Liver transplant dysfunction: outcomes and prospects for the prevention of liver cirrhosis in the recipient

Abstract

Liver transplantation is the only radical method of treatment and gives the last chance for recovery to patients with terminal stages of diffuse liver diseases. The available number of donor organs does not cover the needs of patients in the ever-growing waiting lists for transplantation. In this connection the possibilities of expanding the criteria of donor transplant eligibility and wide introduction of lifetime pre-donation are being actively studied. Together with the expansion of the donor pool and reduction of waiting list mortality, donors with expanded criteria differ from optimal and as- sociated with increased risks of postoperative complications. However, careful analysis of all risk factors on both the donor and recipient side allows for an optimal donor-recipient pairing. This approach can ensure short-term and long-term results of transplantation from a marginal donor similar to those of transplantation from an optimal donor. The liver taken from a marginal donor has less adaptive properties and is vulnerable to ischemia and reperfusion. Ischemia affecting the graft from the time of explantation, during transportation and during implantation triggers a cascade of alterative reactions that is exacerbated by the onset of reperfusion. The joint influence of ischemia and reperfusion can cause the graft dysfunction in the early postoperative period in the range from reversible to complete functional graft failure. In this connection, the issues of preservation and transportation of the donor liver as well as optimization of surgical tactics in order to minimize the influence of ischemia and reperfusion are becoming more and more urgent. The aim of the literature review was to analyze the data available in the literature about the hepatic transplant dysfunction, factors predisposing to it and methods of its prevention. The main criteria of donor selection for liver transplantation and the currently admissible limits of their expansion are given. The main mechanisms of ischemic and reperfusion damage of the transplant, inherent morphological changes and the most frequent outcomes are considered. A number of questions requiring further study within the framework of the problem under consideration are formulated.