Maksasiirdamine

Maksasiirdamine, or liver transplantation, is the surgical replacement of a diseased liver with a healthy liver from a donor. It is performed for end‑stage liver disease, acute liver failure, and in some cases for select metabolic disorders or hepatocellular carcinoma within established criteria.

Indications commonly include cirrhosis from various causes (viral hepatitis, alcohol-related liver disease, nonalcoholic fatty liver disease), acute hepatic failure with life-threatening deterioration, and certain metabolic diseases such as Wilson disease or familial tyrosinemia. Patients with hepatocellular carcinoma may be considered if tumors meet criteria such as the Milan criteria. Donor sources include deceased donors and living donors who donate a portion of their liver, typically a right or left lobe. Living donation carries risks to the donor and requires careful psychological and medical evaluation.

The procedure involves removing the diseased liver and replacing it with the donor liver. Vascular and biliary reconnections are performed to reestablish blood flow and bile drainage. The operation typically requires a lengthy surgical time and a prolonged recovery period.

Immunosuppression is essential after transplantation to prevent rejection. Common regimens include a calcineurin inhibitor (such as tacrolimus or cyclosporine), corticosteroids, and other agents that reduce immune activity. Patients require lifelong follow-up to monitor liver function, detect rejection or infection, and manage drug side effects.

Outcomes have improved markedly since the 1960s, with 5-year survival often exceeding 60–70% in many centers, particularly with living donor transplants. Risks include rejection, infection, bleeding, biliary complications, and vascular problems such as hepatic artery or portal vein thrombosis. Recurrence of the original liver disease and long-term immunosuppression-related complications are ongoing considerations.