Preparation of Recipient and Donor Before Liver Transplantation
The priority during liver transplantation preparation is to ensure that the planned operation will not create an unacceptable situation for either recipient or donor. The most important objective is to avoid any harm to the donor in particular. The aim is for two healthy individuals to emerge from the operation.
If the operation is found to pose an unacceptable risk to the prospective donor, the process is stopped immediately and another candidate is evaluated. It is therefore essential to confirm that enough liver tissue will remain to support the donor after donation. In addition, the anatomy of structures such as the hepatic artery, portal vein, hepatic veins, and bile ducts must allow safe division of the liver. Detailed tests and imaging are used before surgery for this purpose.
Despite these precautions, if a risk to the donor is discovered during surgery, the operation is canceled, although this is rare. Generally, the volume of liver remaining with the donor (the remnant liver) should not be less than 30%. The source notes that in young, suitable donors this percentage may sometimes be as low as 25%.
Recipient Preparation
Liver transplantation is presented as the only definitive treatment for liver failure. Before surgery, however, the recipient must also undergo a detailed medical evaluation. Its purpose is to determine whether the recipient can tolerate the operation, identify and treat any correctable problems in advance, and reduce the risk of postoperative complications. If a serious contraindication to transplantation is found, the patient is informed and the operation is canceled.
Conditions That May Require Cancellation of the Recipient's Operation
- Advanced portal vein thrombosis
- Hepatocellular carcinoma invading major liver vessels or spreading outside the liver
- An insufficient volume of liver tissue available from the donor for the recipient
- Vascular or bile duct anatomy of the donor liver portion that creates unacceptable surgical risk for the recipient
Generally, the weight of the transplanted liver segment should be at least 1% of the recipient's body weight. In patients in good general condition with a young donor, the source notes that a ratio as low as 0.8% may be considered.
Examinations of Recipient and Donor Before Liver Transplantation
- Physical examination
- Detailed blood and urine tests and evaluation of organ system functions (blood group, complete blood count, biochemistry, coagulation tests, hepatitis markers, EBV, CMV IgM/IgG, TSH, PTH, HbA1c, beta-hCG, PSA, AFP, tumor markers, urinalysis, and further tests directed at the underlying cause)
- Microbiological tests (catheter, urine, ascitic fluid, and blood cultures where necessary)
- Radiological investigations:
- Recipient: Complete abdominal ultrasonography, portal vein Doppler ultrasonography, chest CT, triphasic abdominal CT, and contrast-enhanced MRI if needed
- Donor: Complete abdominal ultrasonography, chest CT, and triphasic abdominal CT
- Consultations with other specialties as indicated, including cardiology, pulmonology, psychiatry, and obstetrics and gynecology
- Other tests and examinations: ECG, echocardiography, pulmonary function testing, endoscopy, colonoscopy, and, where indicated, mammography, breast ultrasonography, and thyroid ultrasonography
The purpose of this entire process is to perform a successful and safe liver transplant while protecting the health of both recipient and donor before and after surgery as effectively as possible.