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Liver Transplantation in the clinics in Germany. Liver cirrhosis

The indications for liver transplantation are the following diseases:

• Viral hepatitis (B, C & D)

• Autoimmune hepatitis: primary biliary cirrhosis, primary sclerosing cholangitis

• Alpha-i antitrypsin deficiency

• Wilson's disease

• Hemochromatosis

• Cystic disease of the liver

• Liver Cancer

• Acute hepatic failure because of intoxication

• Mucoviscidosis

Liver transplantation is a very complicated operation requiring special skills. This is based on the following university hospitals: Aachen, Charite Berlin, Bonn, Essen, Frankfurt, Göttingen, Hamburg, Hannover, Heidelberg, Homburg, Kiel, Cologne, Leipzig, Magdeburg, Mainz, Munich, Münster, Nürnberg, Regensburg, Rostock, Tübingen, and Würzburg.

When is liver transplantation necessary?

Over time, the process of replacement of the liver cells by connective tissue comes to its last stage, namely liver cirrhosis. For many years, the functionally active cells adopt the vital functions, namely clarification of the body from toxins, thermoregulation, metabolism, and regulation of digestion.

But the process of destruction reaches its terminal stage, and then there are adverse symptoms such as ascites, distensibility of esophageal veins, gastrointestinal hemorrhage are the most frequent causes of death, yellow sickness, sleep disorders and imperception. The end stage of this process is the hepatic coma.

In contrast to the renal insufficiency (the renal function can be replaced by the haemodialysis), the non-functional liver is not possible to replace. To say more precisely it is possible but only for a short time, so-called albuminous haemodialysis which is used after the transplantation in order to fortify the body until the new liver begins to function.

From where is it possible to receive a donor liver?

There are two ways to receive a donor liver:

1. from deceased donors who had a healthy liver
2. from a living donor who gives a part of the liver to the transplanted recipient. And the donor does not fell it functionally because the liver reaches 85% of its original mass thanks to its good regenerative abilities.

How is liver transplantation carried out?

A L-shaped discission of the abdominal wall is made at first. Blood vessels intercross in turn and the diseased liver is removed. At that time, a mechanical pump conducts a return of the blood from the lower half of the body to the heart. The next step is the transplantation with the formation of vascular and bile-excreting anastomosis. The bile outflow is sent to the intestines because the donor gallbladder is removed.

While the transplant has not yet begun to function, the apparatus for artificial liver replaces the hepatic function. After a successful liver transplantation therapy is aimed at suppressing the immune system. The risk of rejection is particularly great in the first 6 months. Nevertheless, the use of innovative immunosuppressant (particularly cyclosporine) has made substantial progress in liver transplantation: during one year the transplants are successful in 70-80% of the cases. Liver homotransplants of a number of patients have functioned for over 10 years.