A variety of liver diseases can lead to end-stage liver disease. There are generally two main categories: those cases caused by viruses (Hepatitis B and C) and/or alcohol and those caused by problems concerning the bile ducts (primary biliary cirrhosis and primary sclerosing cholangitis). There are other causes of end-stage liver disease, but they are less frequent.

Acute fulminant hepatic failure is also an indication for transplant in selected cases.

Liver transplantation is obviously the most attractive therapeutic option for HCC in selected cases.

Child’s C and selected cases of child’s B cirrhotics and patients who develop Spontaneous bacterial peritonitis, Hepatorenal Syndrome, Encephalopathy, recurrent GI bleeding & signs of portal hypertension should be transplanted as soon as possible.

In cadaveric (Deceased Donor) liver transplantation – DDLT, the donor may be a victim of an accident, haemorrhage or head injury. The donor’s heart is still beating but the brain has stopped functioning.

Donor livers can also be obtained from a family member who donates a portion of his/her liver to the patient (Living Donor Liver Transplant – LDLT). Liver has amazing power of regeneration and after LDLT liver regenerates, in both, donor and recipient. Depending on the age and weight of the patient either right or left lobe of the liver is removed from the donor. The volume of the residual liver in the donor is very crucial.

Blood group and body weight are matched. HLA typing is not necessary as in case of kidney transplant.

1 year survival of 80-90% and 4 yr survival of 75-80% is well established.

After transplantation average hospital stay is about 3 weeks. This varies depending on the condition of the patient at the time of transplant, extent of portal hypertension, extent of coagulopathy and occurrence of the infective complication.

After initial three months most of the patients get back to their routine activity. They need precautions and immunosuppression as for any other transplant patient. Liver is an immune privileged organ and needs less immonosuppression.

During surgery – Bleeding

Two of the most common complications following liver transplantation are:

Rejection. About 70% of all liver-transplant patients have some degree of organ rejection prior to discharge. Antirejection medications are given to ward off the immune attack.

Infection. Because antirejection drugs that suppress immune system are needed to prevent the liver from being rejected, patient is at increased risk for infections. This problem diminishes as time passes. Not all patients have problems with infections, and most infections can be treated successfully as they occur.

Biliary leak / stricture