Liver Transplantation

Liver transplantation (LTx) has become an accepted clinical method in cases of end-stage or fatal acute liver diseases. The majority of LTx are performed orthotopically. Heterotopic transplantations are reserved for special indications like acute liver failure and metabolic diseases. The shortage of donor organs lead to the development of techniques like transplantation of reduced-size organs, transplantation of "split-livers" and living-related LTx. These techniques were pioneered in children but are now being used on adults as well. They (from living related donor) are the main method for LTx in Japan and Korea.

Split Liver Transplantation

Unlike reduced-size LTx, split LTx allows for optimal distribution of available liver tissue: a portion of the liver is given to an adult and another to a paediatric recipient. Generally, the middle hepatic vein is retained with the right lobe that goes to an adult, whereas the left lateral segment along with the left hepatic vein goes to a child. Splitting can be done in situ at the donor center or ex vivo, usually at the recipient center. The in situ technique seems to be associated with the best results. Although there is no large series yet of split LTx between two adults, it seems that one liver can provide sufficient parenchymal mass for two adult recipients.

Living Related Liver Transplantation

Removing a liver lobe from a living donor is a more complex surgery than donor nephrectomy. In experienced centers, living related LTx is now performed with excellent results. In addition, the elective nature of the procedure allows it to be performed at the best time for both the recipient and the donor, which may have a positive influence on outcomes.

Today (2007) around 11.000 to 13.000 LTx are performed worldwide each year.

Liver transplantation is the only hope for many chronic liver patients with end stage liver disease. However in the US alone there are currently 17,000 patients on the waiting list for liver transplantation. Adult-to-adult liver transplantation from a living donor is increasingly performed in the United States but is concentrated in a few large-volume centers. In a study 449 adult-to-adult transplantations of partial livers from living donors were performed in 42 centers. Fourteen centers had performed more than 10 such transplantations each and together accounted for 80 percent of such transplantations. These centers also performed more transplantations of livers from cadaveric donors and more transplantations from living donors in children than other centers.

15-20 liver transplantations / Mio Inhabitants would be enough to fulfil the need for donor livers of non-malign liver diseases in the final stadium. Today, developed countries are able to obtain 20 to 40 donors per million inhabitants per year and countries close to Brazil, such as Argentina and Chile, achieve a rate of 10 to 12 donors per million inhabitants per year.

Liver Transplant Centres

The number of liver transplant centres varies from country to country enormously. More important than just the number however is the experience the liver transplant centres have. Liver transplantation is a huge logistic project and a very special surgical procedure.

Liver Transplant was first attempted for the first time in India in the year 1995 at the AIIMS, New Delhi though this was unsuccessful. Up to now LTx is performed in only about 10 centres in India with their total experience amounting to about 250 liver transplants (2007).

Hospitals which have attempted liver transplants without reported success

• AIIMS New Delhi
• Sir Ganagaram Hospital- Delhi
• SGPGI- Lucknow
• Stanley Medical College- Chennai

Hospitals which have had one success each (some had teams coming in from abroad)

• Jaslok Hospital- Mumbai
• St John's Hospital- Bangalore
• CMC Hospital- Vellore
• Sri Ramachandra Medical College & Research Institute

Hospitals performing LTx

• Apollo hospital- Chennai
• Global Hospitals - Hyderabad
• Indraprastha Apollo Hospitals (Delhi)More than 20 Liver transplantation have been carried out till date. more...
  Apollo Hospital in New Delhi is the world's fourth-largest hospital, is well stocked with high-technology medical equipment from abroad.
• Sir Ganga Ram Hospital (Delhi). more...

Contact us regarding "Liver Transplantation"
or call Tilo Stolzke at +49 451 400 83 01 directly.

Studies and Publications on Chronic Liver Disease

• Pegylated interferon-alpha2a/ribavirin treatment of recurrent hepatitis C after liver transplantation.
  Dinges S, Morard I, Heim M, Dufour JF, Müllhaupt B, Giostra E, Clavien PA, Mentha G, Negro F. Transpl Infect Dis. 2009 Feb.
• "State of the Art" in Liver Resection and Living Donor Liver Transplantation: A Worldwide Survey of 100 Liver Centers.
  Breitenstein S, Apestegui C, Petrowsky H, Clavien PA. World J Surg. 2009 Jan 27.
• Abdominal drains in liver transplantation: useful tool or useless dogma? A matched case-control study.
  de Rougemont O, Dutkowski P, Weber M, Clavien PA. Liver Transpl. 2009 Jan.

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