Biologie et transplantation hépatique

Liver transplantations have increased in France over the past ten years thanks to the extended pool of liver donors, the use of marginal organs and an enlarged set of clinic and biological criteria for patients on the waiting list. The selection of patients eligible for liver transplantation uses clinical and biological scores as MELD score (Model for End Stage Liver Disease). This score can be modified in relation to liver pathology (expert composant, natremia) or associated with additional scores such as α-foetoprotein score. The green indocyanin clearance, with a simplified measurement, gains a new interest for the estimation of liver functionality. A Donor Risk Index able to assess with a sufficient fiability the liver donor quality has not yet been defined. Biology has an essential place in the immediate post-TH period to detect urgent complications in some recipients with high risk of mortality, primary non function of the graft, artery thrombosis and also infections. Biology plays a minor role in other early complications as ischemia-reperfusion and biliary stenosis. For post-transplantation follow up in the longer term, a regular biology assessment enables the diagnosis of recurrent diseases or chronic rejection. It allows to estimate the graft functionality and could assess a fibrosis development, using blood non-invasive biomarkers associated or not with elastometry.