Advanced Liver-Biliary Pancreatic & Surgical Clinic
Liver Transplantation
Liver transplantation is a surgical procedure in which a diseased or failing liver is replaced with a healthy liver from a donor. It is typically recommended for individuals with end-stage liver disease, acute liver failure, or certain liver cancers when other treatments are no longer effective.
Indications for Liver Transplantation
Liver transplantation is a life-saving procedure for patients with irreversible liver disease or liver-related complications. Traditional indications include:
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End-stage liver disease (cirrhosis with complications)
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Acute liver failure
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Hepatocellular carcinoma (meeting Milan/UCSF criteria)
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Autoimmune liver diseases (e.g., primary sclerosing cholangitis, primary biliary cholangitis)
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Metabolic liver disorders (e.g., Wilson’s disease, Alpha-1 Antitrypsin Deficiency)
Newer Indications for Liver Transplantation
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Cholangiocarcinoma (selected cases) – Patients following neoadjuvant therapy.
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Hepatic Epithelioid Hemangioendothelioma (HEHE) – Rare liver vascular tumors.
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Neuroendocrine Liver Metastases (NELM) – Highly selected cases with liver-only disease.
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Colorectal Liver Metastases (Experimental cases) – Undergoing clinical trials.
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Acute-on-Chronic Liver Failure (ACLF) – An emerging indication for transplantation.
Types of Liver Transplantation
Deceased Donor Liver Transplant (DDLT) ( Restricted only to public sector hospitals)
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The liver is obtained from a brain-dead donor.
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Can be performed as:
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Whole liver transplant – The entire liver is transplanted.
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Split liver transplant – The liver is divided and used for two recipients (usually an adult and a child).
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Living Donor Liver Transplant (LDLT)\
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A portion of the liver is transplanted from a living donor to the recipient
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Types of LDLT:
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Right lobe liver transplant – More commonly used for adult recipients.
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Left lobe liver transplant – Often used for children or small adults.
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Left lateral segment transplant – Used mainly for pediatric recipients.
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Extended right lobe transplant – Includes the right lobe with middle hepatic vein
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Auxiliary Liver Transplantation
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A portion of a healthy liver is transplanted, while the recipient’s diseased liver remains.
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Used for acute liver failure where liver regeneration is expected.
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Variants:
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Auxiliary Partial Orthotopic Liver Transplantation (APOLT) – Part of the donor liver supports the recipient’s native liver.
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Heterotopic Auxiliary Liver Transplant – The donor liver is placed in another location, keeping the native liver.
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Special types of Liver Transplantation
ABO-Incompatible Liver Transplantation
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Liver transplant between incompatible blood groups.
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Requires special treatments (e.g., plasmapheresis, rituximab) to prevent rejection.
Dual Graft Liver Transplantation
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Two partial liver grafts (from two living donors or one living and one deceased donor) are used for a single recipient.
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Performed when one donor graft is too small for the recipient.
Auxiliary Partial Liver Transplant for Metabolic Disorders
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Used for genetic liver diseases (e.g., urea cycle disorders).
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Provides functional donor liver while preserving part of the native liver
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Special types of Liver Transplantation
ABO-Incompatible Liver Transplantation
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Liver transplant between incompatible blood groups.
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Requires special treatments (e.g., plasmapheresis, rituximab) to prevent rejection.
Dual Graft Liver Transplantation
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Two partial liver grafts (from two living donors or one living and one deceased donor) are used for a single recipient.
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Performed when one donor graft is too small for the recipient.
Auxiliary Partial Liver Transplant for Metabolic Disorders
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Used for genetic liver diseases (e.g., urea cycle disorders).
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Provides functional donor liver while preserving part of the native liver
Liver Transplant Variants in Specific Conditions
Liver Transplant for Hepatocellular Carcinoma (HCC)
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Used in patients meeting Milan or UCSF criteria.
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Can be performed with bridging therapies before transplant.
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Liver Transplant for Acute Liver Failure
Emergency liver transplantation in patients with fulminant liver failure.
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Liver Transplant for Metabolic Liver Diseases
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Used in conditions like Wilson’s disease, Crigler-Najjar syndrome, and urea cycle disorders.
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Liver Transplant for Cholestatic Liver Diseases
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Used in primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and biliary atresia.
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Severe Polycystic Liver disease
Liver Transplant for Emerging Indications
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Colorectal Liver
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Hilar cholangiocarcinoma (Bile duct cancer)
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Hepatic Epithelioid Hemangioendothelioma (HEHE)
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Neuroendocrine Liver Metastases (NELM)
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Fibrolamellar Hepatocellular Carcinoma (FLC)
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Cystic Liver Tumors Hepatoblastoma (Children)
