Citizendia

Intervention:
Liver transplantation
Human liver
ICD-10 code:
ICD-9 code:50.5
MeSHD016031
Other codes:

Liver transplantation or hepatic transplantation is the replacement of a diseased liver with a healthy liver allograft. The International Classification of Health Interventions (ICHI is a system of classifying Procedure codes being developed by the World Health Organization. ICD-9-CM Volume 3 is a system of Procedural codes. It is a subset of ICD-9-CM (volumes 1 and 2 are used for Diagnostic codes. Medical Subject Headings ( MeSH) is a huge Controlled vocabulary (or metadata system for the purpose of indexing journal articles and books Procedure codes are numbers or alphanumeric codes used to identify specific health interventions taken by medical professionals The liver is a vital organ in the human body and is present in Vertebrates and some other animals An allograft or allogeneic transplant or homograft is a transplant in which transplanted cells, tissues, or organs are sourced from The most commonly used technique is orthotopic transplantation, in which the native liver is removed and the donor organ is placed in the same anatomic location as the original liver. Liver transplantation nowadays is a well accepted treatment option for end-stage liver disease and acute liver failure.

Contents

History

The first human liver transplant was performed in 1963 by a surgical team led by Dr. Human beings, humans or man (Origin 1590–1600 L homō man OL hemō the earthly one (see Humus Liver transplantation or hepatic transplantation is the replacement of a diseased Liver with a healthy liver Allograft. Year 1963 ( MCMLXIII) was a Common year starting on Tuesday (link will display full calendar of the Gregorian calendar. Thomas Starzl[1] of Denver, Colorado, United States. Thomas E Starzl (born March 11, 1926) is an American physician, researcher, and is an expert on Organ transplants He performed the The City and County of Denver (pronounced /ˈdɛnvɚ/ is the Capital and the most populous city of Colorado, in the United States The United States of America —commonly referred to as the Dr. Starzl performed several additional transplants over the next few years before the first short-term success was achieved in 1967 with the first one-year survival posttransplantation. Year 1967 ( MCMLXVII) was a Common year starting on Sunday (link will display full calendar of the 1967 Gregorian calendar. Despite the development of viable surgical techniques, liver transplantation remained experimental through the 1970s, with one year patient survival in the vicinity of 25%. This article is about the Decade 1970-1979 For the Year 1970 see 1970. [2] The introduction of cyclosporine by Sir Roy Calne markedly improved patient outcomes, and the 1980s saw recognition of liver transplantation as a standard clinical treatment for both adult and pediatric patients with appropriate indications. Ciclosporin (ˌsaɪkləˈspɔrən cyclosporine ( USAN) or cyclosporin (former BAN) is an Immunosuppressant drug widely The 1980s was the decade spanning from January 1 1980 to December 31 1989. Liver transplantation is now performed at over one hundred centres in the USA, as well as numerous centres in Europe and elsewhere. The United States of America —commonly referred to as the One year patient survival is 85-90%, and outcomes continue to improve, although liver transplantation remains a formidable procedure with frequent complications. Unfortunately, the supply of liver allografts from non-living donors is far short of the number of potential recipients, a reality that has spurred the development of living donor liver transplantation. The liver is a vital organ in the human body and is present in Vertebrates and some other animals An allograft or allogeneic transplant or homograft is a transplant in which transplanted cells, tissues, or organs are sourced from

Indications

Liver transplantation is potentially applicable to any acute or chronic condition resulting in irreversible liver dysfunction, provided that the recipient does not have other conditions that will preclude a successful transplant. Metastatic cancer outside liver, active drug or alcohol abuse and active septic infections are absolute contraindications. While infection with HIV was once considered an absolute contraindication, this has been changing recently. In Medicine, a contraindication (pronounced as contra-indication is a condition or factor that increases the Risks involved in using a particular drug, Advanced age and serious heart, pulmonary or other disease may also prevent transplantation (relative contraindications). In Medicine, a contraindication (pronounced as contra-indication is a condition or factor that increases the Risks involved in using a particular drug, Most liver transplants are performed for chronic liver diseases that lead to irreversible scarring of the liver, or cirrhosis. Cirrhosis is a consequence of chronic Liver Disease characterized by replacement of liver tissue by fibrous Scar tissue as well as regenerative

