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CHALLENGES AND POTENTIAL FUTURE DEVELOPMENTS IN LIVER

Domino liver transplantation Domino LT involves transplanting a liver from a patient with metabolic disease who needs LT into a patient with end-stage liver disease with the expectation that the recipient will not develop the metabolic syndrome or the recurren...

FURTHER READING Busuttil R, Klinymalm G (eds). Transplantation of the liver , 3rd edn. Philadelphia, PA: Elsevier-Saunders, 2015. Clavien P , Trotter J (eds). Medical care of the liver transplant patient, edn. Oxford: Wiley-Blackwell, 2012. Croome K, Muiesan...

Haemorrhage Portal hypertension and coagulopathy of CLD are important causes of bleeding that are unique to LT procedures. A study of more than 12 /uni00A0 000 LTs showed 12.5% needing re-explorations during the same hospitalisation, of which 68% were for bl...

IMMEDIATE POST-TRANSPLANT CARE Following LT , patients are monitored in an intensive care unit (ICU) and maintained on a ventilator, usually for less than 24 hours. If haemodynamically stable and awake with good early liver graft function and renal function th...

IMMUNOSUPPRESSION FOLLOWING LIVER TRANSPLANTATION Liver is considered to be an ‘immunoregulatory’ solid organ with specialised venous endothelial turnover, a high number of extramedullary haematopoietic stem cells and the ability to produce numerous immunoreg...

INDICATIONS AND PATIENT SELECTION The indications for liver transplantation (LT) fall into four groups: 1 chronic liver disease (CLD); 2 acute liver failure (ALF); 3 metabolic liver disease (including liver-based inborn errors of metabolism); 4 primary hepati...

Introduction No content extracted automatically.

LIVER TRANSPLANTATION FOR HEPATIC MALIGNANCY As a general rule, malignancy in a solid organ is not an indication for transplantation. This is because of the risk of recurrence with immunosuppression post transplant; immuno suppression suppresses not only the ...

LIVER TRANSPLANTATION Disease recurrence after LT has increased over the past decade, as many more patients are living more than 15–20 years with their liver graft. Disease recurrence after LT can be divided into four main groups: (i) malignant disease, (ii) v...

Learning objectives To know: The surgical principles of liver transplantation • Potential future developments in liver transplantation • To understand: The main indications and patient selection for liver • transplantation

Liver support devices ALF has a high mortality in the range of 50–80%. Extra corporeal liver support systems have the potential to provide temporary support to bridge patients with ALF to LT or spontaneous recovery . Artificial liver support devices function a...

Living donor liver transplantation In 1988, Silvano Raia in Sao Paolo, Brazil, was the first to introduce the concept of LDLT in a child. Although unsuc - - cessful, this was followed by a report of a successful outcome in paediatric LDLT by Russell Strong in...

Machine perfusion With the advances and improvements in outcomes in LT over the last four decades, there has been a focus on expanding deceased donor organs. Static cold storage (SCS) remains the standard-of-care preservation method in LT . This is achieved by...

PAEDIATRIC LIVER TRANSPLANTATION Paediatric LT has now been carried out for more than three decades and enjoys excellent success with good long-term outcomes. Split LT and LDLT have contributed to reduced waiting times in these children with improved outcomes ...

POST-LIVER TRANSPLANT COMPLICATIONS Primary non-function Primary non-function (PNF) is one of the most serious and life-threatening conditions in the immediate post-transplant period. It is defined as an aggravated form of reperfusion injury resulting in irre...

Paired-exchange programmes Liver paired exchange (LPE) allows liver donors and their intended incompatible recipients to exchange livers with another donor–recipient pair so that a compatible transplant can be performed. The advantage is that it allows the two...

Split and reduced-size liver transplantation Split LT is a valuable option for making the best use of - good-quality deceased donor liver grafts, by splitting the graft into a left lateral segment (segments II and III) for a paediatric recipient and an extende...