Liver Transplantation

  • Rafael Díaz-NietoEmail author
  • Krishna Menon
Part of the In Clinical Practice book series (ICP)


Liver transplantation is the only curative intent treatment for End Stage Liver Disease nowadays. There is a wide variety of diseases that can represent an indication for liver transplantation. Shortage of organs and mortality on the waiting list are the main challenges that the transplant teams need to face. Organ allocation systems and prioritization criteria are used with the intention of reducing mortality on the waiting list while some surgical approaches like split transplantation and living donor liver transplantation are used to increase the number of grafts available. Liver transplantation is a technically complex surgical procedure and is associated with specific complications and unique challenges in the postoperative management. In this book chapter we describe the most common indications, surgical techniques and postoperative management of patients requiring liver transplantation as well as a brief description of current outcomes and future perspectives.


  1. 1.
    Starzl TE. In: Putnam CW, editor. Experience in hepatic transplantation. W. B. Saunders Co: Philadelphia; 1969.Google Scholar
  2. 2.
    Calne RY, Williams R. Liver transplantation in man. Observations on technique and organization in five cases. BMJ. 1968;4:535–50.CrossRefGoogle Scholar
  3. 3.
    Penn I, Halgrimson CG, Starzl TE. Liver transplantation in man. Ann N Y Acad Sci. 1970;170:251–8.CrossRefGoogle Scholar
  4. 4.
    European Association for the Study of the Liver. EASL clinical practice guidelines: liver transplantation. J Hepatol. 2016;64(2):433–85.CrossRefGoogle Scholar
  5. 5.
    Martin P, DiMartini A, Feng S, et al. Evaluation for liver transplantation in adults: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Hepatology. 2014;59(3):1144–65.CrossRefGoogle Scholar
  6. 6.
  7. 7.
    Mathurin P, Moreno C, Samuel D, et al. Early liver transplantation for severe alcoholic hepatitis. N Engl J Med. 2011;365:1790.CrossRefGoogle Scholar
  8. 8.
    Kemmer N, Kaiser T, Zacharias V, Neff GW. Alpha-1-antitrypsin deficiency: outcomes after liver transplantation. Transplant Proc. 2008;40:1492.CrossRefGoogle Scholar
  9. 9.
    Carey EJ, Iyer VN, Nelson DR, et al. Outcomes for recipients of liver transplantation for alpha-1-antitrypsin deficiency–related cirrhosis. Liver Transpl. 2013;19:1370.CrossRefGoogle Scholar
  10. 10.
    Herlenius G, Wilczek HE, Larsson M, et al. Ten years of international experience with liver transplantation for familial amyloidotic polyneuropathy: results from the Familial Amyloidotic Polyneuropathy World Transplant Registry. Transplantation. 2004;77:64.CrossRefGoogle Scholar
  11. 11.
    Yang JD, Larson JJ, Watt KD, et al. Hepatocellular carcinoma is the most common indication for liver transplantation and placement on the waitlist in the United States. Clin Gastroenterol Hepatol. 2017;15:767.CrossRefGoogle Scholar
  12. 12.
    Ostapowicz G, Fontana RJ, Schiødt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002;137:947.CrossRefGoogle Scholar
  13. 13.
    Eghtesad B, Aucejo F. Liver transplantation for malignancies. J Gastrointest Cancer. 2014;45:353.CrossRefGoogle Scholar
  14. 14.
    Fahrner R, Dennler SGC, Dondorf F, et al. Liver resection and transplantation in Caroli disease and syndrome. J Visc Surg. 2018;pii: S1878–7886(18):30079–1.Google Scholar
  15. 15.
    Tepetes K, Selby R, Webb M, et al. Orthotopic liver transplantation for benign hepatic neoplasms. Arch Surg. 1995;130:153.CrossRefGoogle Scholar
  16. 16.
    Hakeem AR, Cockbain AJ, Raza SS, Pollard SG, Toogood GJ, Attia MA, Ahmad N, Hidalgo EL, Prasad KR, Menon KV. Increased morbidity in overweight and obese liver transplant recipients: a single-center experience of 1325 patients from the United Kingdom. Liver Transpl. 2013;19(5):551–62.CrossRefGoogle Scholar
  17. 17.
    Bronsther O, Fung JJ, Izakis A, et al. Prioritization and organ distribution for liver transplantation. JAMA. 1994;271(2):140–3.CrossRefGoogle Scholar
  18. 18.
    Zoghbi GJ, Patel AD, Ershadi RE, et al. Usefulness of preoperative stress perfusion imaging in predicting prognosis after liver transplantation. Am J Cardiol. 2003;92:1066.CrossRefGoogle Scholar
  19. 19.
    Guckelberger O, Mutzke F, Glanemann M, et al. Validation of cardiovascular risk scores in a liver transplant population. Liver Transpl. 2006;12:394.CrossRefGoogle Scholar
  20. 20.
