of dying from cirrhosis is greater than the risk of dying from the liver transplant surgery.

Contraindications

• MELD < 15
• Alcohol or drug abuse
• HCC outside the Milan criteria
• Severe heart or lung disease
• HIV/AIDS
• Extrahepatic malignancy

Procedure of transplantation

Liver may be transplanted from living or brain dead donor. In case of a brain-dead donor, the entire liver is transplanted. In case of a living donor, a only a portion of the donor liver is removed and transplanted. The liver has an exceptional ability to regenerate, and so the liver in both the donor and recipient will grow to almost normal size.

Complications

• Hepatic artery thrombosis
• Biliary leakage

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