NationMaster - Encyclopedia: Liver transplantation

Liver transplantation or hepatic transplantation is the replacement of a diseased liver with a healthy liver allograft. The most commonly used technique is orthotopic transplantation, in which the native liver is removed and the donor organ is placed in the same anatomic location as the original liver. Liver transplantation nowadays is a well accepted treatment option for end-stage liver disease and acute liver failure. The liver is an organ in some animals, including mammals (and therefore humans), birds, and reptiles. ... An allograft is a transplanted organ or tissue from a genetically non-identical member of the same species. ...

History

The first human liver transplant was done in 1963 by Dr. Thomas Starzl of Denver, Colorado, United States, and by Sir Roy Calne of the University of Cambridge, United Kingdom. Dr. Starzl performed several additional transplants over the next few years before the first short-term success was achieved in 1967 with the first one-year survival posttransplantation. Despite the development of viable surgical techniques, liver transplantation remained experimental through the 1970s, with one year patient survival in the vicinity of 25%. The introduction of cyclosporine by Sir Roy Calne markedly improved patient outcomes, and the 1980s saw recognition of liver transplantation as a standard clinical treatment for both adult and pediatric patients with appropriate indications. Liver transplantation is now performed at over one hundred centers in the USA, as well as numerous centers in Europe and elsewhere. One year patient survival is 85-90%, and outcomes continue to improve, although liver transplantation remains a formidable procedure with frequent complications. Unfortunately, the supply of liver allografts from non-living donors is far short of the number of potential recipients, a reality that has spurred the development of living donor liver transplantation. 1963 (MCMLXIII) was a common year starting on Tuesday (the link is to a full 1963 calendar). ... Thomas Starzl was a pioneer in transplant surgery and has often been referred to as the modern-day father of transplantation. ... Nickname: The Mile-High City Location of Denver in Colorado Coordinates: Country United States State Colorado City-County Denver (coextensive) Founded November 22, 1858 Incorporated November 7, 1861 - Mayor John Hickenlooper (D) Area - City 401. ... Sir Roy Calne is a fellow of the Royal Society. ... The University of Cambridge, located in Cambridge, England, is the second-oldest university in the English-speaking world, with a reputation as one of the worlds most prestigious universities. ... 1967 (MCMLXVII) was a common year starting on Sunday of the Gregorian calendar (the link is to a full 1967 calendar). ... The 1970s decade refers to the years from 1970 to 1979, inclusive. ... Ciclosporin (INN), cyclosporine or cyclosporin (former BAN), is an immunosuppressant drug. ... The 1980s refers to the years of 1980 to 1989. ... An allograft is a transplanted organ or tissue from a genetically non-identical member of the same species. ... Living donor liver transplantation (LDLT) has emerged in recent decades as a critical surgical option for patients with end stage liver disease, such as cirrhosis and/or hepatocellular carcinoma often attributable to one or more of the following: long-term alcohol abuse, long-term untreated Hepatitis C infection, long-term...

Indications

Liver transplantation is potentially applicable to any acute or chronic condition resulting in irreversible liver dysfunction, provided that the recipient does not have other conditions that will preclude a successful transplant. Metastatic cancer outside liver, active drug or alcohol abuse and active septic infections are absolute contraindications. While infection with HIV was once considered an absolute contraindication, this has been changing recently. Advanced age and serious heart, pulmonary or other disease may also prevent transplantation (relative contraindications). Most liver transplants are performed for chronic liver diseases that lead to irreversible scarring of the liver, or cirrhosis. Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrotic scar tissue as well as regenerative nodules, leading to progressive loss of liver function. ...

Techniques

Before transplantation liver support therapy might be indicated (bridging-to-transplantation). Artificial liver support like liver dialysis or bioartificial liver support concepts are currently under preclinical and clinical evaluation. Virtually all liver transplants are done in an orthotopic fashion, that is the native liver is removed and the new liver is placed in the same anatomic location. The transplant operation can be conceptualized as consisting of the hepatectomy (liver removal) phase, the anhepatic (no liver) phase, and the postimplantation phase. The operation is done through a large incision in the upper abdomen. The hepatectomy involves division of all ligamentous attachments to the liver, as well as the common bile duct, hepatic artery, and portal vein. Usually, the retrohepatic portion of the inferior vena cava is removed along with the liver, although an alternative technique preserves the recipient's vena cava ("piggyback" technique). After the hepatectomy is accomplished, the allograft liver is implanted. This involves anastomoses (connections) of the inferior vena cava, portal vein, and hepatic artery. After blood flow is restored to the new liver, the biliary (bile duct) anastomosis is constructed, either to the recipient's own bile duct or to the small intestine. The surgery usually takes between five and six hours, but may be longer or shorter due to the difficulty of the operation and the experience of the surgeon. Liver dialysis or artificial extracorporeal liver support is a detoxification treatment for liver failure and has shown promise for patients with hepatorenal syndrome. ...

