A liver transplant is a surgical procedure in which a part of a healthy liver from a deceased or living donor is replaced for a liver that is not functioning properly for some reason.
Liver transplantation is the only treatment for chronic liver failure. Cirrhosis is the most common liver transplant disease group in the world. This is followed by some congenital diseases and some liver tumors.
WHAT IS LIVER TRANSPLANT ?
Liver failure in which liver transplantation is performed occurs in two forms, acute and chronic.
Acute liver failure can develop within days or weeks. The most common cause is mushroom poisoning and the use of certain drugs. Chronic liver failure is often due to cirrhosis, hepatitis B and C, biliary tract diseases, some nutritional disorders, some genetic diseases, excessive alcohol use, an inherited problem, disorder called hemochromatosis, which causes the body to absorb and store too much iron) or metabolic diseases. can develop. In this case, liver transplantation can bring the person back to a healthy life.
Common causes of cirrhosis leading to liver failure and thus liver transplantation can be listed as follows:
Hepatitis B and C disease
Liver disease that causes liver damage due to excessive alcohol consumption
Disorders that cause fat to accumulate in the liver, inflammation, or liver cell damage
Hemochromatosis and Wilson's disease
Diseases that affect the bile ducts (primary biliary cirrhosis, primary sclerosing cholangitis and biliary atresia)
Biliary atresia is the most well-known reason for liver transplantation, especially in children.
WHO IS SUITABLE FOR
LIVER TRANSPLANT ?
Some hereditary anomalies, excessive alcohol and drug use, viruses that cause cancer or hepatitis can initiate irreversible damage to the liver. In this case, the liver hardens and shrinks, large and small swellings occur on it and cirrhosis develops. cirrhosis of the liver; It is a condition that can lead to fatal results such as bleeding, jaundice, accumulation of fluid in the abdomen (ascites), infection and accumulation of toxic wastes in the body and coma. Ultimately, the only option is a liver transplant.
For liver transplantation, first of all, the blood groups of the patient and the donor must be suitable. Afterwards, the examination of the donor candidate begins. This process; It consists of social, psychological and medical evaluations. medical evaluation; blood and urine tests, investigation of infectious diseases, radiological examinations and taking the opinions of other medical units (cardiology, chest diseases, etc.). Many factors such as the amount of liver needed by the patient, the general health of the donor candidate, whether the liver can be divided appropriately, and the structure of the biliary tract play a role in the realization of the surgery between the patient and the donor candidate.
HOW IS LIVER TRANSPLANT PERFORMED ?
If you are informed that you can receive the liver of a deceased donor, you will be asked to come to the hospital immediately. You will undergo a series of examinations to make sure you are healthy enough for surgery.
Liver transplant surgery is performed using general anesthesia, so you will be anesthetized during the procedure. The transplant surgeon makes a long incision in your abdomen to reach your liver. The location and size of your incision depends on the surgeon's approach and your anatomy.
The surgeon removes the diseased liver and places the new liver in your body. It then connects your blood vessels and bile ducts to the donor liver. Depending on your situation, the surgery can take up to 12 hours. Once your new liver is in place, the surgeon uses stitches and staples to close the incision. You will then be transported to the intensive care unit to begin recovery.
If you are receiving a liver from a living donor, your surgery is planned in advance. The surgeon first performs surgery on the donor and removes the part of the liver reserved for transplant. Then the surgeon removes the diseased liver from your body and places the donated liver in your body. It then connects your blood vessels and bile ducts to the new liver.
The transplanted liver part in your body and the part left behind in the donor's body are rapidly regenerated and reach their normal volume within a few weeks.
In order to be able to have a liver transplant, you will be subjected to some evaluations. It is important whether you are healthy enough to have the surgery and your ability to use lifelong medications after the transplant. If you have any medical conditions that may hinder the success of the transplant, it should be determined.
