Short and Long Term Outcomes of Liver Transplantation from Cadaveric Donors and Living Related Donors

Abstract

Liver transplantation or hepatic transplantation is the replacement of a diseased liver with healthy one. The source of liver is either from deceased donor (CLT or DDLT) or from living donor (LDLT). The first successful human liver transplant was performed in 1967 by Starzl in Denver, although the survival rates of this operation and several afterword trials were not promising, this didn’t changed until introduction of cyclosporine and other effective immunosuppressive. Through advances in immunosuppression and improvements in surgical techniques, Liver transplantation has become a widely accepted and effective therapeutic choice for a variety of irreversible acute and chronic end-stage liver disease (ESLD), with one-year patient and graft survival rates exceeding 80%. The commonest indications of liver transplantation in adults are; chronic viral hepatitis especially HCV and HBV, Alcoholic liver disease and primary malignancy of the liver, while the commonest indications in children are biliary atresia, metabolic disorders as well as hepatic tumors. In Egypt, HCV is the commonest cause of cirrhosis, cancer and though liver transplantation. As liver transplantation become standard treatment for a lot of End stage hepatic patients, Scoring systems as CTP, MELD and PELD were found to help listing and prioritizing patient candidate for transplantation. Various organ allocation systems have been established, though shortage of cadaveric donor is a huge obstacle, threatening a lot of patients’ lives who could die while waiting their turn in the waiting list. LDLT appeared to be a solution for this problem. LRLT was first attempted in 1989 followed by the first successful operation by Strong and his colleagues. Over the past decade, this modality has been widely popularized for the pediatric age group, mainly using the left lateral segment or left lobe. In 1997, adult-to adult LRLT programs was performed using the living donor's right lobe and spread rapidly to more centers. In Egypt as in many Eastern and Asian countries, the use of cadaveric donors is prohibited, Thus, LRLT is the only possible option for ESLD patients. Candidates for liver transplantation either CLT or LDLT, must be subjected to strict medical care preoperatively, as well as live donors in case of LDLT, to achieve best results of the procedure. With very good survival rates and outcomes of Liver transplantation, we now are looking forward to ensure a good quality of life for both recipient and donor. As LDLT has become a rival to the basic OLT or cadaveric liver transplant, several studies tried to compare outcomes of both procedures. The main advantage of LDLT over CLT is decreasing waiting time for the patients, making the operation timely fashioned, saving a lot of patients who die while waiting for available cadaver liver. Also, studies appear that LDLT provide better liver graft quality with shorter Cold ischemic time and less rejection episodes than DDLT. On the other hand, the main disadvantage of LDLT is putting a completely healthy donor at risk of post-operative mobidity or even mortality, facing us with the most basic rule of (Do No HARM). Donor’s health and quality of life must be guaranteed and pre, intra and postoperative care must be done to ensure that. Despite the fact that liver transplantation in general is a highly sophisticated and highly technical surgical procedure, it appears that LDLT is much more difficult than CLT. As a result of these more technical difficulties LDLT holds more surgical complications (especially Biliary and vascular) with longer hospital stay than CLT. Though several studies have shown decrease in a lot of this complications if operation done by experienced team in more experienced center.