Liver transplantation, as the name implies, is the treatment of removing a diseased liver that has failed to respond to conventional treatment and replacing it with a healthy one. The purpose is to treat liver disease, improve the quality of life and prolong the patient’s life. In theory, liver transplantation should be the ideal treatment for most liver diseases. Unfortunately, healthy livers are not industrially produced and require someone to donate in order to obtain one, so scarce donor resources result in many patients being denied access to treatment. In addition the high cost of transplant surgery and post-operative long-term anti-rejection medication and regular check-ups are not affordable for all patients. Therefore, in order to fully and effectively utilize donor resources and avoid wasting resources and heavy financial burdens, we need to understand what type of patients are suitable or need liver transplantation. Let’s first talk about the indications for liver transplantation. As mentioned earlier, liver transplantation needs to be considered when liver disease reaches the point where conventional treatment is ineffective. These include congenital diseases of the liver and biliary tract: hepatomegaly, Wilson’s disease, congenital biliary atresia, Buga syndrome, and so on. These are mostly infants and children whose livers are not able to function properly due to congenital reasons and are life-threatening. Due to the lack of effective treatment, many children do not survive for long and therefore need to be replaced with new livers as soon as possible. The treatment effect of transplantation in such patients is very satisfactory, and many of them can survive for a long time, get married and have children; 2. Infectious liver diseases or liver damage caused by other reasons: including viral hepatitis (such as cirrhosis of liver B, the most common in China), alcoholic cirrhosis, severe fatty liver, etc. resulting in liver failure, patients who do not survive for a long time, even less than 3 months. The overall prognosis of these diseases are good and also allow patients to survive for a long time, but some of them have the risk of recurrence, mainly seen in viral hepatitis; 3. Liver tumors: mainly malignant tumors, and primary liver cancer. There are also some benign tumors that, due to the liver itself or the special location of the tumor, have no chance of surgical treatment requiring a new liver for long-term survival. Although liver transplantation can treat underlying liver lesions such as cirrhosis while also removing liver tumors as a whole, there is still a risk of short-term recurrence for malignant tumors, so strict indications for surgery are needed to avoid wasting donor resources and causing both physical and financial burdens to patients. Because the indications for liver transplantation for the first two types of diseases are clear, there are fewer controversies, and the prognosis is relatively good, so we will not go into details here. Next, we will talk about the more controversial indications for liver transplantation in patients with hepatocellular carcinoma. Generally speaking, we need to grasp the following principles: 1. Patients can obtain the longest possible survival time and high quality of life through transplantation, and largely due to conventional treatment. In view of this, the medical community has developed many criteria for patients capable of transplantation. The most classic one is the Milan criteria. According to the criteria, patients with no more than 3 liver tumors, maximum diameter not exceeding 5 cm, no vascular invasion and extrahepatic metastases are most suitable for transplantation and can obtain a 5-year survival rate of more than 70%. 2. Maximize the rational use of the donor (donor liver) and enable more people to have the chance of transplantation to cure the disease. The classic criteria of liver transplantation for hepatocellular carcinoma, the Milan criteria, are too harsh and although they fully guarantee the efficacy, they limit the opportunity of transplantation for many patients and do not give a reasonable principle of transplantation sequencing, and more importantly, the difference between transplantation and surgical resection for patients with good liver function is not The difference between transplantation and surgical resection for patients with good liver function is not significant. In our country, many people are already beyond the standard when they find liver cancer, and at the same time, their liver function cannot bear other treatments such as interventions, so is the chance of treatment completely lost? In addition, liver cancer in China occurs on the basis of hepatitis B cirrhosis, which is different from liver cancer on the basis of hepatitis C in western countries in terms of long-term outcome, and our liver cancer development is not as aggressive as western countries. Patients with the same tumor condition have different expected survival time, that is, the time they can wait for liver transplantation, due to the different functional status of the liver. Therefore, we have developed our own criteria based on these characteristics, drawing on foreign experience, so that more people can have access to transplantation while ensuring efficacy, and also having a basis to enable limited transplantation for severe patients. At present, the main criteria we consider are: the number of tumors is still not recommended to exceed 3, the maximum diameter can reach 9cm, and also there should not be vascular invasion and extrahepatic metastasis, and the patient’s body should be able to withstand the blow of surgery. Patients with the same condition are then ranked according to the liver function MELD score. In this way we can give more patients access to treatment and achieve good results, while taking into account equity. Of course, liver cancer patients do not necessarily take liver transplantation as soon as they are found. Given the scarcity of donors and the heavy financial burden, we still put treatments such as surgical resection as the first choice, and consider liver transplantation when liver function is not suitable for other treatments or when the tumor recurs after treatment or the results are not satisfactory. What are the surgical options for liver transplantation? Generally speaking, we classify cadaveric liver transplantation and living liver transplantation according to the source of the donor. The former liver comes from a healthy human body that has recently passed away, while the latter comes from a partial liver surgically removed by a loved one; according to the integrity of the transplanted liver, it is divided into whole liver transplantation and partial liver transplantation; according to the surgical method, it is divided into classical in situ liver transplantation and backpack liver transplantation, etc. Currently, cadaveric whole liver transplantation is the main method in China, which is suitable for giving liver transplantation to adults; living partial liver transplantation is more suitable for children with liver function impairment due to congenital diseases. One is because the abdominal cavity of children is smaller and not suitable for whole adult liver transplantation; in addition, because the adult who supplies the liver also has to bear the risk of surgery, so it is hoped that the surgery can obtain better treatment results based on ensuring the safety of both the liver supplying and receiving parties. And for liver cancer patients, living transplantation is not recommended as the first choice. As for which type of surgery to be adopted, it is up to the surgeon to decide based on the patient’s condition and personal surgical skills. What are the things to pay attention to after liver transplantation to ensure the normal function of the transplanted liver for a long time? Besides paying attention to some key operational skills during the surgery, patients and their families should also know some post-operative self-protection matters. 1.After surgery, patients should take anti-rejection drugs regularly and reasonably according to the doctor’s requirements, and regularly recheck the blood concentration, and promptly consult the doctor to adjust the dosage of drugs as appropriate to ensure that the transplanted liver will not be rejection or drug damage to health; 2.If the patient has viral hepatitis, he should use hepatitis B immunoglobulin or related antiviral drugs under the doctor’s guidance to prevent virus reinfection and hepatitis 3.Patients should do well in self-protection after surgery, especially within six months, to prevent colds and gastrointestinal infections, and stay away from the crowd for a short period of time to prevent cross-infection, because at this time, the immunity is low and common infections can be life-threatening; 4.Patients with liver cancer transplantation also need regular tumor-related examinations to detect tumor recurrence as early as possible and provide timely treatment to achieve long-term survival. In conclusion, liver transplantation is an effective and relatively complete treatment for liver diseases, especially end-stage diseases. As long as the indications are strictly controlled, patient selection is reasonable, donor quality is guaranteed, strict and effective surgical operation and post-operative management are carried out, and doctors and patients and families work together, safe and effective treatment can be ensured and scarce donor resources and economic waste can be avoided.