LIVER TRANSPLANTATION

In orthotropic liver transplantaion, the bile duct between recipent and donor liver are repaired in end to end fasion or else  Roux en Y choledochojejunostomy.

Biliary atresia is an indication for Liver transplantation in children while primary Biliary Cirrhosis, Sclerosing cholangitis and Hematochromatosis an established indications for Liver transplantation in adults

Indication for Liver Transplantation:

Children

• Biliary atresia
• Neonatal hepatitis
• Congenital hepatic fibrosis
• Alagille’s disease”
• Byler’s disease
• a 1 -Antitrypsin deficiency
• Inherited disorders of metabolism
• Wilson’s disease
• Tyrosinemia
• Glycogen storage diseases
• Lysosomal storage diseases
• Protoporphyria
• Crigler-Najjar disease type I
• Familial hypercholesterolemia
• Primary hyperoxaluria type I
• Hemophilia

Aduts

• Primary biliary cirrhosis
• Secondary biliary cirrhosis
• Primary sclerosing cholangitis
• Autoimmune hepatitis
• Carob’s disease’
• Cryptogenic cirrhosis
• Chronic hepatitis with cirrhosis
• Hepatic vein thrombosis
• Fulminant hepatitis
• Alcoholic cirrhosis
• Chronic viral hepatitis
• Primary hepatocellular malignancies
• Hepatic adenomas
• Nonalcoholic steatohepatitis
• Familial amyloid polyneuropathy
• “Arteriohepatic dysplasia, with paucity of bile ducts, and congenital malformations, including pulmonary stenosis.
• “Intrahepatic cholestasis, progressive liver failure, mental and growth retardation
• `Multiple cystic dilatations of the intrahepatic biliary tree.
• Hematochromatosis is also an indication for Liver Transplantation
• ‘Among genetic and metabolic conditions, Hematachroatosis is the most common reason for Liver Transplantation’
• The first human liver transplant was performed in 1963 by Dr. Thomas Starzl.
• Caval, portal vein, hepatic artery, and bile duct anastomoses are performed in succession, the last by end-to-end suturing of the donor and recipient common bile ducts or by choledochojejunostomy to a Roux-en- Y loop if the recipient common bile duct cannot be used for reconstruction (e.g., in sclerosing cholangitis).”- Harrison 17/e p
• Bile duct anastomosis in orthotopic liver transplant is done by

1. Choledochocholedochostomy or
2. Roux-en-Y choledochojejunostomy

• Choledochocholedochostomy
• end to end anastomosis between donor CBD and the recipient CBD
• used when the recipient bile duct is not diseased
• preferred method of bile duct anastomoses
• Roux-en-Y choledochojejunostomy
• alternative bile duct anastomosis when choledochocholedocostomy is not possible, that is when recipient extrahepatic bile duct is diseased (eg. sclerosing cholangitis), or small or when there is significant recipient donor duct size mismatch.
• Liver transplantation is indicated for those children and adults, who in the absence of contraindications suffer from severe, irreversible liver disease for which alternative medical or surgical treatments have been exhausted or are unavailable.
• Most common indication

in children ________  Biliary atresia

in adults → Cirrhosis

Harrison 17/e writes- “Currently, chronic hepatitis C and alcoholic liver disease are the most common indications for liver transplantation, accounting for over 40% of all adult candidates who undergo the procedure.”