The large majority of liver transplants use the entire liver from a non-living donor for the transplant, particularly for adult recipients. A major advance in paediatric liver transplantation was the development of reduced size liver transplantation, in which a portion of an adult liver is used for an infant or small child. Further developments in this area included split liver transplantation, in which one liver is used for transplants for two recipients, and living donor liver transplantation, in which a portion of healthy person's liver is removed and used as the allograft. Living donor liver transplantation for pediatric recipients involves removal of approximately 20% of the liver (Couinaud segments 2 and 3). Living donor liver transplantation (LDLT) has emerged in recent decades as a critical surgical option for patients with end stage liver disease, such as cirrhosis and/or hepatocellular carcinoma often attributable to one or more of the following: long-term alcohol abuse, long-term untreated Hepatitis C infection, long-term...

Immunosuppressive management

Like all other allografts, a liver transplant will be rejected by the recipient unless immunosuppressive drugs are used. The immunosuppressive regimens for all solid organ transplants are fairly similar, and a variety of agents are now available. Most liver transplant recipients receive corticosteroids plus either tacrolimus or Cyclosporin. Transplant rejection occurs when the immune system of the recipient of a transplant attacks the transplanted organ or tissue. ... Immunosuppression is the medical suppression of the immune system. ... In physiology, corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. ... Tacrolimus (also FK-506 or Fujimycin) is a 23-membered macrolide lactone discovered in 1984 from the fermentation broth of a Japanese soil sample that contained the bacteria Streptomyces tsukubaensis. ... ...

Liver transplantation is unique in that the risk of chronic rejection also decreases over time,although recipients need to take immunosuppresive medication for the rest of their lives.It is theorized that the liver may play a yet-unknown role in the maturation of certain cells pertaining to the immune system. There is at least one study by Dr. Starzl's team at the University of Pittsburgh which consisted of bone marrow biopsies taken from such patients which demonstrate genotypic chimerism in the bone marrow of liver transplant recipients. A scanning electron microscope image of a single human lymphocyte. ... The University of Pittsburgh is a state-related, doctoral/research university in Pittsburgh, Pennsylvania. ... Grays Anatomy illustration of cells in bone marrow. ... A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... In zoology, a chimera is an animal which has (at least) two different populations of cells, which are genetically distinct and which originated in different zygotes (fertilised eggs). ...

Results

Prognosis is quite good. 1-year survival (in Finland) is 83%, 5-year survival is 76% and 10-year survival is 66%. Majority of deaths happen during the first three months after transplantation.

Living donor transplantation

Living donor liver transplantation (LDLT) has emerged in recent decades as a critical surgical option for patients with end stage liver disease, such as cirrhosis and/or hepatocellular carcinoma often attributable to one or more of the following: long-term alcohol abuse, long-term untreated Hepatitis C infection, long-term...

References

External links

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Organ transplants

Types of Transplants: Allograft - Alloplant - Allotransplantation - Autotransplantation - Xenotransplantation Transplant redirects here. ... An allograft is a transplanted organ or tissue from a genetically non-identical member of the same species. ... Alloplant is an experimental, chemically processed biomaterial used for transplantation. ... The transplantation of organs between members of the same species. ... Autotransplantation is the transplantation of tissue from one part of the body to another in the same individual. ... Xenotransplantation is the transplantation of cells, tissues or organs from one species to another such as from pigs to humans. ...

Tissue and Organs Transplanted: Organ transplant - Bone grafting - Bone marrow - Corneal - Face - Hand - Heart - Heart-Lung - Kidney - Liver - Lung - Pancreas - Penis - Skin grafting - Spleen - Uterus Transplant redirects here. ... Bone grafting is a surgical procedure where bone is taken from a donor site and implanted into the patient. ... Bone marrow transplantation or hematopoietic stem cell transplantation (HSCT) is a medical procedure in the field of hematology and oncology that involves transplantation of hematopoietic stem cells (HSC). ... Cornea Transplant Another Cornea Transplant, approximately one week after surgery. ... A face transplant is a skin graft that involves replacing part or all of a patients face with a donor face. ... Hand transplantation is a surgical procedure to transplant a hand from one human to another. ... Diagram illustrating the placement of a donor heart in an orthotopic procedure. ... A heart-lung transplant is a procedure carried out to replace both heart and lungs in a single operation. ... The donor kidney is typically placed inferior of the normal anatomical location. ... An organ transplant is the transplantation of a whole or partial organ from one body to another (or from a donor site on the patients own body), for the purpose of replacing the recipients damaged or failing organ with a working one from the donor site. ... A pancreas transplant is an organ transplant that involves implanting a healthy pancreas (one that can produce insulin) into a person who has diabetes. ... Penis transplantation is a surgical transplant procedure in which a replacement penis, either one grown artificially (untested in humans) or from a deceased human donor (allograft), is transplanted onto a patient. ... Skin grafting is a type of organ transplant involving the transplantation of skin. ... There are very few or no other articles that link to this one. ... History For many years, organ transplantation has been a medical and surgical challenge. ...

