LIVER TRANSPLANTATION

D. Banerjee Transplant Surgeon


Liver is an essential organ for life. It has two lobes, right and left. It is situated in the right upper abdomen of human and weighs approximately 2% of the total body weight. Liver has many functions like synthesis of proteins, production of bile and metabolism of various substances.

T E Starzl reported the first human liver transplant from University of Colorado, USA in 1963. Overcoming many setbacks in the early years, liver transplantation rapidly evolved in the 1980s to become a highly successful modality of treatment for patients with cirrhosis and fulminant hepatic failure. The causes of cirrhosis include chronic viral hepatitis, excessive alcohol intake, autoimmune disease, biliary cirrhosis, sclerozing cholangitis etc. Fulminant hepatic failure, can result from viral infection, paracetamol poisoning and other rare causes.

At present liver transplantation is a standard treatment available in many countries including some developing countries like Brazil and Israel. In India there are very few centres which have started to develop this service for liver failure patients.

The source of the organ for transplantation could either be a brainstem dead heart beating cadaver or a live person. The whole of the liver is taken out by operation from a cadaver for transplantation. From a living person only one lobe of the liver either right or left is removed by operation and implanted into the liver transplant recipient patient. Before implanting, the diseased liver of the recipient is removed. The residual liver left behind in the live donor grows in size to compensate for the loss of one lobe. As a result the donor can resume his / her normal life after recovering from the operation. However, the donor operation is not free from risks or complications.

After transplantation of the liver, complications like, rejection of the organ, infections as a result of using immunosuppressive medicines and recurrence of the previous liver disease like viral hepatities in the new liver, are not uncommon. Notwithstanding these drawbacks, outcome of liver transplants in most patients is very good compared to other therapies available. Patients who have developed liver tumours prior transplantation have a poorer outcome compared to patients with other benign diseases. With the advent of modern immuno­suppressive medications used for countering immunological rejection of transplanted organs, liver recipients can expect to live many years of useful life post transplant.