Summary of the course

We’ve now come to the end of our course on liver transplantation. In this article, we would like to summarise all the things you have learnt in our activities.

Week 1 was our foundation week, where we considered what happens ‘when livers go bad’. Here we taught you more about some basic liver biology and you found out about some of the major liver diseases that may lead someone to need a transplant. Here we covered the anatomy and functions of the liver and also discussed the major liver cell types present. Our activity on liver function tests showed us how functions of these individual cell types are linked to tests that a doctor might do to diagnose liver disease, and we saw how these help with listing a patient for transplantation in Step 1.15. We also reviewed the major functions of your immune system to help you understand our activities relating to rejection in later weeks.

We also had the opportunity to introduce you to some of the ethical issues surrounding donation of organs for transplant and introduced the idea of split liver and living-donor transplantation. Finally, we got to hear from a patient who has experienced having a liver transplant for Primary Sclerosing Cholangitis, Mr Alan Hyde, and this led to some frank and interesting comments from you all, further informing us what it’s like to be a transplant recipient or waiting on the list for a liver.

We then moved on to consider the operation itself. We learnt that specialist nurses called transplant coordinators are absolutely vital to the success of a transplant programme, a theme we revisited in Week 3 when we discussed increasing the number of donor organs. In Week 2, we highlighted the different roles of the donor and recipient coordinator teams, revisiting some of our conversations about ethics and split liver procedures along the way. This led us to an important distinction, the difference between DCD and DBD donor organs. We learnt how the nature of the donor organ available has important consequences, not just for the way the liver is collected, but also for how well it might perform for the recipient in Step 3.10. We also saw how DCD livers may be more susceptible to post-transplant conditions like cholangiopathy when we talked about transplant pathology with Professor Hubscher. Post-transplant care of the patient included discussion of the drug types that may need to be taken for the longer term after the transplant, and we heard about the operation itself from Mr Perera. We also had a chance along the way to learn more about two more fascinating surgeons, Thomas Starzl and Paul McMaster, who were vital to developing the process of transplantation internationally and locally.

We began Week 3 by seeing how inspirational characters like Thomas Starzl have contributed to the development and history of transplantation, allowing us to hear more about how the invention of immunosuppressive drugs was key to the success of the procedure. These drugs allow us to protect a new liver from the recipient’s immune system, which was one of the great challenges for the early transplant pioneers. We identified many other challenges that are faced by transplant programmes today, and heard what some of our local doctors consider to be the advances that will benefit their patients the most in the future. Their suggestions gave us the opportunity to highlight some areas of innovation for you, so we covered immunotherapy, normothermic perfusion, stem cell therapy and possible new medicines.

We hope that you have enjoyed learning from us and your fellow students. Let’s go on to test what you’ve learnt in our final test. However, don’t forget to add any comments below.