Besides that, there are tests, procedures and consultations you must pass. Blood and urine tests, liver ultrasound, and heart tests are done to check the health of the cardiovascular system. In addition, routine cancer screenings can also be done. You can get nutritional counseling to ensure that your meals are healthy, and you can get psychological support for the success of the transplant process and to prevent anxiety. In addition to these situations, it is also helpful to seek addiction counseling if you have harmful habits such as alcohol and cigarettes.
After these tests are complete, the transplant center's committee meets and comes to an opinion on whether a liver transplant is the best treatment for you. After that, you queue for your new liver on the waiting list. The waiting time for a donor liver differs. Some people may wait days, while others may wait longer. While you wait for a new liver, your doctor will treat you for complications caused by your liver failure, making you as comfortable as possible.
The purpose of liver transplantation is to return the person to a normal, active, productive life. It is aimed that both the patient and the donor return to their pre-operative performance.
After surgery you will likely stay in the intensive care unit for a few days. Doctors and nurses keep you under control to watch for signs of complications. They also often test your liver function for signs that the new liver is working properly.
You spend 5 to 10 days in the hospital. Make frequent checkups as you continue to recover at home. Your transplant team will design a control program for you. You may have blood tests a few times a week at first, then less frequently over time.
As with kidney transplant and whole organ transplant patients, liver transplant patients also use drugs to suppress the immune system for life. This is the basic condition for treatment success. If the drug is not used or if there is an irregular use, the immune system immediately starts a war against this foreign organ and this may end with the loss of life of the organ.
You can return to your daily activities and work a few months after the surgery. Your condition after a liver transplant depends on many factors, including what caused your liver failure. About 88% of patients survive at least one year after transplant, while 73% live at least 5 years.
FREQUENTLY ASKED QUESTIONS
What is the Risk of Surgery for the Donor ?
The accepted risk in the world is around 1%.
What Does Tissue Rejection Mean ?
Our body's immune system recognizes its own cells and does not react to them. However, when someone else's cells (blood, organ...) enter the body, he immediately realizes that these cells are foreign, and he takes up arms against them and seeks ways to expel this foreigner from the body. Microbes entering the body are treated in a similar way. This reaction of the body, which damages the transplanted organ, is called tissue rejection. Tissue rejection is a reaction that can be seen at any time in organ and tissue transplants and causes the transplanted tissue or organ to become useless (death) if it is detected early and precautions are not taken. In order to prevent tissue rejection, organ transplant patients use drugs to minimize this effect of the immune system for life. This is called immunosuppression. Despite these drugs, tissue rejection sometimes develops. It is possible to recognize this by the deterioration of the functions of the newly implanted liver and the detection of findings of tissue rejection in the liver biopsy. This type of flare-up is usually treated smoothly and everything returns to normal.
How Much of the Liver Is Taken to Transplant to the Patient ?
For adult recipients, the right lobe is taken. This part of the liver is about 60%. In some adults, the left lobe can be removed (40%). For Child Recipients, a piece called the left lateral segment is taken (20%).
Is Liver Transplant Risky?
This risk varies with the severity of the disease requiring liver transplantation. These patients are generally in very severe condition, with exhausted all kinds of reserves. On the other hand, liver transplantation is one of the largest known surgeries. "Severe patient + major surgery" is the most important factor that increases the risks. In addition, while the liver is changing, the largest veins of the body are cut and stitched, and serious unwanted bleeding may occur in these veins. Sometimes the newly inserted liver may not work well in the body it is attached to. Infections can cause serious problems in these patients whose immune system is suppressed.
Will the Liver Remaining in the Donor Regenerate Himself?
Yes, it reaches its full size in 6 weeks in unproblematic cases.
Does the Transplanted Liver Regenerate Itself?
The transplanted liver reaches the required size in 6-8 weeks, as in the donor. In normal humans, the liver is about 2% of body weight. For example, a 75 kg person would have 1500 g liver.
How Does the Presence of a Liver Tumor in Recipients Affect the Outcome?
Tumors smaller than 3 cm in diameter have a very low chance of recurrence. Transplantation is not performed if the diameter of a single tumor is greater than 5 cm or, in the presence of more than one tumor, a total of 8 cm.