Techniques

Before transplantation liver support therapy might be indicated (bridging-to-transplantation). Artificial liver support like liver dialysis or bioartificial liver support concepts are currently under preclinical and clinical evaluation. Liver dialysis is a detoxification treatment for Liver failure and has shown promise for patients with Hepatorenal syndrome. Virtually all liver transplants are done in an orthotopic fashion, that is the native liver is removed and the new liver is placed in the same anatomic location. The transplant operation can be conceptualized as consisting of the hepatectomy (liver removal) phase, the anhepatic (no liver) phase, and the postimplantation phase. The operation is done through a large incision in the upper abdomen. The hepatectomy involves division of all ligamentous attachments to the liver, as well as the common bile duct, hepatic artery, and portal vein. Usually, the retrohepatic portion of the inferior vena cava is removed along with the liver, although an alternative technique preserves the recipient's vena cava ("piggyback" technique).

The donor's blood in the liver will be replaced by an ice-cold organ storage solution, such as UW (Viaspan) or HTK until the allograft liver is implanted. Viaspan, also known as University of Wisconsin solution ( UW solution) was the first solution thoughtfully designed for use in Organ transplantation and Histidine-tryptophan-ketoglutarate (Custodiol HTK solution is a high-flow low- Potassium preservation solution used for Organ transplantation. Implantation involves anastomoses (connections) of the inferior vena cava, portal vein, and hepatic artery. After blood flow is restored to the new liver, the biliary (bile duct) anastomosis is constructed, either to the recipient's own bile duct or to the small intestine. The surgery usually takes between five and six hours, but may be longer or shorter due to the difficulty of the operation and the experience of the surgeon.

The large majority of liver transplants use the entire liver from a non-living donor for the transplant, particularly for adult recipients. A major advance in paediatric liver transplantation was the development of reduced size liver transplantation, in which a portion of an adult liver is used for an infant or small child. Further developments in this area included split liver transplantation, in which one liver is used for transplants for two recipients, and living donor liver transplantation, in which a portion of healthy person's liver is removed and used as the allograft. Living donor liver transplantation for pediatric recipients involves removal of approximately 20% of the liver (Couinaud segments 2 and 3). Claude Couinaud ( 16 February, 1922, Neuilly-sur-Seine - 2008 is a French surgeon and anatomist who made significant contributions in the field of

Immunosuppressive management

Like all other allografts, a liver transplant will be rejected by the recipient unless immunosuppressive drugs are used. Transplant rejection occurs when a transplanted organ or tissue fails to be accepted by the body of the transplant recipient Immunosuppression involves an act that reduces the activation or Efficacy of the Immune system. The immunosuppressive regimens for all solid organ transplants are fairly similar, and a variety of agents are now available. Most liver transplant recipients receive corticosteroids plus either tacrolimus or Cyclosporin or Mycophenolate Mofetil. Corticosteroids are a class of Steroid hormones that are produced in the Adrenal cortex. Tacrolimus (also FK-506 or Fujimycin) is an immunosuppressive drug whose main use is after allogenic Organ transplant to reduce the Ciclosporin (ˌsaɪkləˈspɔrən cyclosporine ( USAN) or cyclosporin (former BAN) is an Immunosuppressant drug widely Mycophenolic acid ( INN) (ˌmaɪkoʊˈfɛnɒlɪk or mycophenolate is an immunosuppressant drug used to prevent rejection in Organ transplantation

Liver transplantation is unique in that the risk of chronic rejection also decreases over time, although recipients need to take immunosuppresive medication for the rest of their lives. It is theorized that the liver may play a yet-unknown role in the maturation of certain cells pertaining to the immune system. An immune system is a collection of mechanisms within an Organism that protects against Disease by identifying and killing Pathogens and Tumor There is at least one study by Dr. Starzl's team at the University of Pittsburgh which consisted of bone marrow biopsies taken from such patients which demonstrate genotypic chimerism in the bone marrow of liver transplant recipients. The University of Pittsburgh, commonly referred to as Pitt, is a non-sectarian coeducational independent state-related, "public" research University Bone marrow is the flexible tissue found in the hollow interior of Bones In adults marrow in large bones produces new Blood cells It constitutes 4% of A biopsy (in Greek: βίος life and όψη look/appearance is a Medical test involving the removal of cells or tissues In Zoology, a chimera is an animal that has two or more different populations of genetically distinct cells that originated in different Zygotes if the

Results

Prognosis is quite good. 1-year survival (in Finland) is 83%, 5-year survival is 76% and 10-year survival is 66%. Majority of deaths happen during the first three months after transplantation.

