🩺 Liver transplantation is the definitive treatment for acute or chronic liver failure. 🚧 The main limiting factor is the shortage of donor organs. Living donors (usually family members) are increasingly used.

📖 About

✅ Highly successful and effective treatment for liver failure.
🔄 Can be done acutely (fulminant failure) or electively (chronic disease).
👵 Usually offered to patients <65 years.
📊 MELD (Model for End-Stage Liver Disease) score helps prioritise patients on the waiting list.

🫀 Source of Transplant

💀 Deceased donor (orthotopic): Liver from a recently deceased individual, transplanted into recipient.
🫂 Living donor: A segment of liver from a healthy donor (often a family member). Both segments regenerate within weeks.
🔑 Factors: ABO blood type compatibility, donor <60 yrs, appropriate size match.

🔪 The Procedure

“Mercedes-Benz” incision used (rooftop + vertical extension).
⏱️ Surgery takes 6–12 hours.
Non-functioning liver is removed → replaced with donor liver.

🚨 Acute Need for Transplant

💊 Paracetamol overdose.
🦠 Fulminant viral hepatitis.

📏 King’s College Criteria

Paracetamol-induced liver failure

Arterial pH <7.3 after 24h OR
PT >100 sec, Creatinine >300 μmol/L, and Grade III–IV encephalopathy.

Non-paracetamol induced

PT >100 sec OR
3 of: Age <10 or >40, >1 week from jaundice → encephalopathy, PT >50 sec, Bilirubin >300 μmol/L, drug-induced cause.

📌 Indications (Chronic/Advanced Disease)

Primary biliary cholangitis (PBC).
Recurrent variceal haemorrhage.
Intractable ascites or SBP.
Refractory encephalopathy.
Severe jaundice or synthetic dysfunction (low albumin, ↑INR).
Fulminant hepatic failure (any cause).

🧾 Pre-Operative Work-up

🧪 Bloods: FBC, LFTs, coagulation, U&E, glucose.
📉 Crossmatch at least 10 units RBC.
📈 ECG & CXR to check fitness.
🖼️ Abdominal USS (if not done in last 4 months).

🛑 Contraindications

❌ Extra-hepatic malignancy.
❌ Active uncontrolled sepsis (e.g. SBP).
❌ Widespread liver metastases.

⚠️ Complications

💀 Death, 💉 haemorrhage, 🦠 sepsis.
⛔ Acute rejection (immune-mediated).
Chronic rejection → graft loss.

💊 Prevention of Rejection

Calcineurin inhibitors: Ciclosporin, Tacrolimus.
Immunosuppressants: Azathioprine.
Adjunct: Steroids.

📊 Risk of Rejection

⬆️ High risk: previous rejection, younger patients, females, autoimmune disease (AIH, PBC).
⬇️ Lower risk: malnourished patients, renal failure.

📚 Exam tip for OSCEs: Always mention King’s College Criteria in fulminant hepatic failure stations. Discuss both indications (e.g. variceal bleeds, refractory ascites) and contraindications (malignancy, sepsis).

Cases — Liver Transplantation

Case 1 — Acute liver failure ⚡: A 28-year-old woman presents with jaundice, confusion, and coagulopathy 3 days after a paracetamol overdose. Bloods: INR 5.2, bilirubin 300 µmol/L, ALT 4500. She develops encephalopathy (grade 3). King’s College criteria met. Diagnosis: acute fulminant liver failure requiring urgent transplantation. Managed with ICU care and immediate transplant listing.
Case 2 — Decompensated cirrhosis 🍺: A 55-year-old man with alcoholic cirrhosis presents with recurrent ascites, variceal bleeding, and hepatic encephalopathy despite maximal therapy. MELD score: 24. Ultrasound: cirrhotic liver, no HCC. Diagnosis: end-stage cirrhosis requiring elective liver transplantation. Managed with transplant listing and abstinence support.
Case 3 — Hepatocellular carcinoma (HCC) 🎗️: A 63-year-old woman with hepatitis C cirrhosis is found to have a 2.5 cm liver lesion on screening ultrasound. MRI confirms HCC within Milan criteria (single lesion <5 cm, no extrahepatic spread). Diagnosis: HCC in cirrhotic liver — transplant candidate. Managed with listing for transplantation and bridging therapy (radiofrequency ablation).

Teaching Point 🩺: Indications for liver transplantation include acute liver failure, decompensated cirrhosis, and HCC (within Milan criteria). Prognostic tools such as MELD and Child-Pugh scores guide timing. Contraindications include active alcohol misuse, uncontrolled infection, and extrahepatic malignancy.

The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms.

Liver Transplantation