Liver Transplantation

Abstract

Liver Transplantation (LT) constitutes the last option in patients in whom the therapeutic tools to preserve liver function have been exhausted and when irreversible chronic liver disease is already established. There are two possible scenarios: *1. *Patients who develop acute liver failure (ALF) secondary to liver ischemia/necrosis as a result of a BDI along with vascular injury. Any patient with ALF has already high mortality rates. However, even if the LT is successful these conditions sustain very high mortality in the postoperative period.*2. *Patients with a BDI develop progressive liver fibrosis and ultimately Secondary Biliary Cirrhosis (SBC) in the long term. SBC evolves from a gradual and steady process determined by an inadequate biliary outflow. In addition, repeated episodes of cholangitis determine a progressive and irreversible remodeling of the hepatic parenchyma toward fibrosis. This presentation is more frequent, and admission to the transplant waiting list is elective. LT in patients with BDIs is technically more complex because of adhesions due to multiple previous surgeries, fibrosis, and inflammation throughout the porta hepatis, coagulopathy, portal hypertension, atrophy-hypertrophy phenomenon, and septic complications. Correct management of patients with BDI is essential to ensure long-term survival. Multiple failed interventions by inexperienced teams and delays in referral to specialized centers are directly related to late, severe, and irreversible complications in BDIs. Although it provides long-term survival with an acceptable quality of life, LT still represents a high biological cost for a patient that initially underwent a routine surgical procedure for the treatment of a benign disease.