Clinical Review

ABC of diseases of liver, pancreas, and biliary system

Transplantation of the liver and pancreas

BMJ 2001; 322 doi: 10.1136/bmj.322.7290.845 (Published 7 April 2001)
Cite this as: BMJ 2001;322:845

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  1. K R Prasad,
  2. J P A Lodge

    Liver transplantation is carried out for many chronic liver diseases and for fulminant hepatic failure. The United Kingdom has seven liver transplantation units, which perform 600–700 transplantations a year. Activity is limited by availability of donor organs, and there are around 200 patients waiting for a liver transplant at any one time. Transplantation of the pancreas is less well established. The pancreas is usually transplanted together with a kidney in patients with end stage diabetes mellitus and renal failure. Worldwide, around 1000 patients (mainly in the United States) receive a pancreatic transplant each year. Only 20–30 a year are transplanted in the United Kingdom.


    Embedded Image

    Donor liver from adult cut down for insertion into child recipient

    Liver transplantation

    Indications and contraindications

    Hepatocellular carcinoma complicates many chronic liver diseases, and a small tumour is not a contraindication to transplantaton because tumour recurrence is uncommon in these patients. However, most patients with large (>5 cm) or multiple hepatomas or most other types of cancer are not considered for transplantation as tumours recur rapidly. Patients with certain rare tumours, such as liver metastases from neuroendocrine disease and sarcomas, can do well for several years. Contraindications to liver transplantation include extrahepatic malignancy, severe cardiopulmonary disease, systemic sepsis, and an inability to comply with regular drug treatment.

    Common indications for liver transplantation

    • Primary biliary cirrhosis

    • Primary sclerosing cholangitis

    • Cryptogenic cirrhosis

    • Chronic active hepatitis (usually secondary to hepatitis B and C)

    • Alcoholic liver disease (after a period of abstinence)

    Timing and selection of patients for transplantation

    The preoperative status of the patient is one of the most important factors predicting the outcome after transplantation. Patients with chronic liver disease and signs of decompensation should be assessed for transplantation before they become critically ill. In certain diseases, such as primary biliary cirrhosis, quality of life issues may form the basis for indication for transplantation. For example, chronic lack of energy can be debilitating in patients …

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