Chapter 89 Liver Transplantation

Primary hepatic malignancy is more common in patients with cirrhosis, especially viral-induced liver disease and non-alcoholic fatty liver disease (NAFLD), and may be best treated by transplantation when advanced liver disease precludes liver resection because of the risk of postoperative liver failure or when the tumour is multifocal as a result of field changes in the cirrhotic liver that predispose to recurrence or further primary malignancies. Potential candidates undergo a comprehensive multidisciplinary assessment, including hepatologists, transplant surgeons, anaesthetists, specialist nurses in liver transplantation (LT), drug and alcohol rehabilitation services, dietician, psychologists and specialists from other clinical disciplines where indicated. After total hepatectomy the implantation starts by placing the liver graft in the orthotopic position. Auxiliary LT involves implanting a healthy liver graft placed either heterotopically or orthotopically while leaving all or part of the native liver intact.

Advanced Learning Content
Chapter 89: Liver Transplantation
Multiple Choice Questions
Weblinks

Guidelines

https://www.bsg.org.uk/clinical-resource/adult-liver-transplantation-a-uk-clinical-guideline/ (free)

Two guidelines from the British Society of Gastroenterology giving information on the various indications of liver transplant, process of assessment of a liver transplant patient, surgical aspects and postoperative complications and outcomes.

https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/22847/pol195.pdf/ (free)

Policy document on the selection of adult and paediatric patients for liver transplant and the principles of organ allocation in the UK.

https://bts.org.uk/wp-content/uploads/2016/09/20_BTS_Liver_Non-alcoholic-1.pdf/ (free)

This comprehensive guideline provides information on the growing indications for liver transplant; namely, non-alcoholic steatohepatitis-related cirrhosis.

https://bts.org.uk/wp-content/uploads/2016/09/03_BTS_LivingDonorLiver-1.pdf/ (free)

Students will find this document an interesting read for living donor liver transplant, including aspects of ethics, legal framework and the process of living donor evaluation.

https://bts.org.uk/wp-content/uploads/2016/09/02_BTS_Antibody_Guidelines-1.pdf/ (free)

ABO-incompatible live transplant is one of the strategies to increase organ availability and this guideline gives comprehensive information on the clinical aspects of ABO-incompatible transplants.

https://bts.org.uk/wp-content/uploads/2016/09/14_BTS_CMV_3RDE-1.pdf/ (free)

Opportunistic infections are a common problem after transplantation. This guideline gives information on the prevention and management of cytomegalovirus infection after solid organ transplantation.

Databases

https://www.nhsbt.nhs.uk/

NHS Blood and Transplant website provides basic information on organ donation and transplantation, a link to registering as an organ donor and the statistics for organs donated and transplanted in the UK.

http://www.eltr.org/

European Liver Transplant Registry gives centre-specific data for liver transplants performed within Europe.

https://unos.org/

The United Network for Organ Sharing manages the national transplant waiting list in the USA and maintains the database that contains all organ transplant data for every transplant event that occurs in the USA. This website gives information on matching organs and the policies and ethics of organ donation and transplantation.

https://www.ctstransplant.org/

The Collaborative Transplant Study is a large database of transplant outcomes from more than 400 transplant centres from across 42 countries. This gives comprehensive information on a wide variety of transplantation-related problems and long-term outcomes.

Report

https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/24053/activity-report-2020-2021.pdf (free)

NHS Blood and Transplant annual activity report gives a comprehensive update about organ and tissue donors, transplant waiting lists and transplant activity for the UK for the previous financial year. Here you will find information for transplant activities in previous years.

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