Far above 1,200 patients were listed waiting for a liver transplant in Germany in 2021. The most frequent reason for this was liver cirrhosis, in which the tissue of the central metabolic organ loses its function due to chronic inflammation, alcohol damage or poisoning. But cancer can be the reason to need a new liver, too. This includes unresectable metastases in the liver descending from tumors in other organs. However, these patients hardly have a chance for an organ from a deceased donor because their liver function is less restricted than in the case of cirrhosis and the remaining organ function is a central criterion for the allocation of the rare donor organs.
In addition to the transplantation of the organs of the deceased, the transplantation surgery team of Jena University Hospital pursues a successful living liver donation program. After an ethics committee verification, healthy people may donate a partial organ for close attachment persons to replace the diseased liver. Each, the transplanted part and the remaining organ assume full organ function, because of the particular regeneration ability of the liver.
Living donation in the two-step procedure
"It is the continuing shortage of donor organs that motivates and drives our clinical and scientific work in this area," Prof. Dr. Utz Settmacher, Director of the Department of General, Visceral and Vascular Surgery, says. In cooperation with colleagues from Brussels, Padua, Oslo, Munich and Tübingen, the Jena surgeons now published in "Annals of Surgery" their transplantation experiences in patients who do not suffer from liver cirrhosis, but mostly from colon cancer metastases in the liver. Special feature: The transplantation was performed in a two-step procedure. To protect the donor, the smallest possible liver part was removed and transplanted. The recipient initially retained a part of the diseased liver to ensure organ function. However, the surgeons reduced the blood flow to this part of the liver to encourage growing of the graft. After about two weeks, it adopts complete organ function and the remaining diseased liver is removed.