From the Guidelines
Orthotopic liver transplantation (OT) is the most effective treatment for patients with end-stage liver disease, offering extended survival with excellent quality of life. According to the AASLD practice guidelines 1, liver transplantation has had a profound impact on the care of patients with end-stage liver disease. The guidelines highlight that most liver transplants are performed using a whole liver from a deceased donor, and the donor liver is placed in the orthotopic position.
When considering OT level liver transplantation, several key points are essential:
- The unique anatomical organization of the liver allows for donor organs to be divided and transplanted into two recipients (split liver transplantation) 1.
- Living donor transplantation is also an option, where only a portion of the donor liver is removed for transplantation, and is a well-established procedure for children and adults 1.
- Perioperative complications may be higher with these techniques, but long-term patient survival seems comparable with that of deceased whole liver transplantation 1.
In terms of patient outcomes, liver transplantation can significantly improve quality of life, with patients experiencing extended survival and excellent functional outcomes. As noted in the AASLD practice guidelines 1, patients with advanced liver disease usually died within months to years before the advent of liver transplantation, but now have the opportunity for extended survival with excellent quality of life after liver transplantation.
Overall, the decision to proceed with OT level liver transplantation should be made on a case-by-case basis, taking into account the patient's individual needs and medical status, and in consultation with a multidisciplinary team of healthcare professionals.
From the Research
OT Level Liver Imaging
- The diagnostic accuracy of imaging modalities such as CT, MRI, and US for liver cirrhosis has been evaluated in a multicenter collaborative study 2.
- The study found that MRI and CT were slightly superior to US in the diagnosis of liver cirrhosis, but no statistically significant difference was found between them.
- The best predictive signs for cirrhosis on US were irregular or nodular surface, blunt edge, or morphological changes in the liver, while liver parenchymal abnormalities, manifestations of portal hypertension, and morphological changes in the liver were the best predictive signs on MRI and CT.
Imaging Modalities for Liver Disease
- Different imaging modalities, including ultrasonography, computed tomography (CT), and MR imaging, may be used in the liver depending on the clinical situation 3.
- Liver imaging surveillance in patients with cirrhosis may allow for detection of hepatocellular carcinoma at an earlier stage, and therefore may improve outcome.
- Endoscopic ultrasound (EUS) has an expanding role in the field of hepatology, complementing traditional investigational modalities such as transabdominal ultrasound, CT, and MRI 4.
Advances in Liver Imaging
- Recent developments have provided new tools for diagnosis and monitoring of liver diseases based on US, CT, and MRI, including assessing steatosis, fibrosis, and focal lesions 5.
- Emerging approaches for qualitative and quantitative liver imaging include radiomics, dedicated techniques such as controlled attenuation parameter, backscatter coefficient, elastography methods, and novel Doppler techniques.
- MRI proton-density fat fraction is currently the most accurate and precise imaging biomarker to quantify liver steatosis, and is the most appropriate noninvasive end-point for steatosis reduction in clinical trials and therapy response assessment 6.