Contemporary Liver Transplantation

This book presents the first comprehensive review of all facets of liver transplantation using DCD donors. Each of the 19 chapters are written by leading experts in the field, representing some of the most experienced DCD liver transplant programs in the world. Several topics have overlapping coverage in different chapters, providing the reader with the perspective of multiple experts on crucial topics. Chapters also highlight the steps towards building a DCD liver transplant program, the importance of donor and recipient selection, as well as state-of-the-art developments and future directions in the utilization of these organs. Donation after Circulatory Death (DCD) Liver Transplantation serves as a valuable resource for all those involved in liver transplantation using DCD donors.

The field of liver transplantation has undergone tremendous change and continues to evolve at a fast pace. This book covers topics beyond standard care and discusses issues that are new and rapidly evolving in the field. These include innovative surgical methods to maximize the donor pool, non-surgical methods to expand the existing pool of additional donors, the changing face of liver rejection, and management of infections in the presence of new antivirals. This book is an interesting read for surgeons, hepatologists, and healthcare workers looking after patients who need or have had a liver transplant.

In the past, liver resections and liver transplantations were performed by different surgical teams, with very little interplay between the two. However, the evolution toward more complex operations called for an increasingly intense interaction between these surgical techniques: split liver and living donor liver transplantation have become popular in the transplant community, utilizing the Coinaud segmental anatomy in a very sophisticated way, while portal and arterial resection and reconstruction have become indispensable methods for treating Klatskin tumors infiltrating the hepatic hilum. This book offers a complete overview of the connections between liver transplantation and hepatobiliary surgery. It focuses on ex situ techniques for resection of tumors at the suprahepatic confluence, with or without venous reconstruction, and on total vascular exclusion of the liver with the aid of a venovenous bypass that should be a surgical option for referral centers in hepatopancreatobiliary surgery. By taking into consideration the development of minimally invasive liver surgery, it will introduce readers to a variety of new perspectives such as: vascular exclusion techniques with or without extracorporeal circulation, hemodynamic implications and lessons learned from liver transplant surgery, and technical details on pediatric transplantation and its informative role in modern biliary tract surgery.

A number of areas within liver transplant continue to evolve as the field matures. The advent of increasingly effective therapy for HCV will dramatically reduce the burden of recurrent disease within the next few years. HCC has become a well established indication for transplant with an increasing emphasis on adjuvant therapies to reduce the risk of tumor recurrence and potentially expand the acceptable limits of tumor burden amenable to liver transplant. Renal dysfunction is a frequent complication of decompensated liver disease and an important predictor of diminished post-transplant survival. Newer approached to therapy including terlipressin will reduce the impact of renal dysfunction in liver transplant candidates and potentially reduce the need for combined liver/kidney transplant. Increasing attention is being paid to role of comorbidities such as diabetes and hypertension on longterm recipient outcomes. Retransplantation remains a challenge with a variety of models available ot redict outcomes. Cardiac disease pretransplant is an area of active investigation with newer entities such as cirrhotic cardiomyopathy a growing concern. These are some of many evolving issues in liver transplant which will be addressed to update our readers and which in turn will enhance the care of patients with liver disease.

The book describes in detail the technical aspects of Living Donor Liver Transplantation (LDLT), the routine practice of the world renowned Liver Transplant Team at Hong Kong's Queen Mary Hospital, and our views on various issues of the operation. The thorough review on the history and technical procedures of LDLT and discussion on various aspects of the operation and its future perspectives will serve as a unique reference for surgeons, researchers, nurses, medical students, patients and laypersons seeking information on LDLT. This latest edition offers updated operative results from our center and the latest modifications of the technique. With contributions from a leading microvascular surgeon, a critical care clinician, a psychiatrist, and two anesthetists from the same liver transplant team, the LDLT experience at Queen Mary Hospital is depicted in an even greater extent.

Liver Transplantation: Challenging Controversies and Topics grew out of a need I perceived within the fields of transplant hepatology and liver transplantation. Liver transplantation has rightly gained recognition as an established therapy for end-stage liver disease. Few would argue that liver transplantation is one of the few truly lifesaving and life-altering treatments within medicine and surgery. Not many realize that 20 years passed from the time of the first human liver transplantation in 1963 to its acceptance as therapy by the 1983 NIH Consensus Conference on Liver Transplantation. In 2008, 25 years will have passed since the 1983 NIH conference—a mere 25 years for a field that has provided patients hope, doctors options, and to some the “gift of life. ” Many issues in liver transplantation involve indications, patient selection, and outcomes after transplantation—these are standard topics, covered by textbooks of hepatology and transplantation. In contrast, the field of liver tra- plantation is young, evolving, dynamic, and issues and decisions are often controversial. Thus, Dr. Trotter and I, as well as our colleagues at the University of Colorado, felt that a text with a different focus was required, one that highlighted controversy and challenged dogma. Out of this perceived need emerged Liver Transplantation: Challenging Controversies and Topics. To meet the transplant community’s need for emerging information about liver transplantation, Dr. Larry Chan, Dr. Igal Kam, and I initiated the Controversies in Transplantation Conference.

A major new reference work on Liver Transplantation written by the transplantation team of one of Asia's leading transplant centres with a foreword by Prof. Sir Roy Calne the liver transplantation pioneer and expert in immunosuppressant techniques. The book begins with an overview of transplantation team composition, international donor selection guidelines and donor management and goes on to discuss technique and management of DDLT, LDLT, Pediatric, Split, Domino and ABO-incompatible liver transplantation. Post-transplant management, immuno-suppression, follow-up, short and long-term complications and their outcomes, as well as recent advances in liver transplantation such as stem cell, hepatocyte and xenotransplantation, are also discussed.