Our Summary

This research paper discusses the advancements and challenges in the field of liver transplantation. Despite great progress over the last 20 years, there is still a significant shortage of available organs for transplantation, which causes many patients on the waiting list to die. Living donation (where a living person donates part of their liver) has increased the number of transplants in Asian countries, but in Western countries, the numbers have not increased.

Efforts have been made to increase the number of deceased donors. This has led to the use of more liver allografts (a transplant where the donor and recipient are not identical twins) from donors who have died due to cardiac death, along with ‘marginal’ and ’extended criteria’ donors. Researchers have gained a better understanding of the workings of liver allografts obtained after the donor’s heart has stopped, which has improved the selection and management of these donors. It has also helped develop methods of mechanical perfusion (pumping a preservation solution through the organ to keep it alive).

The paper also notes that, while short-term outcomes from liver transplants have improved, long-term outcomes have not seen the same progress. Patients still face complications from the long-term use of drugs to suppress their immune systems, including infections, cancer, and kidney failure. There is also some evidence to suggest that the body’s immune response can cause long-term damage to the transplanted liver.

FAQs

  1. What are the main challenges in the field of liver transplantation?
  2. What strategies are being developed to increase the number of available liver allografts?
  3. What are some of the long-term complications that liver transplant recipients may face?

Doctor’s Tip

One helpful tip a doctor might tell a patient about liver transplant is to adhere strictly to the prescribed medication regimen. This typically includes immunosuppressant medications to prevent rejection of the transplanted liver. It is important to take these medications exactly as directed by your healthcare provider to ensure the long-term success of the transplant. Missing doses or stopping medication without medical guidance can increase the risk of rejection and compromise the function of the new liver.

Suitable For

Patients who are typically recommended for liver transplant include those with end-stage liver disease or acute liver failure that cannot be managed with medical therapy alone. Common indications for liver transplant include cirrhosis, viral hepatitis, alcoholic liver disease, autoimmune liver disease, genetic liver diseases, and liver cancer. Patients who are at high risk for liver-related complications or death without a transplant are also considered for transplantation. Additionally, patients with certain metabolic disorders or acute liver failure may also be candidates for liver transplant. It is important for patients to undergo a thorough evaluation by a multidisciplinary team to determine their candidacy for transplant and to assess their overall health and ability to tolerate the procedure.

Timeline

Before liver transplant:

  • Patient is diagnosed with end-stage liver disease and is evaluated for transplant eligibility
  • Patient is placed on the national transplant waiting list
  • Patient undergoes extensive testing and evaluation to determine suitability for transplant
  • Patient waits for a suitable donor liver to become available
  • Patient may experience worsening symptoms of liver disease, such as fatigue, jaundice, and fluid retention
  • Patient may require hospitalization for complications of liver disease

After liver transplant:

  • Patient undergoes surgery to remove the diseased liver and replace it with a healthy donor liver
  • Patient is closely monitored in the intensive care unit immediately after surgery
  • Patient begins a regimen of immunosuppressive medications to prevent rejection of the new liver
  • Patient undergoes frequent follow-up appointments and monitoring to assess liver function and adjust medications as needed
  • Patient may experience complications such as infection, rejection, or side effects of immunosuppressive medications
  • Patient gradually resumes normal activities and experiences improved quality of life
  • Patient may require ongoing medical care and monitoring for the rest of their life to ensure the success of the transplant.

What to Ask Your Doctor

  1. What is the success rate of liver transplants at this facility?
  2. How long is the waiting list for a liver transplant?
  3. What are the risks and potential complications of a liver transplant?
  4. What is the recovery process like after a liver transplant?
  5. How will I need to adjust my lifestyle after a liver transplant?
  6. What medications will I need to take after a liver transplant?
  7. How often will I need to follow up with my transplant team after the surgery?
  8. What are the signs of rejection or complications that I should watch out for?
  9. How long can I expect my new liver to last?
  10. Are there any alternative treatments to a liver transplant that I should consider?

Reference

Authors: Jadlowiec CC, Taner T. Journal: World J Gastroenterol. 2016 May 14;22(18):4438-45. doi: 10.3748/wjg.v22.i18.4438. PMID: 27182155