Thursday, September 15, 2011

Partial Liver Transplants

Partial liver transplants are having amazing results in recipients, reducing the need for medication and the risk of organ rejection. Because the operation is so rare, organ transplant networks and organizations do not track the number of partial transplants performed or have specific guidelines for it.
Doctors say children fare better with the operation because their livers have better rejuvenating abilities than adults, and that this procedure can only be used for cases of acute liver failure. Chronic liver problems, like hepatitis or cancer, would not be cured with this procedure.
While the procedure is covered by insurance companies, the cost is roughly the same as traditional transplants. The long-term health care savings however are huge: After patients get off anti-rejection drugs, they save thousands of rupees a year.
In the last two decades, liver transplantation (LTx) has become the treatment of choice for several liver diseases including hepatocellular carcinoma in selected cases. Living-donor liver transplantation and split liver transplantation are measurements to reduce the severe lack of cadaveric grafts by expanding the donor pool. Major centers around the world now routinely perform partial LTx in infants and adults with survival success equivalent to that after full-size liver transplantation.
Although wide-ranging investigations such as intraoperative ultrasound, angiography, computed tomography, and magnetic resonance imaging are used routinely to delineate the hepatic vascular and biliary anatomy, not all anomalies can be demonstrated with certainty by these investigations. Therefore, the transplant surgeons should have a profound knowledge of normal liver anatomy and should recognize the presence and implications of anatomical variations. Normally, patients with haemodynamic instability, obesity, multiple upper gastrointestinal surgeries, and severe debilitation are usually excluded from partial liver transplantation.
Vascular and biliary complications may lead to loss of valuable grafts and cause significant morbidity and mortality. It is hoped that increasing experience, center effects, coupled with refinement of technique and a sound knowledge and application of anatomy, modern diagnostic tools such as the 3-dimensional visualization of the liver will lead to an improved outcome for patients undergoing partial liver transplantation. The use of reduced-sized, split grafts, and live-donor livers has reduced the size but not eliminated the problem. Donor-to-recipient size mismatch was an additional limitation to LTx in children until the development of partial liver transplantation techniques. Although these techniques have significantly reduced waiting list mortality in children, they do not completely address the major problem of limited organ availability.


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