Summary and Conclusion
From 1967, when Thomas E Starzel performed the first successful liver
transplantation until now, the field of liver transplantation has undergone
remarkable advances. The combination of improvements in rejection rates and in
surgical technique led to an enormous expansion of the field.
Liver transplantation is the most effective method in treatment of end stage
liver disease. According to the study, one and five patient and graft survival
are(96%-87.7%) and (80%-67.4%) respectively.
Recipient complications which are directly or indirectly caused by surgical
factors are procurement injury of the graft, intraoperative hemorrhage, primary
graft non-function, biliary complications , vascular complications (stenosis or
thrombosis) affecting hepatic artery , portal vein , inferior vena cava and hepatic
veins, wound complications, incisional hernias, post-transplant infections,
neuropsychiatric complications and disturbed quality of life, in addition to
iatrogenic injuries of portahepatis structures , bowel, other organs or great vessels
that increase morbidity on the patients. Our incidence of potentially or actually
life-threating complications (i.e. ≥ Clavien score III) 72% in cadaveric and 88% in
LDLT respectively.
Biliary complications are the most common technical complications
including leakage and strictures. On the other hand, vascular complications
especially hepatic artery thrombosis are the most serious as they lead to graft loss
in the early postoperative period. Early detection and treatment is paramount
important for graft salvage.
Standardization of hepatectomy and implantation and refinement of
techniques, dissection, hemostasis and anastomosis with adequate adjustments in
case of technical difficulties and preoperative recognition of risk factors are a must
for favorable outcomes. At the same time, detailed knowledge of vascular and
biliary anomalies is very important for transplant surgeons as they are commonly
encountered. For example, Duct to duct anastomosis without a T-tube or Roux-enY
bilioenteric anastomosis is recommended to avoid biliary complications.
The number of cadaveric liver transplantation is far more than living donor in
the USA due to advanced united network of organ sharing UNOS system and
availability of cadaveric organs. On the other hand, LDLT is the only technique in
some countries including Egypt. LDLT is associated with more technical
complications than cadaveric and donor safety is an important concern.
For donor safety in LDLT, strict guidelines of selection and his free informed
consent as well as evaluation and follow up must deserve extensive
interdisciplinary discussion on national and international base. Laparoscopic donor
hepatectomy is a new advent in the field of LDLT and, according to the study; it
leads to reduction of postoperative donor hospital stay. Innovation in the surgical
technique and researches in liver regeneration and factors controlling it must
continue and further efforts should be directed towards development of cadaveric
liver transplantation in countries lacking this program.
Further recommended studies should include larger samples of data, with
meta-analysis in many liver transplant centers of preoperative and operative
parameters and liver transplant complications. It is recommended to use Clavien
score 5-tire grading system of surgical complications that classify them into serious
(III, IV and V) and no serious (I and II), in order to monitor liver transplant
technical complications of recipients and donors for further evaluations. |
