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Current concepts in transplant surgery: liver transplantation today

  • Current Concepts in Clinical Surgery
  • Published:
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Abstract

Introduction

The discipline of liver transplantation (LTx) has been developed over the past decades, and LTx is now considered the gold standard for the treatment of patients with end-stage liver diseases and early liver tumors in cirrhotic livers. This procedure is now performed routinely in many transplant centers, and it has provided an enormous technical innovation to the field of hepatobiliary surgery. Allocation decision of liver organs is based on medical need and timing.

Materials and methods

The Mayo Model for End Stage Liver Disease based on patient-specific criteria was developed and applied to prioritize patients on the waiting list. From the donor aspects of LTx, sources of organ, excluding xenotransplantation, can be brain-dead donors, living donors, and non-heart-beating donors. Today, the majority of livers are procured from cadaveric donors. In addition to the conventional LTx, other types are living-donor LTx, reuse of grafts as domino transplantation, ex situ as well as in situ split LTx, and reduced-size LTx. The transplantation procedure consists of several steps including donor selection and management, liver procurement and preservation, back-table preparation, recipient operation with liver implantation, postoperative care, immunosuppression, and follow-up.

Results

The postoperative complications are divided into surgical, non-surgical, and multifactorial complications. Surgical complications account about 34% of morbidities after LTx and are mainly categorized to vascular and biliary complications. The main medical ones are non-surgical bleeding and infections. The multifactorial complications include primary non- or poor function and small-for-size syndrome. The pretransplant outcome predictors of LTx can be divided into donor, recipient, operative, and postoperative factors.

Conclusion

LTx is now considered a safe and standardized procedure with a substantially improved graft and patient survival and acceptable morbidity rates. However, the new problems, including recurrence of hepatitis C or hepatocellular carcinoma, chronic biliary complications, opportunistic infections, and development of de-novo malignancies are the major problems affecting the long-term outcome of transplanted patients.

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Acknowledgment

We are thankful to Mr. Dirk Fischer for drawing the pictures for this manuscript.

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Authors and Affiliations

  1. Division of Visceral Transplantation, Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    A. Mehrabi, H. Fonouni, S. A. Müller & J. Schmidt

  2. Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, 69120, Heidelberg, Germany

    J. Schmidt

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  1. A. Mehrabi
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  2. H. Fonouni
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  3. S. A. Müller
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  4. J. Schmidt
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Corresponding author

Correspondence to J. Schmidt.

Additional information

Mehrabi and Fonouni contributed equally to this work.

An invited review about the different techniques in liver transplantation was submitted for publication in “Der Chirurg.”

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Mehrabi, A., Fonouni, H., Müller, S.A. et al. Current concepts in transplant surgery: liver transplantation today. Langenbecks Arch Surg 393, 245–260 (2008). https://doi.org/10.1007/s00423-007-0262-6

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  • DOI: https://doi.org/10.1007/s00423-007-0262-6

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