Living donor transplantation

Living donor liver transplantation (LDLT) has emerged in recent decades as a critical surgical option for patients with end stage liver disease, such as cirrhosis and/or hepatocellular carcinoma often attributable to one or more of the following: long-term alcohol abuse, long-term untreated Hepatitis C infection, long-term untreated Hepatitis B infection. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental Cirrhosis is a consequence of chronic Liver Disease characterized by replacement of liver tissue by fibrous Scar tissue as well as regenerative Hepatocellular carcinoma (HCC also called hepatoma) is a primary malignancy (cancer of the Liver. Alcoholism is a term with multiple and sometimes conflicting definitions Hepatitis C is a blood-borne infectious disease that is caused by the Hepatitis C virus ( HCV) affecting the Liver. The concept of LDLT is based on (1) the remarkable regenerative capacities of the human liver and (2) the widespread shortage of cadaveric livers for patients awaiting transplant. A cadaver or corpse is a dead Body. "Cadaver" is normally used as a more formal term for a body being used in medical training or research In LDLT, a piece of healthy liver is surgically removed from a living person and transplanted into a recipient, immediately after the recipient’s diseased liver has been entirely removed.

Historically, LDLT began as a means for parents of children with severe liver disease to donate a portion of their healthy liver to replace their child's entire damaged liver. The first report of successful LDLT was by Dr. Silvano Raia at the Universidade de São Paulo (USP) Medical School in 1986. Dr Silvano Raia is a Brazilian surgeon who specializes in Liver diseases The University of São Paulo (in Portuguese Universidade de São Paulo; USP) is one of the three public universities funded by the State of São Paulo. Year 1986 ( MCMLXXXVI) was a Common year starting on Wednesday (link displays 1986 Gregorian calendar) Surgeons eventually realized that adult-to-adult LDLT was also possible, and now the practice is common in a few reputable medical institutes. It is considered more technically demanding than even standard, cadaveric donor liver transplantation, and also poses the ethical problems underlying the indication of a major surgical operation (hepatectomy) on a healthy human being. Hepatectomy consists on the surgical resection of the Liver. While the term is often employed for the removal of the liver from a Liver transplant recipient this In various case series the risk of complications in the donor is around 10%, and very occasionally a second operation is needed. Common problems are biliary fistula, gastric stasis and infections; they are more common after removal of the right lobe of the liver. A biliary fistula, a type of Fistula where Bile leaks from the Bile ducts into outside areas can occur as a complication following biliary trauma An infection is the detrimental Colonization of a host Organism by a foreign Species. Death after LDLT has been reported at 0% (Japan), 0. 3% (USA) and <1% (Europe), with risks likely to improve further as surgeons gain more experience in this procedure. [3]

In a typical adult recipient LDLT, 55% of the liver (the right lobe) is removed from a healthy living donor. The donor's liver will regenerate to 100% function within 4-6 weeks and will reach full volumetric size with recapitulation of the normal structure soon thereafter. It may be possible to remove 70% to 75% of the liver from a healthy living donor without harm in most cases. The transplanted portion will reach full function and the appropriate size in the recipient as well, although it will take longer than for the donor. [1]

References

  1. ^ STARZL T, MARCHIORO T, VONKAULLA K, HERMANN G, BRITTAIN R, WADDELL W. "HOMOTRANSPLANTATION OF THE LIVER IN HUMANS". Surg Gynecol Obstet 117: 659-76. PMID 14100514.  
  2. ^ Starzl TE, Klintmalm GB, Porter KA, Iwatsuki S, Schroter GP. (1981). "Liver transplantation with use of cyclosporin A and prednisone. ". New England Journal of Medicine 305: 266–269. PMID 7017414.  
  3. ^ Umeshita K, Fujiwara K, Kiyosawa K, et al (August 2003). "Operative morbidity of living liver donors in Japan". Lancet 362 (9385): 687–90. doi:10.1016/S0140-6736(03)14230-4. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 12957090.  

Further reading

External links

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