Currently, liver transplantation is recognized worldwide as the only effective radical treatment for end-stage liver disease, not only saving the patient’s life, but also improving the quality of life and freeing the patient from the disease altogether. History of Liver Transplantation On March 1, 1963, Starzl performed a liver transplant on a 3-year-old child with congenital biliary atresia, which was the first human liver transplant. In the following four years, Starzl performed seven more human liver transplants, but the longest survival time among these seven patients was only 23 d due to the poor preoperative general condition of the recipient, poor donor liver preservation techniques and short preservation time, lack of strong immunosuppressive agents, infection and poor surgical technique. In the 1960s and 1970s, liver transplantation remained in the clinical research stage due to the low survival rate after liver transplantation. had been in the clinical research stage and was not widely used as a clinical treatment. With the introduction of the new immunosuppressants cyclosporine and pramipexole (FK506), liver transplantation changed the languishing situation and the development of liver transplantation surged forward. In 1980, Starzl first combined cyclosporine and corticosteroids to suppress the immune rejection reaction. Within 1 year, it increased the 6-month survival rate of patients by a factor of 1, i.e., from 35-40% to 70-80%. In 1987, the University of Wisconsin invented the UW (University of Wisconsin) Organ Preservation Solution, which allowed the cold ischemic time of the liver to be extended to 24 days. The quality of donor liver preservation was significantly improved, complications caused by donor liver preservation such as primary graft non-function were greatly reduced, and liver transplantation was changed from an emergency procedure to a semi-elective procedure. During this period, new transplantation techniques such as volume reduction liver transplantation, split liver transplantation and live donor liver transplantation were also developed. The successful clinical application of the new immunosuppressant Pulcoflora (FK506) in 1989 became an important milestone in the history of liver transplantation, providing a powerful immunosuppressant for some patients who could not tolerate cyclosporine therapy. In the same year, the backpack liver transplantation technique began to be used in clinical practice. From 1989 to 1990, living partial liver transplantation was successfully performed. After nearly 40 years of vigorous development, liver transplantation has now spread worldwide. By the end of 1999, 80,221 liver transplants were performed worldwide, and the number is increasing by about 8,000 cases per year, and 8,312 liver transplants were performed in 225 centers worldwide in 1999, and the longest survivor has reached 31 years. Especially in recent years, this work has been widely carried out and developed rapidly in China. The main manifestations are: the number of transplants has increased dramatically every year, more and more transplantation units and centers of certain scale have been formed gradually; the near and long-term efficacy of transplantation has been improving; new procedures have been carried out continuously; organ transplantation drugs such as UW fluid, CsA, FK506 and Senepipe are commonly used in clinical practice; and related basic research has become more extensive and in-depth. 1. Where is the liver located in the human body? What are some anatomical features? What functions does the liver perform in the human body? The human liver is located mostly in the upper right part of the abdominal cavity and is the largest substantial organ in the body, generally weighing about 1200g-1600g, accounting for 2-3% of body weight. The normal liver is reddish-brown in appearance, soft and brittle. The liver is responsible for several important functions in the human body: 1. metabolism of nutrients (sugars, fats, proteins, etc.); 2. synthesis of proteins and most clotting factors needed for human growth; 3. synthesis and secretion of bile; 4. biotransformation; 5. immune function. 2. What is liver transplantation? Liver transplantation is a surgical procedure that removes a diseased liver that has lost its function and implants a healthy, viable liver into the body to save the life of the patient at risk, regardless of the cause of the liver disease that has progressed to a life-threatening stage. Liver transplantation has become the only effective treatment for end-stage liver disease, and it has become a routine treatment for advanced liver disease, and more than 100,000 patients with end-stage liver disease have been given a second life through liver transplantation. The survival rate is over 90% at 1 year after surgery, over 80% at 5 years, and the longest survivor is now more than 33 years, and is as healthy as a normal person in mind and body. 3. What are the diseases that require liver transplantation? (1) Advanced cirrhosis caused by various reasons: such as hepatitis B cirrhosis, hepatitis C cirrhosis, alcoholic cirrhosis, and Bu-plus syndrome. (2) Cholestatic diseases: such as sclerosing cholangitis, primary biliary cirrhosis, secondary biliary cirrhosis, biliary atresia, etc. (3) Liver tumors: primary liver cancer, giant hepatic hemangioma, liver metastatic cancer, etc. (4) Congenital metabolic disorders: mostly seen in children, such as hepatic glycogen accumulation, hyperlipoproteinemia, Wilson’s disease, hepatomegaly, etc. 4. When hepatitis B patients need liver transplantation Not all hepatitis patients need liver transplantation. Liver transplantation should be considered only in the following three cases: (1) Hepatitis B develops into advanced cirrhosis with one or more of the following complications, such as portal hypertension upper gastrointestinal bleeding, intractable ascites, hepatorenal syndrome, hepatic coma, etc. (2) Acute and chronic severe hepatitis, especially chronic severe hepatitis, the liver function has been severely impaired and lost the compensatory function, if not treated in time, it may lead to death in 2-3 weeks, the survival rate of conservative medical treatment is only about 10%, so once diagnosed, liver transplantation needs to be actively performed. (3) Hepatitis-related liver cancer patients: 85% of liver cancer patients in China are combined with chronic hepatitis or liver cirrhosis, which is medically classified into early stage and late stage. Early stage liver cancer, also known as small liver cancer, refers to tumor diameter less than 5 cm. the survival rate of these patients can reach more than 80% after liver transplantation for more than 5 years, and they do not need preventive chemotherapy at all after surgery, and their quality of life is the same as normal people. Advanced liver cancer refers to tumors larger than 5 cm in diameter, and most of these patients will not survive more than 12 months even if they are actively treated. However, with liver transplantation, the survival rate of more than 1 year after surgery is 90%, and the survival rate of 3 years is about 50%, which can effectively prolong the life of patients. 