Transplantation for MLD

Transplantation for Metabolic Liver Diseases

Metabolic Liver Diseases

Metabolic liver diseases refer to a heterogenous group of diseases that are due to genetic abnormalities that usually affect a single gene and result in inability of liver to synthesize a particular gene product. The gene product is usually a protein which performs a unique, vital function either in the liver itself or in other organs. The liver itself may or may not be affected by the disease. Typical examples of metabolic liver disease are Criggler-Najjar syndrome, primary hyperoxaluria, urea cycle disorders, tyrosinemia, haemochromatosis and Wilson’s disease. Some of them like Wilson’s disease, tyrosinemia and haemochromatosis affect the liver and present as liver failure. The liver itself is normal in few other metabolic diseases like Criggler-Najjar syndrome and urea cycle disorders. In the latter diseases, the problem is caused by lack of the protein product of the genetic defect which affects some body function or another organ, other than the liver itself.

Most of these diseases are currently being treated by orthotopic liver transplantation where defective, native liver is completely removed and a new liver from a donor without the genetic defect is transplanted into the recipient. Though the metabolic liver disease is cured by orthotopic liver transplantation, patients will have to be on life long immunosuppression. This is required as the new liver is foreign to the patient and without immunosuppression, patient’s body will destroy the new liver by a process called “rejection”. Problems with immunosuppression are susceptibility to infections, tumours and possibility of irreversible kidney injury.

Most of these diseases are currently being treated by orthotopic liver transplantation where defective, native liver is completely removed and a new liver from a donor without the genetic defect is transplanted into the recipient. Though the metabolic liver disease is cured by orthotopic liver transplantation, patients will have to be on life long immunosuppression. This is required as the new liver is foreign to the patient and without immunosuppression, patient’s body will destroy the new liver by a process called “rejection”. Problems with immunosuppression are susceptibility to infections, tumours and possibility of irreversible kidney injury.