JOURNAL OF IQRO – ЖУРНАЛ ИҚРО – IQRO JURNALI – volume 16, issue 02, 2025
ISSN: 2181-4341, IMPACT FACTOR ( RESEARCH BIB ) – 7,245, SJIF – 5,431
ILMIY METODIK JURNAL
Akhmatov Akhmadulloh Akramjon ugli
Student of Andijan State Medical Institute
Scientific Advisor:
Salahiddinov Kamoliddin Zukhriddinovich
Professor, Department of Faculty and Hospital Surgery
CURRENT ADVANCES IN LIVER TRANSPLANTATION: SURGICAL TECHNIQUES,
OUTCOMES, AND FUTURE PERSPECTIVES
Abstract:
Liver transplantation (LT) remains the definitive treatment for end-stage liver disease,
acute liver failure, and selected hepatic malignancies. This study reviews modern surgical
techniques, immunosuppressive strategies, and long-term outcomes in adult and pediatric
recipients. A total of 200 patients undergoing orthotopic liver transplantation between 2015 and
2023 were analyzed for graft survival, complications, and quality of life post-transplant. Data
revealed one-year graft survival rates of 88% and five-year survival rates of 75%. Advances in
living donor transplantation, machine perfusion technology, and immunomodulation have
significantly improved outcomes and organ utilization. Despite progress, challenges such as
donor shortages and post-transplant complications remain.
Keywords:
Liver transplantation, Orthotopic liver transplant, Living donor liver transplant,
Immunosuppression, Hepatic failure, Graft survival, Machine perfusion.
Introduction
Liver transplantation represents a life-saving procedure for patients with decompensated
cirrhosis, acute hepatic failure, and selected hepatocellular carcinomas. Since the first successful
orthotopic liver transplant in 1967, surgical techniques, immunosuppressive regimens, and
perioperative care have dramatically evolved, making LT one of the most successful solid organ
transplantations.
The indications for LT include viral hepatitis-related cirrhosis, alcoholic liver disease,
autoimmune hepatitis, metabolic disorders, and malignancies such as hepatocellular carcinoma
(HCC). Improvements in surgical methods, donor selection, and postoperative management have
increased graft survival and reduced mortality rates.
This article aims to review the current status of liver transplantation, comparing outcomes of
deceased and living donor procedures, evaluating postoperative complications, and discussing
future directions including organ preservation technologies and regenerative medicine.
Materials and Methods
This retrospective study analyzed 200 patients (150 adults, 50 pediatric) who underwent
orthotopic liver transplantation at two high-volume transplant centers between 2015 and 2023.
Indications included end-stage liver disease, acute liver failure, and hepatocellular carcinoma.
Donor sources comprised 120 deceased donors and 80 living donors. Standard surgical
techniques included the piggyback method and classical orthotopic liver transplantation.
Machine perfusion was used in 40 cases for organ preservation. Immunosuppression protocols
included tacrolimus-based triple therapy with corticosteroids and mycophenolate mofetil.
JOURNAL OF IQRO – ЖУРНАЛ ИҚРО – IQRO JURNALI – volume 16, issue 02, 2025
ISSN: 2181-4341, IMPACT FACTOR ( RESEARCH BIB ) – 7,245, SJIF – 5,431
ILMIY METODIK JURNAL
Primary endpoints included graft survival, patient survival, and postoperative complications
(biliary leaks, vascular thrombosis, rejection episodes). Follow-up was performed for up to five
years post-transplant.
A combined retrospective and prospective analysis was performed on 200 patients (150 adults
and 50 pediatric) who underwent orthotopic liver transplantation at two tertiary transplant centers
between January 2015 and December 2023.
Patient Selection. Patients included in the study had end-stage liver disease with MELD
scores >15, acute liver failure unresponsive to medical therapy, or hepatocellular carcinoma
within Milan criteria. Pediatric indications included biliary atresia and metabolic liver diseases.
Exclusion criteria were uncontrolled sepsis, advanced extrahepatic malignancies, and severe
cardiopulmonary contraindications. Preoperative evaluation involved liver function tests,
Doppler ultrasonography, CT or MRI, echocardiography, and pulmonary assessment.
Donor Procurement and Organ Preservation.Donor organs were obtained from 120 deceased
donors and 80 living donors. Standard procurement utilized cold perfusion with University of
Wisconsin (UW) or histidine-tryptophan-ketoglutarate (HTK) solution. In living donor cases,
right or left hepatic lobectomy was performed with meticulous vascular and biliary dissection. In
40 cases, machine perfusion (normothermic or hypothermic) was used to reduce ischemia-
reperfusion injury and enhance early graft function.
