Liver transplantation has evolved significantly since the first attempts in the 1960s. There are now over 26,000 liver transplants performed worldwide annually. Techniques include orthotopic replacement of the native liver, auxiliary transplantation which leaves part of the native liver, and split or reduced liver transplants which use portions of livers to help multiple recipients. Living donor transplants and domino transplants also increase organ availability. While transplantation success rates are over 90% in many countries, the need for liver transplants in India and other parts of Asia far exceeds the number that can currently be performed.

1. Liver Transplantation
Lecture one : Dr Md AB QUIYUM

2. Liver Transplant History
• the first attempts of LT…. ……dogs.
first attempted human LT… 1963 by Thomas Starzl, although the
(pediatric patient died intraoperatively due to uncontrolled
bleeding).[2azathioprine prednisolone
1967, when Starzl transplanted a 19 month old girl with hepatocellular
carcinoma who was able to survive for over 1 year before dying of
metastatic diseas.
LDLT …late 1980 …paediatric waiting list
OTLT …1980…cyclosporine
1990….tAcrolimus

3. • Annualy >6000 LT in USA & Europe 1 y sr > 90%
• Worldwide >26000 WhO
• The first deceased donor liver transplant (DDLT) in India was done in 1995
and was unsuccessful. This was followed by a few unsuccessful attempts
until the first successful DDLT in 1998 and shortly thereafter by the first
successful Living donor liver transplant (LDLT) in November 1998 both
performed by Rajashekar (1).
• At present, the need for liver transplantation in India is estimated to be
around 20/million population (or 25,000 LT per year). The current rate of LT
performed in India is around 1.2/million population. Around 1200 and
1400 LT have been performed in India in the years 2013 and 2014,
respectively

4. • 30 lakh
• At Rs 20-30 lakh, transplant of liver available only to rich. Less than 2% of
liver transplants taking place in India happen in public institutions.Jan 22,
2016
• Prof Ali said it takes Tk 35-50 lakh for a liver transplantation in Bangladesh,
which in Singapore costs Tk 2.5 crore and in India around Tk 70 lakh. At
present eight patients are awaiting liver transplantation in Birdem, he
added.Aug 28, 2011
• A large number of patients from Bangladesh go to India for liver
transplantation and other liver-related surgeries. Over 150 liver
transplants have been done on Bangladeshi patients by Dr Gupta's team,
according to the hospital.

5. Steve jov
Famous liver transplant recipients
•Eric Abidal (born 1979), French footballer (Olympique Lyonnais, FC Barcelona), transplant in 2012
•
•George Best (1946-2005), Northern-Irish footballer (Manchester United), transplant in 2002 (survival: 3 years)
•Steve Jobs (1955-2011), American businessman (Apple Inc.), transplant in 2009 (survival: 2 years)

6. Liver transplant anatomy

7. Liver segments

9. Portal vein

10. Hepatic artery

12. Hepatic vein & IVC

13. MHV controversy

14. Biliary tree

16. Type of transplant

17. Domino
• Domino liver transplants are a way to use livers removed from recipients
in liver transplant to benefit others. This allows two patients to benefit
from a single liver graft as the second patient receives a liver removed
from the first patientThis is possible in certain conditions where the first
patient has a disease like maple syrup urine disease or familial amyloid
polyneuropathy where the only problem in the liver is reduced or absent
production of an enzyme due to a genetic effect. Such livers are
structurally and functionally normal except for one enzyme deficiency and
have no cirrhosis that could increase risk of malignancy in the liver. The
first patient receives a liver from a normal person so that the enzyme
starts getting produced in the donor liver and is therefore cured. His liver
is used to save life of a person with severe life threatening cirrhosis whose
own liver has failed. This domino liver restores his liver function in the
second patient and the metabolic defect even if persistent can be
managed by dietary management as it is not life threatening. Two birds
with one stone err liv.

18. Axillary
• Auxiliary partial orthotopic liver
transplantation (A-OLTX) is a
procedure whereby only a portion
of the native liver is removed, and
the remainder of the native liver is
left in situ. A-OLTX provides
temporary support until the native
liver recovers and
immunosuppression can be
withdrawn.
• Used in acute / fulminant hepatic
failure.

19. Split LT
• split-liver transplantation (SLT) involves the division of donor
liver from a deceased adult between a pediatric recipient
and an adult recipient to maximize the benefit of each
available donor organ. minimise paediatric waiting list
mortality. Two main types of split liver transplantation have
to be distinguished. First there is the'classical' split, to
achieve a right extended graft (segments I, IV–VIII) and a left
lateral graft (segments II and III), for one adult and one small
paediatric recipient. Secondly liver splitting along the line of
Cantilie resulting in one right (segments V–VIII) and one left
(segments I–IV) hemi-liver to supply two adult recipients can
be performed

20. Reduced LT
• Reduced-size hepatic transplantation (RSHT) was
developed to alleviate the mortality resulting from
the scarcity of suitable cadaveric grafts. RSHT
consists of various techniques that reduce a full
liver to a smaller size. These techniques include
reduced-size cadaveric liver transplantation (RLT),
split liver transplantation (SLT), and living-related
liver transplantation (LRLT). RLT utilizes part of a
liver, while the rest is discarded; in SLT, the whole
liver is used for two recipients after bipartition;
and in LRLT, a portion of the liver retrieved from a
living donor is transplanted. Whereas RLT only
redistributes the pool of organs to the advantage
of pediatric recipients, both SLT and LRLT increase
the availability of grafts for transplantation. RSHT
yields results comparable to full-liver allografting
and drastically reduces the mortality of patients
waiting for transplantation.

21. ortho
• orthotopic transplantation, in
which the native liver is
removed and replaced by the
donor organ in the same
anatomic position as the original
liver.

22. heterotropic
• isadvantages of OLT still remain, e.g., patients with
advanced chronic liver disease often present with a
combination of portal hypertension, abundant
venous collaterals, and severe clotting
disturbances, which makes dissection and removal
of the host liver difficult to perform.
Intraoperative, the OLT recipient is challenged by a
decreased cardiac output, which is further
compromised by the decreased venous return
during the anhepatic phase unless a venovenous
bypass is used. Furthermore, in patients with acute
liver failure, the extra operative stress endured
during removal of the native liver may threaten the
patient’s recovery. In contrast, heterotopic liver
transplantation (HLT) can avoid these problems, in
particular when the host liver preserves
biosynthetic and clearance functions or when the
potential for recovery after acute liver failure is
present. Initial results of the HLT performed either
in animals in 1950s or in patients in 1960s were,
however, very disappointing due to inadequate
techniques and ineffective immunosuppression

23. Salvage LT

24. Terminology
• 1.Graft
• 2.orthotopic
• 3.Heterotopic
• 4.procurement
• 5.primary graft disfunction
• 6.Retransplantation
• 7.Salvage transplantation
• 8.Post transplant metabolic syndrome
• 9.small for size
• 10.Artificial liver support
• 11.Rapid study.