Our Summary

This research paper discusses how some countries use liver transplants from donors who have died from circulatory death to deal with organ shortages. However, these organ transplants can often lead to complications or even failure of the new organ. This risk is thought to be linked to the length of time the organ has been without blood supply after death.

The paper reviews how the criteria for choosing donors and the use of different techniques to keep organs in good condition prior to transplantation have improved the success rate of these transplants. There is also the potential to restore and improve organs that were previously thought not to be suitable for transplantation. These techniques also allow for the assessment of the organ’s function before it is implanted, which helps match it more effectively to a recipient.

The authors then discuss different techniques used to maintain organs before transplantation. They review studies on the success of these methods, discuss how they may work to protect the organ, and the criteria used to select organs. They also cover protocols that use more than one technique to keep the organ in good condition and possible future developments in this field.

FAQs

  1. What factors are believed to contribute to the risk of complications or failure in liver transplants from donors who have died from circulatory death?
  2. How have advancements in donor selection criteria and organ preservation techniques improved the success rate of liver transplants?
  3. What methods are currently used to maintain organs before transplantation and how effective are they?

Doctor’s Tip

One helpful tip a doctor might provide to a patient undergoing a liver transplant is to follow a healthy and balanced diet post-transplant to support the function of the new organ. This includes consuming plenty of fruits, vegetables, whole grains, lean proteins, and limiting processed foods, saturated fats, and sugar. Staying hydrated and avoiding alcohol and tobacco are also important for the health of the new liver. Additionally, it is crucial to follow all medication and treatment instructions provided by the medical team to prevent rejection and ensure the success of the transplant. Regular check-ups and monitoring of liver function are also essential for long-term health and well-being.

Suitable For

Patients who are typically recommended for liver transplant are those with end-stage liver disease, such as cirrhosis, hepatitis B or C, alcoholic liver disease, autoimmune hepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, and certain metabolic disorders. These patients may experience symptoms such as jaundice, fatigue, swelling in the abdomen or legs, confusion, and easy bruising or bleeding. They may also have complications such as ascites, variceal bleeding, hepatic encephalopathy, or hepatocellular carcinoma.

In order to be considered for a liver transplant, patients must undergo a thorough evaluation to determine their overall health status and the severity of their liver disease. They must also meet certain criteria, such as having a life expectancy of less than two years without a transplant, having no active substance abuse, and being able to comply with post-transplant medications and follow-up care.

Liver transplants are typically recommended for patients who are not responding to medical treatment, have a high risk of mortality without a transplant, and have a good chance of survival and improved quality of life with a new liver. The decision to recommend a liver transplant is made by a multidisciplinary team of healthcare providers, including hepatologists, transplant surgeons, transplant coordinators, social workers, and psychologists.

Overall, liver transplant can be a life-saving treatment for patients with end-stage liver disease, and advances in organ preservation techniques and donor selection criteria have improved the success rates of these transplants. However, the demand for donor livers still exceeds the supply, and efforts are ongoing to increase the availability of organs for transplantation.

Timeline

Before a liver transplant:

  1. Patient is evaluated by a transplant team to assess their medical history, overall health, and suitability for a transplant.
  2. Patient is placed on the transplant waiting list based on their severity of illness and availability of donor organs.
  3. Patient undergoes extensive medical testing and monitoring while waiting for a suitable donor liver.
  4. Patient may experience symptoms of liver failure such as jaundice, fatigue, swelling, and confusion.

After a liver transplant:

  1. Patient undergoes surgery to remove the diseased liver and implant the donor liver.
  2. Patient is monitored closely in the intensive care unit (ICU) immediately following the surgery.
  3. Patient may experience complications such as infection, rejection of the new liver, or issues with blood clotting.
  4. Patient undergoes regular follow-up appointments and medical monitoring to ensure the success of the transplant and prevent complications.
  5. Patient may need to take immunosuppressant medications for the rest of their life to prevent rejection of the new liver.
  6. Patient can experience improved liver function, increased energy levels, and a better quality of life following a successful transplant.

What to Ask Your Doctor

  1. Can you explain the risks and potential complications associated with liver transplant surgery?
  2. How will I be evaluated to determine if I am a suitable candidate for a liver transplant?
  3. What criteria are used to select a suitable liver donor for transplantation?
  4. How long will I need to wait for a suitable liver donor to become available?
  5. What techniques are used to maintain the donor liver in good condition before transplantation?
  6. How will the function of the donor liver be assessed before it is implanted in my body?
  7. What is the success rate of liver transplants from donors who have died from circulatory death compared to other types of donors?
  8. What are the potential long-term effects of receiving a liver transplant?
  9. How often will I need to follow up with my healthcare team after the liver transplant surgery?
  10. Are there any lifestyle changes or medications I will need to take after the liver transplant?

Reference

Authors: De Carlis R, Paolo Muiesan, Taner B. Journal: J Hepatol. 2023 Jun;78(6):1169-1180. doi: 10.1016/j.jhep.2023.04.008. PMID: 37208104