Liver transplantation or hepatic transplantation is the replacement of a diseased liver with the healthy liver from another person (allograft). Liver transplantation is a treatment option for end-stage liver disease and acute liver failure, although availability of donor organs is a major limitation. The most common technique is orthotopic transplantation, in which the native liver is removed and replaced by the donor organ in the same anatomic position as the original liver. The surgical procedure is complex, requiring careful harvest of the donor organ and meticulous implantation into the recipient. Liver transplantation is highly regulated, and only performed at designated transplant medical centers by highly trained transplant physicians and supporting medical team. The duration of the surgery ranges from 4 to 18 hours depending on outcome. Favorable outcomes require careful screening for eligible recipient, as well as a well-calibrated live or cadaveric donor match.
Liver transplantation is a potential treatment for acute or chronic conditions which cause irreversible and severe ("end-stage") liver dysfunction. Since the procedure carries relatively high risks, is resource-intensive, and requires major life-modifications after surgery, it is reserved for dire circumstances. Judging the appropriateness/effectiveness of liver transplant on case-by-case basis is critically important as outcomes are highly variable.
Although liver transplantation is the most effective treatment for many forms of end-stage liver disease, the tremendous limitation in allograft availability and widely variable post-surgical outcomes make case selection critically important. Assessment of a person's transplant eligibility is made by a multi-disciplinary team that includes surgeons, medical doctors, and other providers.
The first step in evaluation is to determine whether the patient has irreversible liver-based disease which will be cured by getting a new liver. Thus, those with diseases which are primarily based outside the liver or have spread beyond the liver are generally considered poor candidates. Some examples include:
- someone with advanced liver cancer, with known/likely spread beyond the liver
- active alcohol/substance abuse
- severe heart/lung disease
- existing high cholesterol levels in the patient
Importantly, many contraindications to liver transplantation are considered reversible; a person initially deemed "transplant-ineligible" may later become a favorable candidate if their situation changes. Some examples include:
- partial treatment of liver cancer, such that risk of spread beyond liver is decreased (for those with primary liver cancer or secondary spread to the liver, the medical team will likely rely heavily on the opinion of the patient's primary provider, the oncologist, and the radiologist)
- cessation of substance abuse (time period of abstinence is variable)
- improvement in heart function, e.g. by percutaneous coronary intervention or bypass surgery
- treated HIV infection (see Special populations)
- for those with high cholesterol or triglyceride levels or other dyslipidemias, using lifestyle changes (diet, portions, exercise) and drugs and counseling to lower one's levels, and to control any hyperglycemia or (pre-)diabetes or obesity
Journal of Clinical chemistry and Laboratory Medicne