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LIVER TRANSPLANT SURGERY-AN OVERVIEW

Mohammed Saud Ali Aljohani , Muteb Radhi A Alshammari , Alhumaidi Mohammed A Alhafi , Abdullah Nafea S Alsharari , Salma Kh A A Alruwayeh , Sami Ahmed H Alanazi , Fahad Hamdan H Alshammari , Khalid Saleh S Alsharari , Fahad Matar Abdulaziz Alzahrani , Walied Abdulaziz M Alaleet

Introduction: The amazing work of Thomas Starzl, et al and other researchers in the 1950s led to the first ever successful liver transplant in 1963 by Starzl in Denver, et al. 5 years later, Sir Roy Calne, conducted the first European liver transplant programme in Cambridge, UK. In the beginning, the progress was very gradual and the death rates of recipients were very high. It is due to the tribute to the early pioneers that they stayed persistent in overcoming the many challenges and obstacles; advances in surgical and anaesthetic techniques, greater understanding of the physiological, haematological, biochemical, microbiological and immunological variations in liver disease and transplantation led to a multidisciplinary approach that led to better outcomes. The progress made, together with more effective immunosuppressive and anti-microbial agents and enhancements in patient and donor selection, has made liver replacement as a routine surgery with very good long term results Aim of work: In this review, we will discuss the most recent evidence regarding liver transplant surgery.Methodology: We did a systematic search for liver transplant surgery-an overview using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). All relevant studies were retrieved and discussed. We only included full articles.Conclusions: Liver transplantation, though currently considered a routine procedure, with known indications and usually excellent results, still has many difficulties. Donor shortage continues to be a major drawback. Transplanted organs are full of risk and could transmit malignancy, infections, metabolic or autoimmune diseases. Methods to solve the donor shortage problem consist of using of organs from donors after circulatory death, from living donors and from those previously infected with Hepatitis B and C and even HIV for selected recipients. Normothermic regional and/or machine perfusion, whether static or pulsatile, normo- or hypothermic, are being studied and will be probably have an essential role in enhancing donation rates and results. The main indications for liver replacement are alcoholic liver disease, HCV, non-alcoholic liver disease and liver cancer. New research have concluded that selected patients with severe alcoholic hepatitis could also get advantages from liver transplant. The advent of new and highly effective treatments for HCV, whether given before or aftertransplant will have a major impact on outcomes. The role of transplantation for those with liver cell cancer continues to evolve as other interventions become more efficient. Immunosuppression is often needed for life-long and adherence continues to be a huge difficulty, particularly in young adolescents. Immunosuppression with calcineurin inhibitors (primarily tacrolimus), antimetabolites (azathioprine or mycophenolate) and corticosteroids remains standard. Results after transplantation are good but not normal in quality or quantity. Premature death may be due to increased risk of cardiovascular disease, de novo cancer, recurrent disease or late technical problems Key words: Surgery, liver transplant, an overview, recent advances

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