Live donor liver transplantation – prospects for patients with liver cancer and end-stage chronic liver disease

A liver transplant is a surgery where doctors replace a diseased liver with a healthy one, either from a living donor or from a brain-dead donor. In most indications, liver transplantation is the only way to bring life as well as prolong survival most effectively for patients with liver diseases.
Common indications for liver transplantation in adults are:
End stage (decompensated) cirrhosis with complications (caused by alcoholic cirrhosis, or chronic hepatitis B) Acute liver failure (Paracetamol poisoning) , Exacerbation of chronic viral hepatitis...) Liver cancer (HCC). Indicated with Milan criteria (1 solitary tumor ≤ 5 cm or up to 3 tumors ≤ 3 cm). Indicated with UCSF criteria (1 solitary tumor ≤ 5 cm or ≤ 3 tumor, largest tumor ≤ 4.5 cm with tumor size ≤ 8 cm). Biological criteria (usually applied in Japan, Korea): AFP and PIVKA II <200 Common contraindications for liver transplantation: Severe acute liver failure – hepatic coma with irreversible cerebral edema. Liver cancer is too large, exceeding the above criteria; or have had distant metastases (bones, lungs...).
Liver transplant procedure
- If the patient is in poor health, the doctor may require hospitalization for monitoring. Patients will be examined and necessary tests done, considering the following factors:
Health status and medications being taken Living habits (eg: Drinking alcohol, using drugs or smoking) Family members and support system - Not every patient who comes to a liver transplant center can have a transplant. The person will be evaluated for certain conditions:
Have severe liver disease that has not been treated by other methods. Do not have serious heart or lung problems. If you have chronic obstructive pulmonary disease that requires monitoring and attention Screen for no other cancer (other than liver cancer) Don't drink alcohol or use drugs Ready to take medication for life after surgery technique
If the patient meets the above conditions, a liver transplant will be indicated. Most liver transplant recipients are receiving donated livers from relatives and friends. For example, parents can donate part of their liver to their children, or adult children donate liver to parents, siblings...
For living donors also need to be evaluated:
Eligibility on blood group (ABO, Rh) with patients without hepatitis B, HIV, cancer diseases CT Scan: estimate liver volume and right and left liver sections. (The portion of the liver left behind after donating should be >= 40% of the original liver). There are no important anatomical abnormalities of the hepatic artery, portal vein, and hepatic vein.. Magnetic resonance imaging: estimation of liver fat (<10-15%), bile tree reconstruction.. After the surgery, both the donor and the recipient of the liver must be monitored before going home. For donors, the usual follow-up period is about 10 days after surgery. For recipients, the average follow-up was 30 days. Your doctor will do tests periodically to make sure your new liver is working properly.
People who receive a liver transplant will have to take anti-rejection drugs for life to help the body accept the new liver. Normally, the immune system keeps people healthy by attacking foreign invaders, so the immune system tends to reject the graft. Therefore, in order to avoid the occurrence of new liver rejection, it is necessary to suppress the immune system.
What are the common problems after a liver transplant?
Complications: Bleeding (intra-abdominal from major vessel damage or incision). Infections: pneumonia, urinary tract or surgical site infections: related to immunosuppression, residual abscess...; Acute liver failure: acute rejection - risk of dialysis, plasmapheresis. Chronic rejection, chronic kidney failure. Biliary stenosis, hepatic artery or vein occlusion, portal vein stenosis or thrombosis. Complications from the use of transplant rejection drugs. Surgical complications: Intestinal obstruction, incisional hernia, pneumonia, deep vein thrombosis. In addition to the possible complications mentioned above, there may be other problems. Abdominal pain: pain in the incision and in the internal incision. Slow intestinal motility: abdominal distension, flatulence, delayed bowel movements. Reactive pleural effusion may occur. Abdominal effusion due to ascites or bile leak after surgery. Infection, abscess under the diaphragm. Venous thromboembolism after a case of lying for a long time... Most liver transplant recipients recover after surgery, can go to work and live normal activities. But there are also others who have problems immediately after surgery or after a few years:
Rejection of new liver: Some patients, despite taking anti-rejection drugs, the body still does not accept the new liver Disease Recurrent liver disease: There are some liver diseases that can recur after transplantation. Side effects of anti-rejection drugs: The drug has short-term side effects. For example, medication increases the risk of getting an infection. The drug also has long-term side effects. For example, drugs can increase the risk of certain types of cancer
Currently, the demand for tissue and organ transplants, including liver transplants in Vietnam is very large and rapidly increasing. Up to now, Vinmec Times City International Hospital is the first private hospital in Vietnam to transplant a liver from a living donor and successfully performed one of the first acute liver transplants in the country. Vinmec's mastery of liver transplantation - the most difficult technique in the field of organ transplantation has opened up new hopes and options for patients with indications for treatment with this method.