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Liver Transplantation


Criteria for establishment of a liver transplant center

The Saudi Center for Organ Transplantation through specialized committees has laid down certain criteria for establishment of liver transplant centers in the Kingdom. They are:
  1. Working staff
  • Consultants in liver transplantation:

  1. Surgeon: At least one consultant transplant surgeon experienced in hepatobiliary surgery with a minimum of one year's experience from a recognized liver transplant center internationally.

  2. Hepatologist: One consultant hepatologist with a minimum of one year's experience from a recognized liver transplant center internationally.

  3. Pediatric gastroenterologist: One consultant pediatric gastroenterologist with a minimum of one year's experience from a recognized liver transplant center internationally.

 

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  1. Technical equipment
  • The hospital in which the liver transplant center will be established should have the following departments:
  1. Cardiology.

  2. Endoscopy.

  3. Radiology.

  4. Hematology and blood bank.

  5. Pathology.

  6. Biochemistry laboratory.

  7. Nephrology with hemodialysis unit.

  8. ICU facility.

  9. Immunology.

  10. Chest diseases.

  11. Psychiatry.

  12. Physiotherapy.

  13. Microbiology laboratory.

 

  • The hospital should contain two operating rooms containing all the necessary equipment for liver transplantation and especially:

  1. Thromboelastrogram.

  2. Cell saver machine.

  3. Rapid infusion system.

  4. Venevenous by-pass machine.

  5. Infra-red coagulator or equivalent.

  6. Blood warmer.

  • Technician needed to operate these machines should be available.
  1. Support Services
  • Laboratory

  1. Routine laboratory services, including pre- and post-transplant work-up.

  2. HLA typing, cytotoxic antibodies, drug levels of cyclosporine and similar drugs.

  • Radiology: The following tests should be available in the hospital or the center: Conventional X-ray facility, ultrasound with the availability of a portable machine, Doppler ultrasonography, isotope scan, angiography, CT scan and percutaneous transhepatic cholangiography.

  • Endoscopy department: should have all diagnostic and therapeutic facilities, including Endoscopic Retrograde Cholangio Pancreateography (ERCP).

  1. Drugs
    The following drugs must be permanently available in the center:
  • Immunosuppressive drugs
  1. Cyclosporine.

  2. Azathioprine.

  3. Prednisolone.

  4. Other similar drugs.

  • Drugs used to treat acute rejection episodes such as methylprednisolone, anti-lymphocyte globulin or anti-thymocyte globulin and monoclonal antibodies (OKT3).

  • Perfusion fluid such as Eurocollins solution or Wisconsin University solution.

  • Drugs to treat bacterial, viral, and fungal or parasitic infections.

Indications for liver transplantation

The Saudi Center for Organ Transplantation, through its scientific committees has established situations in which a liver transplant could be performed.

First: fulminant hepatic failure resulting from:
  1. Viral hepatitis.
  • A, B, C, D, EBV, CMV
  1. Drug-induced liver disease.
  • Halothane.

  • Disulfiram.

  • Acetaminophen.

  • Others.
  1. Metabolic liver disease.

  2. Wilson's disease.

  3. Reye's syndrome.

  4. Massive hepatic trauma.

  5. Others.
Second: advanced chronic liver diseases such as:
  1. Primary biliary cirrhosis.

  2. Primary sclerosing choloangitis.

  3. Biliary atresia.

  4. Idiopathic autoimmune hepatitis.

  5. Chronic alcoholic cirrhosis.

  6. Chronic toxic hepatitis.

  7. Chronic viral hepatitis.

  8. Vascular disease.
    e.g., Budd-Chiari syndrome.

  9. Veno-occlusive diseases.
Third: inherited metabolic disorders such as:
  1. a-1 antitrypsin deficiency.

  2. Wilson's disease.

  3. Homozygous type II hyperlipoproteinemia.

  4. Crigler-Najjar syndrome.

  5. Glycogen storage.

  6. Protein C deficiency.

  7. Oxalosis.
Fourth: localized liver tumors such as:
  1. Primary hepatocellular carcinoma.

  2. Other liver tumors.

  3. Isolated hepatic metastatic disease ,e.g., Carcinoid.
Contra-indications for liver transplantation

Absolute contra-indications:
  1. Active extra-hepatobiliary infections.

  2. Extra-hepatic malignancy.

  3. AIDS.

  4. End-stage cardiac or pulmonary failure.

  5. Narcotics or alcohol addiction.

 
Relative contra-indications

  1. Age of patients less than 4 weeks and more than 65 years.

  2. Active hepatitis B infection.

  3. Extensive abdominal surgery.

  4. Hepatocellular carcinoma more than 5 cm in size or multifocal carcinoma more than 3 cm in size.

  5. Cholangiocarcinoma.