Liver Transplantation

01 Overview

Liver transplantation replaces a failing liver with a whole or partial graft from a deceased or living donor, and remains the only curative treatment for end-stage liver disease and selected liver cancers.

02 Anatomy

The recipient's diseased liver is removed and replaced with the donor graft, requiring anastomosis of the vena cava (or a piggyback technique preserving the recipient's own cava), portal vein, and hepatic artery, along with biliary reconstruction.

03 Physiology

The transplanted liver restores synthetic function, detoxification, bile production, and metabolic regulation. Its regenerative capacity allows partial grafts — such as those used in living-donor or split-liver transplantation — to grow to an adequate functional mass.

04 Indications

Common indications include:

• Decompensated cirrhosis
• Acute liver failure
• Hepatocellular carcinoma within accepted criteria
• Selected metabolic liver diseases
• Certain cholestatic liver diseases

05 Contraindications

Relative and absolute contraindications include:

• Uncontrolled extrahepatic malignancy
• Active substance use without stabilisation
• Severe irreversible cardiopulmonary disease
• Uncontrolled sepsis
• Anatomical factors precluding safe reconstruction

06 Donor Assessment

Deceased donor livers are assessed for size match, steatosis, and function, while living donors undergo detailed volumetric imaging and medical evaluation to confirm an adequate and safe remnant liver volume.

07 Recipient Assessment

Recipients are staged using validated severity scores, assessed for cardiopulmonary fitness and portal hypertension complications, and screened for factors affecting candidacy such as malignancy extent or infection.

08 Surgical Technique (Summary)

Hepatectomy of the native liver is followed by graft implantation, with vascular reconstruction of the vena cava, portal vein, and hepatic artery, and biliary reconstruction performed either duct-to-duct or via a Roux-en-Y loop.

09 Immunosuppression (Overview)

Maintenance typically combines a calcineurin inhibitor with an antiproliferative agent and tapering corticosteroids. The liver is relatively immune-tolerant, often allowing lower long-term immunosuppression than other organs.

10 Complications

Recognised complications include:

• Primary graft non-function
• Hepatic artery thrombosis
• Biliary leak or stricture
• Acute or chronic rejection
• Recurrence of the original liver disease

11 Follow-up

Ongoing monitoring includes liver function tests, immunosuppressant levels, imaging surveillance for vascular and biliary complications, and screening for disease recurrence, cardiovascular risk, and new malignancy.