Liver Transplantation

Liver Transplantation

Liver transplantation is the only curative treatment for end-stage liver disease (cirrhosis) with decompensation. In my practice, the success of liver transplantation is more than 90%. At least 75% of the patients can expect to be alive and healthy at 5 years after their liver transplant. Liver transplantation is a major surgery that involves the removal of the patient's diseased liver and replacing it with a new liver. Depending on the source of the new liver, liver transplantation can be:

1) Living donor liver transplantation (LDLT): In LDLT, a healthy person (usually a near relative) donates a part of his/her liver, which is then implanted into the space created by the removal of the patient's diseased liver. LDLT takes advantage of the natural ability of the liver to regenerate once a part of it is removed. The remnant liver of the donor as well as the liver graft received by the patient, both regenerate over a period of time.

2) Deceased donor liver transplantation (DDLT): In this procedure, the whole liver is retrieved from a brain-dead person whose family members have consented to donate the organs of their loved one. This liver is then implanted into the patient. DDLT is usually an emergency procedure and only patients who are listed as potential recipients as per government rules are eligible for receiving a deceased donor liver.

3) DDLT from a non-heart-beating donor: Under closely supervised situations, liver can also be retrieved from a person whose heart has stopped beating (cardiac death) and used for transplantation. This procedure is called donation after cardiac death (DCD).

4) ABO-incompatible liver transplantation: Blood group compatibility (blood group matched) is usually the basic prerequisite when choosing a donor for liver transplantation. However, a blood group-matched donor may not always be available. In such circumstances, blood group unmatched (ABO- incompatible) liver transplantation can be successfully performed. However, the patient who is planned for an ABO incompatible liver transplant needs to undergo pre-operative preparation with medicines and a procedure called plasmapheresis in order to remove the blood group antibodies from his/her circulation

5) Paired exchange liver transplantation: Also called a swap liver transplantation; this involves the exchange of donor's livers between two donor-recipient pairs. Paired exchange liver transplant is possible only on an elective basis and helps in avoiding ABO incompatible liver transplant for two recipients.