    Krowka MJ, Mandell MS, Ramsay MA, et al. Hepatopulmonary syndrome and portopulmonary hypertension: a report of the multicenter liver transplant database. Liver Transpl. 2004;10:174.CrossRefGoogle Scholar
  21. 21.
    Widmer JD, Schlegel A, Ghazaly M, et al. Piggy-back or cava replacement - which implantation technique protects liver recipients from acute kidney injury and complications? Liver Transpl. 2018;24:1746–56. Scholar
  22. 22.
    Pratschke S, Rauch A, Albertsmeier M, et al. Temporary intraoperative porto-caval shunts in piggy-back liver transplantation reduce intraoperative blood loss and improve postoperative transaminases and renal function: a meta-analysis. World J Surg. 2016;40(12):2988–98.CrossRefGoogle Scholar
  23. 23.
    Moini M, Schilsky ML, Tichy EM. Review on immunosuppression in liver transplantation. World J Hepatol. 2015;7(10):1355–68.CrossRefGoogle Scholar
  24. 24.
  25. 25.
  26. 26.
    Lee K-W, Simpkins CE, Montgomery RA, et al. Factors affecting graft survival after liver transplantation from donation after cardiac death donors. Transplantation. 2006;82(12):1683–8.CrossRefGoogle Scholar
  27. 27.
    Mateo R, Cho Y, Singh G, et al. Risk factors for graft survival after liver transplantation from donation after cardiac death donors: an analysis of OPTN/UNOS data. Am J Transplant. 2006;6(4):791–6.CrossRefGoogle Scholar
  28. 28.
    Menon KV, Hakeem AR, Heaton ND. Review article: liver transplantation for hepatocellular carcinoma - a critical appraisal of the current worldwide listing criteria. Aliment Pharmacol Ther. 2014;40(8):893–902.CrossRefGoogle Scholar
  29. 29.
    Nadalin S, Capobianco I, Panaro F, Di Francesco F, Troisi R, Sainz-Barriga M, Muiesan P, Königsrainer A, Testa G. Living donor liver transplantation in Europe. Hepatobiliary Surg Nutr. 2016;5(2):159–75.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Ceresa CDL, Nasralla D, Jassem W. Normothermic machine preservation of the liver: state of the art. Curr Transplant Rep. 2018;5:104–10.CrossRefGoogle Scholar
  31. 31.
    Radtke A, Nadalin S, Sotiropoulos GC, Molmenti EP, Schroeder T, Valentin-Gamazo C, Lang H, Bockhorn M, Peitgen HO, Broelsch CE, Malagó M. Computer-assisted operative planning in adult living donor liver transplantation: a new way to resolve the dilemma of the middle hepatic vein. World J Surg. 2007;31(1):175–85.CrossRefGoogle Scholar
  32. 32.
    Radtke A, Schroeder T, Molmenti EP, Sotiropoulos GC, Schenk A, Paul A, Frilling A, Lang H, Nadalin S, Peitgen HO, Broelsch CE, Malagó M. Anatomical and physiological comparison of liver volumes among three frequent types of parenchyma transection in live donor liver transplantation. Hepato-Gastroenterology. 2005;52(62):333–8.PubMedGoogle Scholar
  33. 33.
    Czigany Z, Scherer MN, Pratschke J, Guba M, Nadalin S, Mehrabi A, Berlakovich G, Rogiers X, Pirenne J, Lerut J, Mathe Z, Dutkowski P, Ericzon BG, Malagó M, Heaton N, Schöning W, Bednarsch J, Neumann UP, Lurje G. Technical aspects of orthotopic liver transplantation-a survey-based study within the Eurotransplant, Swisstransplant, Scandiatransplant, and British Transplantation Society Networks. J Gastrointest Surg. 2019;23(3):529–37.CrossRefGoogle Scholar
  34. 34.
    Nasralla D, Coussios CC, Mergental H, Akhtar MZ, Butler AJ, Ceresa CDL, Chiocchia V, Dutton SJ, García-Valdecasas JC, Heaton N, Imber C, Jassem W, Jochmans I, Karani J, Knight SR, Kocabayoglu P, Malagò M, Mirza D, Morris PJ, Pallan A, Paul A, Pavel M, Perera MTPR, Pirenne J, Ravikumar R, Russell L, Upponi S, Watson CJE, Weissenbacher A, Ploeg RJ, Friend PJ. Consortium for organ preservation in Europe. A randomized trial of normothermic preservation in liver transplantation. Nature. 2018;557(7703):50–6.CrossRefGoogle Scholar
  35. 35.
    Lee EC, Kim SH, Park SJ. Outcomes after liver transplantation in accordance with ABO compatibility: a systematic review and meta-analysis. World J Gastroenterol. 2017;23(35):6516–33.CrossRefGoogle Scholar
  36. 36.
    Lim KB, Schiano TD. Long-term outcome after liver transplantation. Mt Sinai J Med. 2012;79(2):169–89.CrossRefGoogle Scholar
  37. 37.
    Charlton MR. Improving long-term outcomes after liver transplantation. Clin Liver Dis. 2014;18(3):717–30.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Hepatobiliary Surgery UnitAintree University HospitalLiverpoolUK
  2. 2.Liver Transplant Unit Royal Free HospitalLondonUK
  3. 3.Institute of Liver StudiesKing’s College HospitalLondonUK

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