5. How to choose the timing of surgery for liver transplant patients? With the maturity of surgical technology, the concept of liver transplantation has now changed from extending life in the past to improving the quality of life. Therefore, for patients with advanced liver disease, surgery should be chosen before the disease has completely deteriorated to reduce postoperative complications, reduce mortality, and improve long-term survival rate, while significantly reducing costs. If the disease progresses to a very severe stage, the risks and costs of surgery are increased by more than a factor of one. In an established liver transplant center, there are strict indications for deciding whether a patient needs a liver replacement 1. The patient has irreversible liver disease. 2. The patient is not curable medically or surgically. 3. The patient is inevitably dying in the short term (6-12 months). 4. Liver transplantation is the only effective treatment. 5. How safe is liver transplantation? Liver transplantation is very safe. Some patients worry that the patient will not be able to get off the operating table. In established liver transplantation centers, the surgery is basically 100% successful. The surgery usually lasts 7-8 hours, and you can eat normally for three days after the surgery, get out of bed at one week, and be discharged from the hospital successfully in about one month and can live like a normal person. 6.What issues should I pay attention to after liver transplantation? Patients must establish long-term contact with the transplantation center after liver transplantation, so that they can directly contact the transplantation doctor and receive professional guidance when they encounter medical problems. The patient should have regular check-ups of liver function, B-ultrasound and drug concentration, and adjust the dosage of drugs under the guidance of the doctor, and the anti-rejection drugs should be taken for life until now, and a minimum amount should be maintained after one year. â‘¡Patients with active hepatitis before surgery can be cured through surgery, and after surgery, they should take drugs to prevent recurrence of hepatitis under the guidance of doctors, and generally stop the drugs after two years of maintenance. â‘¢Patients with preoperative liver cancer do not need chemotherapy after surgery if it is early stage liver cancer. Patients with intermediate and advanced liver cancer need to use prophylactic chemotherapy after surgery to reduce the recurrence rate of liver cancer. 7.What is the quality of life after liver transplantation? After liver transplantation, patients can resume normal work and family life after 3 months, and they can take up general physical and mental labor, as well as participate in sports. Patients should develop good habits after liver transplantation: 1) Absolutely no smoking and drinking alcohol. 2) Do not receive live vaccines (including cowpox, measles vaccine, mumps vaccine, polio vaccine, etc.) and contact with people who have a recent history of vaccination. (3) Do not eat raw food and drink raw water. (4) Do not take any Chinese medicine to increase immunity. 8. Is there an age limit for liver transplantation? There is no absolute contraindication for liver transplantation, it depends on the patient’s condition. 9.Can the cost of liver transplantation be covered by medical insurance Our current basic medical insurance does not cover liver transplantation, some types of insurance, such as critical illness insurance, can provide such insurance, but we understand that many transplantation drugs are currently included in the provincial and municipal medical insurance drugs. Here we also call on medical insurance institutions to include liver transplantation in the insurance coverage earlier, so that more patients with liver disease can be excluded from the disease. 10, misconceptions about liver transplantation 1) Consider liver transplantation only when a person is dying For a patient with chronic liver disease, it is important to choose the right time for transplantation. In other words, at what stage of chronic disease development, liver transplantation will bring the most ideal therapeutic effect and prognosis to the patient. If liver transplantation is performed too early, a shortage of donors will not be used in a just and rational manner; if it is performed too late, difficult perioperative complications and high mortality rates may occur, reducing the efficacy of liver transplantation. For these patients, the key is the choice of when to operate, i.e., the timing of surgery. In China, as liver transplantation has not been carried out on a large scale for a long time, people have a fear of liver transplantation and often consider liver transplantation only when repeated medical treatment is ineffective, the patient’s general condition is poor and vital signs are unstable, which actually misses the best time for liver transplantation. It is generally accepted that if the patient’s condition has progressed to the hospital-dependent stage, i.e., he needs to be hospitalized every so often to receive liver preservation and supportive therapy, and the patient’s expected survival is six months to a year, he should receive a liver transplant. At this point, surgical treatment is effective, less risky and less expensive, and in fact, its overall cost will be lower due to the elimination of the considerable cost of repeated preoperative medical treatment, thus reducing the financial burden on the patient. If the patient undergoes surgery only when the disease has progressed to a very advanced stage, with general edema, massive ascites and liver coma, the risk is high, the cost is high and the results are not as good as those of early surgery. (2) Liver transplantation is a nine-life surgery Many patients have concerns that liver transplantation is too risky and a nine-life surgery. In fact, liver transplantation has been developed for more than 40 years, the surgical technique has been perfected, the level of intensive care has been improved, and the mortality rate after liver transplantation has been reduced to less than 3%. However, the mortality rate after partial hepatectomy is still 3% to 15%. Especially for liver malignancy combined with cirrhosis, the efficacy of liver transplantation is significantly better than that of partial hepatectomy. Therefore, liver transplantation is very mature and safe, and its surgical risks, complications and mortality are basically equivalent to those of conventional major abdominal surgery. In particular, it should be clarified that the risk and prognosis of liver transplantation are closely related to the patient’s preoperative status, and early acceptance of the surgery can help improve postoperative survival and reduce postoperative complications, as well as reduce the hospitalization period and hospitalization costs.