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Why liver transplantation?

No prospect of an alternative cure

Patients who are candidates for transplantation suffer from acute or chronically progressive liver disease with no prospect of an alternative cure, such as conservative drug treatment or surgical partial liver removal. A distinction is made between benign (acute or chronic) and malignant diseases (e.g. liver carcinoma). In most cases, the scarring connective tissue transformation leads to the destruction of healthy liver tissue (cirrhosis) and thus to the loss of function of the liver. This loss of function is expressed in different degrees of severity, which are classified according to certain criteria (e.g. CHILD-PUGH score, MELD score). This classification of liver disease is essential for the indication and urgency of notification to Eurotransplant.

With the progression of liver cirrhosis and thus liver damage, the risk of secondary diseases also increases. It is not uncommon for patients to develop abdominal fluid (ascites), enlarged spleen and varicose veins in the oesophagus and stomach (oesophageal and fundic varices). The latter pose a risk of acute bleeding because of the increased tendency to bleed due to impaired liver function. (Clotting factors are produced in the liver). In addition, liver damage can also result in the sometimes irreversible damage of other organs, especially the kidneys, the heart or the lungs. The development of liver cirrhosis is a slowly progressive process and can occur as a result of various causes.

In Germany, the most common disease leading to liver cirrhosis is chronic alcohol abuse, followed by liver inflammation caused by hepatitis B and C viruses. Primary sclerosing cholangitis (PSC), which is associated with destruction of the bile ducts in the liver, occupies a special position with regard to surgery. The disease often occurs together with an inflammatory bowel disease (especially ulcerative colitis) and can develop into a malignant bile duct disease. In PSC, the bile duct of the new liver is connected directly to the small intestine of the recipient (biliodigestive anastomosis). However, PSC can recur after a successful transplant and may even require a new liver transplant after several years.

 

Diseases to be treated by liver transplantation

Overview of common diseases leading to liver transplantation:

Metabolic diseases
  • Alpha-1 antitrypsin deficiency
  • Wilson's disease (copper metabolism disorder)
  • Haemochromatosis (iron storage disease)
  • Amyloidosis
Malignant diseases
  • Hepatocellular carcinoma (HCC)
  • Neuroendocrine liver tumours
  • Malignant haemangioendothelioma
Other diseases
  • Congenital cystic liver
  • Budd-Chiari syndrome (hepatic vein occlusion)

Examinations before liver transplantation

and doctor's appointments to be arranged

List of standard examinations
  • Blood tests
  • ECG
  • Lung function
  • X-ray of the lungs
  • Gastroscopy and colonoscopy
  • Ultrasound of the abdominal organs and heart
  • Stress test of the heart
  • Computed tomography (CT) or magnetic resonance imaging (MRI) of the abdomen
  • Bone density measurement
  • Psychosomatic evaluation
  • Checking vaccination status
  • Swabs for hospital germs
  • Urine tests for germs and possibly alcohol
  • Possibly hair analysis
  • Regular weight checks

 

The MELD score

Model of End Stage Liver Disease

With the results of these examinations, your data and your medical findings, a report is now made to Eurotransplant to include you on the list of possible organ recipients. If you are included on the waiting list for liver transplants, your degree of severity will be listed there according to the MELD score (Model of End Stage Liver Disease). The MELD score is calculated from 3 laboratory parameters:

  • Serum creatinine
  • total bilirubin
  • INR (measure of blood clotting)

 

The calculated score can reach values from 6 (mild disease) to 40 (severe disease ). There is a separate score for children; the PELD score here also includes albumin. The MELD score provides a more accurate indication of the severity of liver disease and the urgency of transplantation, which is essential for listing for liver transplantation. During the waiting period, it is necessary that your laboratory values are checked regularly at the centre, depending on the level of the score. For you as a patient, it is therefore important that the centre consistently updates the MELD score with Eurotransplant.

matchMELD standard criteria (Standard Exceptional, EMELD)

In some cases, the urgency of liver transplantation is not adequately reflected by thelabMELD (billirubin, creatine, INR). For this reason, there is the possibility for waiting list candidates to apply for a so-called matchMELD or Exceptional MELD (EMELD) with Eurotransplant for some diseases.
Diseases for which an EMELD is frequently applied for are, for example, hepatocellular carcinoma, primary sclerosing cholangitis or cystic liver. In addition, there are a number of rare diseases for which an EMELD is possible.

In order for EMELD to be granted, the criteria specific to the disease must be present in each case. These are determined during the presentation in the consultation regularly. You will be informed about this in detail. If an EMELD has been issued, regular updates are necessary every 3 months. For organ placement with Eurotransplant, the higher MELD value is always taken into account, i.e. if the labMELD is higher than the EMELD, the latter counts, and vice versa.

 

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