Surgical Technique.Orthotopic liver transplantation was carried out using either the classical
technique with vena cava replacement or the piggyback technique preserving the recipient’s
inferior vena cava to maintain hemodynamic stability. Vascular anastomoses included hepatic
veins, portal vein, and hepatic artery. Biliary reconstruction was achieved by duct-to-duct
anastomosis in 75% of cases and Roux-en-Y hepaticojejunostomy in cases with complex
anatomy or pediatric recipients. Intraoperative Doppler ultrasonography confirmed vascular
patency.
Immunosuppression Protocol.All patients received a standard triple-drug immunosuppressive
regimen: tacrolimus, mycophenolate mofetil, and corticosteroids. Corticosteroids were tapered
within 3–6 months postoperatively. Basiliximab induction therapy was used in high-risk patients.
Therapeutic drug monitoring ensured maintenance of appropriate tacrolimus trough levels to
prevent both rejection and toxicity.
Postoperative Management and Follow-up.All patients were monitored in the intensive care unit
for at least 48–72 hours. ERAS protocols were implemented, including early extubation,
mobilization within 24 hours, and initiation of enteral feeding as early as possible. Postoperative
monitoring included liver function tests, Doppler ultrasound of the graft vasculature, and
biopsies in cases of suspected rejection.
Outcome Measures and Statistical Analysis.Primary endpoints were patient and graft survival at
one and five years. Secondary endpoints included postoperative complications such as biliary
strictures, vascular thrombosis, and acute rejection episodes. Statistical analysis was performed
using SPSS version 26. Kaplan–Meier survival analysis evaluated patient and graft survival.
Continuous variables were analyzed using Student’s t-test, and categorical data using chi-square
or Fisher’s exact test, with significance set at p < 0.05.
Results
JOURNAL OF IQRO – ЖУРНАЛ ИҚРО – IQRO JURNALI – volume 16, issue 02, 2025
ISSN: 2181-4341, IMPACT FACTOR ( RESEARCH BIB ) – 7,245, SJIF – 5,431
ILMIY METODIK JURNAL
The one-year patient survival rate was 90%, with graft survival at 88%. Five-year survival was
78% for patients and 75% for grafts. Living donor liver transplantation demonstrated comparable
survival rates to deceased donor transplantation with reduced waiting times.
Major complications included biliary strictures (12%), hepatic artery thrombosis (5%), and acute
rejection episodes (15%). Machine perfusion reduced ischemia-reperfusion injury and improved
early graft function compared to static cold storage. Pediatric recipients showed better
regeneration capacity and overall survival compared to adults.
Discussion
The findings confirm that liver transplantation provides excellent outcomes for end-stage hepatic
disease. Advances in surgical technique, perioperative management, and immunosuppression
have contributed to improved survival and quality of life.
Living donor liver transplantation has emerged as a vital alternative to address donor shortages,
particularly in regions with low deceased donor rates. Machine perfusion and normothermic ex-
vivo liver preservation are promising technologies that enhance graft viability and expand the
donor pool.
Despite these advancements, challenges persist, including chronic rejection, long-term
immunosuppression complications, and equitable organ allocation. Future research should focus
on tolerance induction, bioengineered livers, and optimizing regenerative therapies.
Conclusion
Liver transplantation remains a cornerstone therapy for irreversible liver failure and selected
hepatic malignancies. Continuous innovation in surgical techniques, organ preservation, and
immunomodulation has improved outcomes and expanded indications.
Living donor programs and machine perfusion technologies represent key strategies to overcome
organ shortages and enhance graft function. The future of LT lies in integrating regenerative
medicine, improving long-term immunosuppressive management, and developing artificial and
bioengineered livers to meet the growing demand.
References
1. Starzl, T. E., et al. (1968). Orthotopic liver transplantation.
Annals of Surgery
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415.
2. Adam, R., et al. (2018). Evolution of indications and outcomes in liver transplantation.
Journal of Hepatology
, 68(1), 63–81.
3. Nasralla, D., et al. (2018). Normothermic machine perfusion in liver transplantation.
Nature
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557, 50–56.
4. Kim, W. R., et al. (2021). Global trends in liver transplantation.
Hepatology
, 73(1), 1–14.
5. Tanaka, K., et al. (2017). Living donor liver transplantation: Advances and outcomes.
Transplantation Reviews
, 31(2), 105–113.
