Liver Transplantation (Liver Transplant)

How does a liver transplant work in practice?

A liver transplant is a surgical procedure involving the removal of a diseased or damaged liver and its replacement with a healthy one. It's typically recommended when the liver can no longer function normally (liver failure or end-stage liver disease).

There are three main ways to perform a liver transplant:

• Liver transplant from a living donor: a portion of the liver, usually the left lobe, is removed from the living donor and transplanted into the patient. Both parts of the liver (the donor's remaining portion and the recipient's transplanted portion) regenerate to achieve adequate liver function;
• Liver transplant from a deceased donor: if the donor, during their lifetime, expressed (verbally or in writing) to their relatives their wish to donate organs upon death, or if they didn't express a wish but their relatives don't object, the liver can be removed and transplanted into a patient on the waiting list;
• Split liver transplant: if the donor expressed this wish during their lifetime, the liver can be surgically divided into two parts, a right and a left half-liver. Current protocols typically transplant the left half into a pediatric patient (≤17 years old at the time of waiting list registration) and the right half into an adult, though transplantation into two adult patients is also possible;

Most liver transplants use organs from deceased donors and are performed "orthotopically," meaning the new liver is placed in the same anatomical position as the removed organ.

The operation has three phases: hepatectomy (liver removal), the anhepatic phase (without a liver), and transplantation.

When is a liver transplant indicated?

Liver disease has various causes: viral infections and/or alcohol abuse, and congenital diseases. The resulting damage progressively alters liver structure, forming nodules and replacing damaged tissue with scar tissue (fibrosis). This scar tissue doesn't function like liver cells, impairing metabolic and synthetic functions, leading to cirrhosis.

Main causes of liver disease include:

• Viral hepatitis (e.g., Hepatitis B and C);
• Chronic alcohol abuse;
• Biliary tract diseases (primary biliary cholangitis and primary sclerosing cholangitis);
• Pigment accumulation diseases in hepatocytes: Wilson's disease (copper accumulation), hemochromatosis (iron accumulation), etc.;

Cirrhosis is a common precursor to liver cancer (hepatocellular carcinoma-HCC).

Liver failure can also develop rapidly following inflammation and death (necrosis) of numerous hepatocytes.

Liver transplantation may be recommended for cirrhosis, and in some cases, liver cancer (hepatocellular carcinoma) and acute liver failure in an otherwise healthy liver.

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Where are liver transplants performed?

The transplantation pathway for end-stage organ failure has three phases:

• Assessment of transplant suitability, registration, and waiting list maintenance;
• Transplant surgery and clinical management until initial discharge;
• Post-transplant follow-up and management of complications;

Healthcare facilities seeking or maintaining authorization (individually or as part of a regional program) must provide all diagnostic and therapeutic services for all three phases.

The facility's medical and nursing team implements multi-professional and multidisciplinary pathways to comprehensively support patients and their families from pre-transplant, demonstrating documented expertise.

These pathways are defined, agreed upon, and shared with operational units involved in waiting list placement and maintenance, transplant surgery, post-operative stay, and post-transplant follow-up.

Parameters evaluating organ transplantation quality include:

• Number of patients on the waiting list;
• Number of transplants per year;
• Waiting list registration time;
• Frequency of clinical checks on waiting patients;
• Average waiting time;
• Number of deaths on the waiting list;
• Average waiting list composition characteristics;
• Adherence to special programs;
• Frequency of waiting list updates;
• Number of urgent requests;
• Transplanted organ ischemia duration;
• Number of transplants from deceased and living donors (past three years);

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