scholarly journals An Overview of Current Status, Recent Techniques and Challenges of Liver Transplantation

2018 ◽  
Vol 6 (2) ◽  
pp. 67-74
Author(s):  
Bharata Regmi ◽  
Manoj Kumar Shah

A liver transplantation (LT) is a surgical procedure that removes a liver that no longer functions properly and replaces it with a healthy liver from a living or deceased donor. It is a viable treatment option for end-stage liver disease and acute liver failure. The most commonly used technique is orthotopic transplantation or deceased donor liver transplantation (DDLT) in which the native liver is removed and replaced by the donor organ in the same anatomic location as the original liver. Ongoing challenges of LT include those concerning donor organ shortages, recipients with more advanced disease at transplant, growing need for transplantation, side effects associated with long-term immunosuppression, toxicities and obesity. Organ shortage has become the most vexing problem in LT, with 10–25% of patients dying while awaiting transplantation. Different ideas has been evolved like living donor liver transplantation (LDLT), marginal donor liver transplantation (MDLT) and  split liver transplantation (SLT) to overcome the growing problem of organ shortage. These techniques are becoming very important in an attempt to narrow the gap between demand and supply of organs. The advances in surgical and anaesthetic techniques, greater understanding of the physiological, haematological, biochemical, microbiological and immunological changes in liver disease and transplantation allowed a multidisciplinary approach that led to better outcomes. These changes, coupled with more effective immunosuppressive and anti-microbial agents and improvements in patient and donor selection, mean that now liver replacement is a routine procedure with excellent long term outcomes.Int. J. Appl. Sci. Biotechnol. Vol 6(2): 67-74 

2021 ◽  
pp. 214-240
Author(s):  
Lainie Friedman ◽  
J. Richard Thistlethwaite, Jr

In the 1980s in the United States (US), young children in liver failure were at proportionately greater risk of dying on the deceased donor liver transplant (DDLT) waitlist than adults because of the lack of appropriately sized grafts. This led to the development of two deceased donor liver techniques—reduced-size (trimming the graft to decrease its size) and split-liver (where one liver could provide grafts to two candidates). These developments decreased but did not eliminate waitlist mortality for young children. Split-liver DDLT paved the way for living donor liver transplantation (LDLT) in children using the lateral segments of the left lobe. Pediatric LDLT began slowly at only a few centers with successful donor and recipient results. Adult-to-adult LDLT expanded quickly despite many US programs having limited experience, low volumes, and significant donor morbidity. The ethical issues raised by the rapid expansion of adult-to-adult LDLT in the US are discussed.


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