IntroductionLiver transplantation today
Section snippets
Progress in liver transplantation
The first series of liver transplants performed was hampered by discouraging results in patients with mostly unfavourable indications and late timing. The introduction of cyclosporine A into transplantation medicine followed by the 1983 Consensus Conference on Liver Transplantation in Washington with the definition of favourable indications lead to a widespread acceptance of liver transplantation as the standard treatment for many end-stage liver diseases. Today ideal indications for liver
Split liver transplantation
In 1988, Rudolf Pichlmayr described a splitting procedure that allows the use of one cadaveric donor liver for two recipients, usually one adult and one pediatric recipient.3 The splitting procedure can be performed either in-situ or ex-situ. In general ex-situ liver splitting leads to comparable results to in-situ liver splitting. In most cases, segments II and III are used for a pediatric recipient, whereas either the right lobe or segments IV to VIII can be transplanted into an adult
Chronic rejection
The incidence of chronic rejection after liver transplantation is declining. Currently most transplantation centers report rates between 4% and 8%, while in earlier series, rates between 15% and 20% were frequently reported.8, 9 This decline is probably a result of improved immunosuppressive therapy. Acknowledged risk factors for chronic rejection after liver transplantation include selected indications, as well as viral infections (ie, cytomegalovirus) and chronic underimmunosuppression.8, 9
Current controversies
Living-related liver donation puts a healthy donor at an unprecedented risk in medicine. Today we can only assess the short- to medium-term risks. Especially in living-related liver donation for an adult recipient, the necessary manipulations at the central bile ducts may cause a significant long-term risk for the healthy donor. The availability of a matched living donor might tempt the surgeon to indicate liver transplantation in cases that otherwise would be declined for liver grafting due to
Outlook
With improved overall results after liver transplantation, the comorbidity of the allograft recipient becomes an increasingly important factor for the long-term prognosis after transplantation. Today it is clear that hypertension, hyperlipidemia, and diabetes mellitus need careful medical attention and treatment because several lines of evidence indicate that these conditions are associated with decreased allograft and patient survival. Thorough surveillance of immunosuppressive therapy is
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Cited by (6)
The influence of late acute rejection episodes on long-term graft outcome after liver transplantation
2005, Transplantation ProceedingsUpdate on liver transplantation using cyclosporine
2004, Transplantation ProceedingsCitation Excerpt :Additional stimuli for liver regeneration are generated in small-for-size liver allografts and in transplanted liver segments. Technical innovations in living-related and cadaveric split-liver transplantation have lead to an increasing use of segmental liver transplantation.1 The induction of liver regeneration has a direct impact on the metabolic competence of the liver with probable consequences for hepatic metabolism of immunosuppressants as well as other drugs.2,3
Technical skills required in split liver transplantation
2016, Annals of TransplantationLong-term results after liver transplantation
2008, ChirurgSplit liver transplantation: A reliable approach to expand donor pool
2005, Hepatobiliary and Pancreatic Diseases InternationalSurgical experience in splitting donor liver into left lateral and right extended lobes
2005, World Journal of Gastroenterology