Liver transplantation

Liver transplantation is a major surgical procedure for end-stage liver disease and requires a comprehensive multidisciplinary approach. Radiology plays a major role in the evaluation of patients before and after liver transplantation as well as potential donor patients.

This article does not discuss the complex medical issues around liver transplantation such as immune typing and post-operative immunosuppression.

Indications

• cirrhosis with refractory complications ¹

  • e.g. due to hepatitis C

• fulminant acute liver failure ¹

  • e.g. due to acetaminophen toxicity

• liver neoplasms with local disease only ¹

  • e.g. hepatocellular carcinoma

• other liver-based metabolic conditions causing systemic disease whereby liver transplantation can be curative or improve survival ¹

  • e.g. alpha-1-antitrypsin deficiency, Wilson disease, hereditary ATTR amyloidosis

Types of liver transplantation

There are three main types of liver transplantation based on the donor organ ^ref:

1. orthotopic liver transplant (OLTx) - deceased donor liver transplanted in total into the recipient (following total hepatectomy). This is the most common type.

2. living donor liver transplantation - a portion of liver is removed from a living donor and transplanted into the recipient (following total hepatectomy). Right lobes are typically transplanted into adults and left lobes into children. The residual liver in the donor regenerates filling the volume of the removed lobes. For more information see here.

3. split transplant - deceased donor liver split into two or more portions and transplanted into two or more recipients (following total hepatectomy). Right lobes are typically transplanted into adults and left lobes into children.

Auxiliary liver transplantation is a subtype of liver transplantation where the recipient's native liver is not completely removed, to allow possible native liver recovery ^ref. This is also considered in patients with liver disease that may be responsive to potential gene therapy in the future ^ref.

Cadaveric donation can be either DBD or DCD:

• DBD: donation after brain death

• DCD: donation after circulatory death

Imaging in liver transplantation

Imaging is required to evaluate donor and recipient livers for successful transplantation. Pre and post-surgical liver assessment is described in detail here: Imaging in liver transplantation.

CT liver volumetry in living donor liver transplantation is required to calculate the graft volume and remnant liver volume, the major goal being to avoid graft size mismatch.