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In the early post transplant period, an intensive medical monitoring is necessary with frequent controls of the vital parameters [[ 1 ]–[ 2 ]]. Whilst post operative artificial ventilation is not mandatory, it is almost without exception, the rule. Stable transplant patients with good general condition can usually be extubated within 6 hours after the transplantation

During the last 2 decades patient and graft survival have dramatically improved (fig. 45a. 1). Despite advances in organ preservation and technical procedures, postoperative complications due to preservation/reperfusion injury have not markedly decreased over the past several years. Perioperative ischemic injuries include hepatocellular damage during cold ischemia time from prolonged preservation and warm ischemia during implantation of the allograft. Typical histological features of preservation and reperfusion injury include centrilobular pallor and ballooning degeneration of hepatocytes. Bile duct cells are more sensitive to reperfusion injury than hepatocytes [ 1 ], resulting in increased levels of bilirubin, gamma-glutamyl [ 1 ] transpeptidase (γGT), and alkaline phosphatase (AP). Vascular complications such as hepatic artery thrombosis (HAT) or stenosis occur in 1.6%–10.5% and up to 5% of patients, respectively. HAT may lead to large bile duct injuries, requiring retransplantation in many patients. Hepatic failure due to HAT is more common in the early postoperative period and can be managed with thrombectomy

Due to excellent results in the short-term outcome after liver transplantation, attention has shifted to reducing long-term complications. Seyam et al. investigated late mortality in more than 1000 patients transplanted between 1982 and 1999. Of the 129 who did not survive within this time period, 56% died of side-effects associated with long-term immunosuppression including malignancies and renal impairment, 22% died of vascular complications, and 15% suffered liver organ failure due to recurrent disease [ 1 ]

Disease recurrence may occur in patients with viral hepatitis, tumor disease, autoimmune diseases, and cholestatic liver diseases. With universal recurrence of HCV in all replicative patients, hepatitis C continues to pose one of the greatest challenges for preventing disease progression in the allograft

Recent data suggest an acceptable outcome in highly selected HIV patients [ 1 ]. Fung et al. propose that HIV patients with renal failure, advanced malnutrition, opportunistic infections within the last 6 to 12 months, previous Kaposi’s sarcoma, or JC polyoma viral infection should be considered contraindicated for OLT [ 1 ]. Between July 1998 and October 2001, five HIV-infected patients underwent OLT because of HBV-, HBV + HDV-, or HCV-induced liver cirrhosis at our transplant center. Retrospective analysis of the data revealed that three of the five patients died due to graft failure [ 2 ]. Norris et al. compared data from HIV-positive patients coinfected with HCV (n = 7) to those with non-HCV-related liver diseases (n = 7). In the non-HCV group, all patients were alive; whereas 5 of 7 HCV-coinfected patients died during a median follow-up of 1 year [ 3 ]. Vogel et al. retrospectively analyzed the data of 7 HIV-positive transplant recipients [ 4 ]. They found that the spectrum of postoperative complications including the course of recurrent hepatitis C infection and rate of rejection was not different from that in HIV-negative patients, except in one with Kaposi’s sarcoma and multicentric Castleman’s disease

A successful adult live donor liver transplantation (ALDT) depends on many factors. However the risk of the operation is considerable and donor safety remains central to this difficult venture! The selection and imaging of the live liver donor candidates are paramount for a good outcome

Liver transplantation is challenged by a shortage of organs and a prolonged waiting-list time. The large disparity between the number of available cadaver donor organs and recipients awaiting OLT has created an ongoing debate regarding the appropriate selection criteria. Novel surgical techniques, including split cadaveric livers, LDLT, and broadening the donor criteria towards acceptance of marginal donors have been used as strategies in order to expand the donor pool. The appliance of Computer Assisted Surgical Planing in Adult Living Donor Liver Transplantation represents a real challenge for transplant surgeons to perform a modern operation with high standards of safety for donor and recipient