Related issues: Cellular memory - Biomedical tissue - Edmonton protocol - Eye bank - Graft-versus-host disease - Immunosuppressive drugs - Islet cell transplantation - Living donor liver transplantation - Lung allocation score - Machine perfusion - Medical grafting - Non-heart beating donation - Organ donation - Post-transplant lymphoproliferative disorder - Total body irradiation - Transplant rejection Cellular memory is the unproven hypothesis that such things as memories, habits, interests, and tastes may somehow be stored in all the cells of human bodies, and not only in the brain. ... This article or section does not cite its references or sources. ... The Edmonton Protocol is a method of implantation of pancreatic islets for the treatment of diabetes. ... Eye banks retrieve and store eyes for cornea transplants and research. ... Graft-versus-host disease is a common complication of allogeneic bone marrow transplantation. ... For a list of immunosuppressive drugs, see the transplant rejection page. ... Microscopic image of an islet of Langerhans (lighter area) surrounded by exocrine pancreas tissue (darker staining) Islet transplantation is the transplantation of islets from a donor pancreas and into another person. ... Living donor liver transplantation (LDLT) has emerged in recent decades as a critical surgical option for patients with end stage liver disease, such as cirrhosis and/or hepatocellular carcinoma often attributable to one or more of the following: long-term alcohol abuse, long-term untreated Hepatitis C infection, long-term... The lung allocation score or LAS is a numerical value used by the United Network for Organ Sharing (UNOS) to assign relative priority for distributing donated lungs for transplantation within the United States. ... Machine perfusion (MP) is a technique used in organ transplantation as a means of preserving the organs which are to be transplanted. ... In medicine, grafting is a surgical procedure to transplant tissue without a blood supply. ... Introduction Prior to the introduction of brain-stem death into law in the mid to late 1970s, all organ transplants from cadaveric donors came from non-heart beating donors (NHBD). ... Organ donation is the removal of specific tissues of the human body from a person who has recently died, or from a living donor, for the purpose of transplanting or grafting them into other persons. ... Post-transplant lymphoproliferative disorder (PTLD) is the name given to a group of B cell lymphomas occurring in immunosuppressed patients following organ transplant. ... Total Body Irradiation (TBI) is a radiotherapy technique used to ablate the bone marrow and immune system prior to bone marrow transplantation or peripheral blood stem cell transplantation. ... Transplant rejection occurs when the immune system of the recipient of a transplant attacks the transplanted organ or tissue. ...

Organizations related to Transplants: Human Tissue Authority - National Marrow Donor Program - United Network for Organ Sharing The Human Tissue Authority is a UK public body created by the Human Tissue Act 2004. ... The National Marrow Donor Program (NMDP) is a nonprofit organization based in Minneapolis, Minnesota, that operates the largest national registry of volunteer hematopoietic cell donors in the United States. ... Located in Richmond, Virginia, the United Network for Organ Sharing (UNOS) is a non-profit, scientific and educational organization that administers the nations only Organ Procurement and Transplantation Network (OPTN), established by the U.S. Congress in 1984. ...

People related to transplants: Christiaan Barnard - Isabelle Dinoire - Jean-Michel Dubernard - Gregory Scott Johnson - List of notable organ transplant donors and recipients Christiaan Neethling Barnard (November 8, 1922 â€“ September 2, 2001) was a South African cardiac surgeon. ... Isabelle Dinoire, born 1967, was the first person to undergo a partial face transplant, after her dog mauled her in May 2005. ... Jean-Michel Dubernard is a medical doctor specializing in transplant surgery, as well as a Deputy in the current French National Assembly. ... Gregory Scott Johnson was legally executed for murder in 2005 for having beaten and stomped his 82-year-old neighbor, Ruby Hutslar, to death in 1985. ... This list of notable organ transplant donors and recipients includes people who were the first to undergo certain organ transplant procedures or were people who made significant contributions to their chosen field and who have either donated or received an organ transplant at some point in their lives, as confirmed...

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