Liver Transplantation for Severe Hepatic Trauma: Historical Review

Objectives: Liver transplantation (LT) is rare in the context of liver trauma. There are no clear indications on which patients may benefit from LT, and what are the factors that may reduce or increase the success rate of LT for a trauma patient. We performed a review of the literature in order to better recognize indications and results in this setting.

Methods: A comprehensive review of the literature involving LT in the context of trauma using Pubmed and Google Scholar up to Dec 2022. As this is an uncommon event, we included all publications including case reports.

Results: A total of 19 case reports and one retrospective trial were included in the review. Most past cases were performed in two stages including resection of the native liver with an anhepatic phase followed by liver transplant within a few days with availability of the donor liver. However, one stage was also performed successfully in hemodynamically stable patients with the presence of a donor organ. Bridge to transplantation by portocaval shunt and piggyback anastomosis to native vena cava demonstrated the best results. LT under conditions of infection resulted in increased mortality but can be feasible if there is a possibility of achieving source control of the infection. Auto-transplantation is an accepted option in cases of severe vascular trauma without extensive damage to the liver tissue and bile ducts.

Conclusions: LT in a trauma patient is valid option with accepted success rates. When performed, it is usually in grade 4 or higher liver trauma in an unstable patient, which has failed other treatment options or if there is irreversible damage to the liver tissue and bile ducts. A decision should be based on a multidisciplinary team discussion in an experienced LT center which should consider the chances of saving the patient with an acceptable quality of life in the face of wasting a costly liver graft.