Liver transplantation involves replacing a diseased liver with a healthy liver allograft, predominantly through orthotopic transplantation. This procedure has evolved since the early experiments in the 1960s, with advancements in techniques improving survival rates for recipients. Key considerations include patient eligibility, scoring systems for assessing liver function, and potential complications for both donors and recipients.

1. Liver
Transplantation
BY:
IMRAN QAISAR
AAMIR RAZA
AQSA SHAHZADI
ZEESHAN AKRAM
SALMAN RAMEEZ UR REHMAN
M.UMER FAROOQ

2. The Liver
▪ The largest single organ in the human
body.
▪ In an adult, it weighs about 1.5 Kg and is
roughly the size of a football.
▪ Located in the upper right-hand part of the
abdomen, behind the lower ribs.

3. What does the liver do?
Multi-function, blood-processing “factory”
• Temporary nutrient storage (glucose-glycogen)
• Remove toxins from blood
• Remove old/damaged RBC’s
• Regulate nutrient or metabolite levels in blood—keep constant
supply of sugars, fats, amino acids, nucleotides (including
cholesterol)
• Secrete bile via bile ducts and gall bladder into small intestines.

4. What is liver Transplantation
▪ Liver Transplantation is the replacement of a diseased liver with a healthy
liver allograft.
▪ Used technique is orthotropic transplantation, in which the native liver is
removed and replaced by the donor organ in the same anatomic location as
the original liver.

5. Brief History
▪ Liver replacement in more than 150 dog experiments
between 1958-61
▪ Between March 1 and October 4, 1963, Starzl attempted
5 human liver replacements. The first patient bled to
death during the operation. The other 4 died after 6.5 to
23 days with functioning grafts
▪ Julie Rodriguez, the child sitting on the knee of the
Swedish surgeon, Carl Groth (Figure), became the first
human liver recipient with survival exceeding one year.
▪ Despite the development of viable surgical techniques,
liver transplantation remained experimental through the
1970s, with one year patient survival in the vicinity of
25%.

6. Why Liver Transplant ???

7. Reasons of Liver transplant

8. LIVER FUNCTION TESTS
▪ LFT (Liver Function Test)
▪ ALT (Alanine Transaminase enzyme)
▪ AST (SGOT) (Aspartate Aminotransferase Test)
▪ ALKALINE PHOSPHATASE
▪ BILIRUBIN
▪ PROTHROMBIN TIME/INR (measures how long it takes blood to clot)
▪ ALBUMIN

9. Acute Liver Disease
▪ Infections
▪ Viral Hepatitis A, B, C, D, E, EBV, CMV, HSV,
▪ Others – Leptospirosis, Toxoplasma,
▪ Drugs – MANY – HERBALS/OTC
▪ Alcohol
▪ Toxins
▪ Vascular obstruction (eg. Budd-Chiari)
(Blockage of a blood vessel)

10. Chronic Liver Disease
▪ Alcohol
▪ Viral hepatitis: B & C
▪ Autoimmune – autoimmmune hepatitis, PBC (Primary Biliary cirrhosis), PSC
(Primary Sclerosing Cholangitis)
▪ Non-alcoholic fatty liver disease (NAFLD)
▪ Drugs (MTX, amiodarone)
▪ Haemochromatosis
▪ Cystic fibrosis, a1antitryptin deficiency, Wilsons disease,
▪ Vascular problems (Portal hypertension + liver disease)
▪ Cryptogenic (Disease whose cause is unkown)
▪ Others: sarcoidosis, amyloid, schistosomiasis

11. Global number of organ transplant

12. When Liver Transplantation
Issues
▪ Whether patient needs LT?
▪ When to refer or consider for LT?
▪ Is patient suitable for LT?

13. Scoring systems
CHILD-TURCOTTE - PUGH SCORE
Measure 1 point 2 points 3 points
Total Bilirubin (mg/dl) < 2 2-3 >3
Serum albumin (g/dl) >3.5 2.8-3.5 <2.8
INR <1.7 1.71-2.3 > 2.3
Ascites None Slight/Suppressed with
medication
Moderate despite
diuretics/Refractory
Hepatic encephalopathy None Grade I-II Grade III-IV
CTP score:
- Disease severity for pts with ESLD
- Used to predict peri-operative mortality in patients with liver disease.

14. Model for End-Stage Liver Disease (MELD)
▪ MELD score = 0.957 x Loge (creatinine mg/dl) + 0.378 x Loge (bilirubin mg/dl) + 1.12
x Loge (INR) + 0.643
Multiply the score by 10 and round to the nearest whole number
▪ Established in Feb 2002
▪ Numerical scale, from 6 (less ill) to 40 (gravely ill)
▪ This ‘score’ tells us how urgently LT is required within next 3 months
▪ Most patients on LT waiting list have MELD score between 11 and 20

15. Living related liver transplant
: Donor requirements
▪ Unsolicited volunteer
▪ Family member (not necessarily blood relative)
▪ No clear medical contra-indications
▪ Size appropriate
▪ ABO matched (Blood group system)
▪ Age <50
▪ Normal liver, HIV negative (Human immuno deficiency virus)

16. Donor problems
▪ Biliary complications (Liver Blood vessels) 6%
▪ Re-operation 5%
▪ Death <0.3%
▪ Mean ICU Stay 0.5 days
▪ Hospital Stay 6.4 days
Brown et al. AASLD 2001

17. Recipient Issues
▪ Re-transplant rate 2.5%
▪ Acute liver Failure (Complete dead) 2%
▪ Biliary complications 23%
▪ Arterial complications 8%
Brown et al. AASLD 2001

18. Recipient Issues
Points Class Life expectancy Perioperative mortality
5-6 A 15-20 years 10%
7-9 B Candidate for
transplant
30%
10-15 C 1-3 months 82%
Shortcomings of CTP scores
• Subjective nature of the assessment of ascites & encephalopathy
• Limited discrimination into only three disease severity categories

19. Infection post Transplant
▪ Week 1
▪ Hepatic Artery thrombosis
▪ Portal Vein thrombosis
▪ Infections (Bacterial/Viral/Fungal)
▪ Drug toxicity
▪ Renal Impairment
▪ Acute cellular rejection
▪ Month 1
▪ Nosocomial infection (Hospital acquired infections)
▪ Bacteria and fungi
▪ 19-28% of patients have bacteremia Staph, Enterococcus (50-60%)

20. Patient Survival rate
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1 3 5 7 9 11 13 15
1985-1989
1990-1994
1995-1999
2000-2004
2005
Years post transplant
Survival(%)

21. Causes of Death
Operative 4% Resp 5%
Cerebrovasc 9% Cardio 9%
Gastro 3% Sepsis 19%
Recurrent HCC 10% De novo malignancy 8%
Graft failure 24% Misc 9%
ANZLT registry 2006.

22. Bibliography
http://www.starzl.pitt.edu/transplantation/organs/liver.html