**2.1 Investigate the indication of liver transplantation for uncontrollable liver trauma**

Our study was aimed to critically question the indication of LT on the basis of blunt and uncontrollable liver trauma; we therefore report our experience with 4 patients who all

The liver is crucial to the post-traumatic recovery of a severely injured patient. This is where proteins are formed, which constitute among other things components for coagulation and non-specific defense. It has a decisive effect on inflammatory processes and represents the center of the energy metabolism. Moreover, the Kupffer cells represent the largest macrophage pool in humans. The knowledge that liver damage alone negatively affects both early and late mortality may be an initial approach leading to organ-specific post-traumatic

In this context, it must be kept clearly in mind that the last two decades have seen a clear paradigm change concerning surgical treatment for liver injuries (19). With the introduction of computer tomography and the availability of clotting factors, conservative treatment of the liver injury became the method of choice for hemodynamically stable patients after blunt liver trauma (20). Different studies have shown that 71-89% of all patients with blunt liver trauma can be successfully conservatively treated. As a result, the survival rate is 85 to 94% (21). There is also agreement that despite all the opportunities for intensive fluid, blood and coagulation substitution, hemodynamically unstable patients must still be operated on (22). Here, the management of a liver injury aims to control hemorrhage, preserve sufficient hepatic function and prevent secondary complications. If an adequate control of the bleeding cannot be achieved despite exhausting the current therapy options, the indication for liver transplant (LT) needs to be assessed critically in individual cases. These cases are

Nonetheless, LT are carried out due to acutely uncontrollable liver injuries in exceptional cases only. For this, indication is judged critically and discussed controversially due to usually existing secondary injuries, early septic complications, and poor general condition. Due to poor results, LT in these patients is occasionally described as "waste of organs",

Patients with subacute and chronic results of a liver injury need to be considered differently from the acute and due to their initial position very special group of surgically uncontrollable patients with liver trauma. However, they share the fact that also the indication for transplantation for instance in patients with "shock liver" in the context of polytrauma or with induced liver failure after a longer intensive therapy need to be

**2. Investigate the significance of liver trauma and prognostic factors in** 

survival after polytrauma is definitively decreased when the liver is involved.

Based on an analysis of the trauma registry data from the German Society of Trauma Surgery (DGU) [Deutsche Gesellschaft für Unfallchirurgie] from 1993 to 2005 (n=24,711), the present study examined whether the participating liver injury in a polytraumatized patient superproportionally increases the incidence of sepsis and multi-organ failure, and whether

**2.1 Investigate the indication of liver transplantation for uncontrollable liver trauma**  Our study was aimed to critically question the indication of LT on the basis of blunt and uncontrollable liver trauma; we therefore report our experience with 4 patients who all

treatment.

extremely scarce in the clinical daily routine (23).

however based on insufficient data (24, 25).

measured (26, 27).

**severely injured patients** 

underwent LT due to accident-caused uncontrollable acute liver trauma at our center along with a comparison and discussion of our results based on the current literature.

#### **2.2 Try to answer the question – Is transplantation a valuable option or just a "waste of organs" in polytraumatized patients with liver injury –**
