Liver Transplantation

Every year, approximately 1000 patients in Germany are treated with new liver parts. The donor organs are mostly from deceased people, whereby one liver can be divided between two needy patients. A living donation is also possible to a certain extent.

This way, parents can donate parts of their liver for their sick children without suffering great damage or disadvantages – the liver can regenerate well. The large number of diseases that disrupt or destroy the function and structure of the liver makes liver transplantation an important therapeutic approach for various diseases.The diseases can be of different nature, but only some are mentioned here: Liver parenchymal diseases, in which the liver tissue is permanently damaged due to viral hepatitis or due to abusive alcohol consumption; diseases of the bile ducts, for example chronic inflammation or increasing occlusion of the bile ducts; metabolic diseases such as Wilson’s disease, galactosemia or the glycogen storage disease; vascular diseases in the liver, which can be caused by viruses, drug consumption or the HELLP syndrome that develops during pregnancy, among other things; cancers of the liver and liver injuries. An organ transplantation of the liver must not be performed if the patient suffers from a portal vein thrombosis.

The portal vein is the main blood vessel of the liver and can endanger the health of the donor organ if it is blocked by thrombosis. The psychological background of the patient must also be analyzed before surgery. If the patient is addicted to alcohol or drugs, a liver transplant must not be performed, as this would put too much strain on the organ.

A successful liver transplantation with long-term survival of the patient is highly dependent on the compatibility of all cellular factors. Under strong immunosuppression, the probability of no rejection can be increased and full function can be maintained. Complications can follow due to bleeding or incomplete connection of the bile duct system.

Heart Transplantation

Since the heart has the shortest shelf life outside the human circulation among all transplantable organs, the assignment of a donor organ and the organ transplantation itself must be initiated as soon as possible. The only justification for a heart transplantation is usually severe heart failure. In advance, the indication, the urgency of a transplantation, is calculated individually for each patient.

Within this framework, an evaluation system has been developed which refers to the functionality of the heart. The heart rate, stroke volume and average blood pressure are taken into account. Who gets a potential donor heart depends on various factors.

These factors include how urgently the patient needs a new heart and how long the patient has been waiting for a new organ. In addition, the time between collection and transplantation, i.e. the delivery and operation time, must be taken into account (maximum 3 to 4 hours). The size of the heart depends on the body weight or build of the organ donor, so the difference between donor and recipient must not exceed 20%.

The organ must also be as compatible as possible at the cellular level. During surgery, the patient must be connected to a heart-lung machine before the heart can be removed. The patient’s body is cooled down to 26-28°C (hypothermia) to minimize cell decay.

The new organ is connected to the patient’s vessels and then the heart is restarted. After treatment with strong immunosuppressive drugs, a rejection reaction can be prevented if necessary, which is most likely in the first four weeks. Patients with a new heart are most likely to die from a bacterial or fungal infection following surgery.

Due to the suppression, the immune system is too weak to fend off pathogens. Approximately half of all patients with a transplanted heart develop a vascular disease of the heart, the so-called transplant vasculopathy, within the first 5 years after the operation. This can lead to a clinically unremarkable heart attack.