359 Ch 358. Liver Transplantation

Liver transplant (LT) = definitive treatment for end-stage liver disease + acute liver failure；台灣 約 1,500-2,000 LT performed since program inception；indications：(1) end-stage chronic liver disease (cirrhosis with decompensation); (2) acute liver failure (Ch360); (3) HCC within Milan criteria; (4) early hilar cholangiocarcinoma (Mayo protocol); (5) acute alcoholic hepatitis (selected); (6) metabolic liver disease (Wilson, hemochromatosis, alpha-1 AT); (7) hepatopulmonary syndrome, portopulmonary HTN；allocation：MELD-Na / MELD 3.0 priority; exception points for HCC, HPS, POPH, FAP, CCA；donor types：deceased donor (DD) > living donor (LD); split liver; DCD (donation after circulatory death)；immunosuppression：tacrolimus + MMF + steroid (induction with basiliximab or rATG)；complications：surgical (vascular, biliary), rejection (acute cellular, AMR), infections, malignancy (PTLD, skin), recurrence of disease, CV, renal；outcomes：1-yr 90%+, 5-yr 75%, 10-yr 60%；台灣 living donor predominant (deceased donor shortage)；2024 emerging：machine perfusion + xenotransplantation pig liver early trials + DCD expansion。