Liver Transplant
What is Liver Transplant?
The vast majority of patients requiring liver transplantation are patients with liver cirrhosis. Today, it is accepted that all patients with end-stage liver cirrhosis with a life expectancy of less than 1 year are candidates for liver transplantation and transplantation is recommended (or recommended) to these patients. Because half of the patients with this condition die within a year due to this disease or its complications.
There is a success rate of over 80% in timely liver transplants. Organ transplantation is the only treatment method for patients with chronic organ failure. When the organ cannot be found, death is inevitable for these patients. If the patients are transplanted before their general condition deteriorates, the risk of surgery decreases and the life expectancy becomes longer, in late transplantation the shorter and the more the costs.
Therefore, appropriate timing and appropriate patient selection is very important. It is a risky surgery due to the general condition of the patients and the size of the surgery. This risk may increase with the severity of the disease requiring liver transplantation. The patients are generally exhausted in all respects and many are in very severe condition.
Unless there is no surgery, dead is inevitable for those patients. Here, liver transplantation means hope for a new life for these patients. Liver transplantation is performed between donors and recipients with the same blood types.
Although liver transplantation can be performed even among people whose blood groups do not match in order to save lives in very urgent conditions, in practice it can only be considered as a last resort due to the size of the surgery.
Liver transplantation can be done from a liver part taken from a relative that will not endanger the life of the donor, but large enough for the recipient to survive, or a liver donated from a person with brain death.
Unlike kidney transplantation, the patient’s liver is completely removed and replaced with a healthy liver. Liver transplantation is the biggest and bloody operation of general surgery. Its duration is around 8-18 hours. It is carried out by a very crowded and well-trained team in this field.
If the transplanted liver is to be taken from a living donor, the recipients and donors are taken to separate operating rooms at the same time, while the appropriate size piece is taken from the healthy liver in one room, the diseased liver is removed in the other room, and then the liver piece from the donor is replaced. After surgery, patients are taken into intensive care. After a few days of treatment, the donor regains well-being to be discharged. The transplant patient is taken to the service after gaining his vital functions in the intensive care unit, where his treatment is continued. In addition to general drug treatments, immunosuppressive drugs are given to all transplant patients after surgery.
As a result of the adjustment of the doses of these drugs and the adaptation of the patient to the new lifestyle, he is discharged home.
Like all organ transplant patients, liver transplant patients also use drugs that suppress the immune system for life. To prevent the organ from being thrown away by the body’s defense mechanism and to maintain its function and vitality depends entirely on this drug treatment.
If the drug is not used or used irregularly, the immune system immediately starts a war against this foreign liver, which ends with the loss of the organ and perhaps life.
The main purpose of liver transplantation is to bring the person to a normal, active and productive life beyond recovery. People can return to their families, jobs, schools, travel safely and take a vacation.
In addition to poor health, reproduction, fertility and sexuality life in recent liver patients come to an end. After liver transplantation, sexual functions return, women begin to menstruate again, pregnancy and birth are possible.
Organ transplants in Turkey are performed at world standards. Success rates in transplantation of important organs such as liver and kidney are over 80-90%. However, a donor is absolutely necessary for all organ transplants.
In Turkey where family ties are very strong, all patient relatives volunteer to donate organs. Unfortunately, the organ of every donor does not fit every recipient, serious health problems arise in donors that prevent organ donation, and organ harvesting cannot be performed in many cases. However, many organs such as heart, lung, pancreas cannot be obtained from living donors.
The first condition of being a donor is that donating organs does not cost the health and life of the donor. As in the whole world, the main source of organ procurement should be cadaver donors with brain death rather than voluntary donors.
Organ donation in Turkey is far below the desired level. While the increase in chronic diseases increases the need for organs, the increase in the number of cadaver donors is far from responding to this. Being an organ donor is generally not old, it is essential that the person and the organs are healthy and their health is not deteriorated after donating organs. donations can also be made. Organ donation is accepted at all hospitals and institutions affiliated with the Ministry of Health.
In Which Cases Do Liver Transplantation Require?
Certain inherited abnormalities, excessive alcohol and drug use, cancer or viruses that cause hepatitis can cause irreversible damage to the liver. In this case, the liver hardens and shrinks, large and small swelling occurs on it and cirrhosis develops.
Liver cirrhosis; It is a condition that can lead to fatal consequences such as bleeding, jaundice, accumulation of water in the abdomen (acid), infection, and coma with the accumulation of toxic wastes in the body. After all, liver transplantation is the only option.
Who can be the right Donor Candidate for Liver Transplant?
Cadaver and Live Donors can be the donors for Liver transplant.
Cadaver:
It is done by taking liver from cases where brain death is detected and whose organs are donated in intensive care units.
Live Donors:
What is the Age Limit for Living Liver Donors?
It is necessary to be older than 18 and younger than 55, accompanying health problems prevent it from being donor.
What Kind of Harmony Is Sought Between Donor and Patient?
Blood type compatibility is required.
0 Rh (-) is the general transmitter, AB Rh (+) is the general receiver.
For example, A Rh (+) can be donors from blood groups A Rh (+) for a recipient, A Rh (-) for a recipient, 0 Rh (+), 0 Rh (-) for a recipient.
What is the Risk of Surgery for the Donor?
The accepted risk in the world is around 1%.
When Do Donors Return to Their Normal Lives?
Problem-free cases are discharged around 10 days and return to their active life in 1 month, and cannot exercise for 3 months.
What Health Problems Do Donors Experience In The Long Term?
They do not experience any health problems, very rarely, permanent sequelae may occur as a result of problems such as jaundice and vascular occlusion that feed the liver due to complications that develop during surgery. However, this probability is less than 1%.
How Much of the Liver Is Taken for Transplantation?
Right lobe is taken for adult recipients. This part of the liver is about 60%. In some adults, the left lobe can be removed (40%). For Child patients, the piece called the left lateral segment is taken (20%).
Does the Liver Remaining in the Donor Regenerate Itself?
Yes, it reaches its full size in 6 weeks in problem-free cases.
Does the Transplanted Liver Meet the Needs of the Patient?
With the calculations made by the surgeon, a large liver is taken to meet the needs of the patient. If these criteria are not met, the transplant cannot be performed.
Does the Transplanted Liver Regenerate Itself?
In the transplanted liver, it reaches the required size in 6-8 weeks, as in the donor. In a normal person, the liver is 2% of body weight. For example, a 75 kg person weighs 1500 gr. It happens to the liver.
If the recipient has Hepatitis B and Hepatitis C, will it relapse in the new liver?
With the use of hepatitis B immunoglobulin, 95% does not recur, hepatitis C recurs. However, a problem occurs again in the liver in a very long time.
What Should Patients Be Protected From?
In general, they should avoid very crowded environments and air pollution. They should stay away from smoking environments and those with flu infections. Shaking hands and kissing on the cheeks is not recommended.
Finding Liver Tumors in Patients, How Does It Affect the Outcome?
The risk of recurrence is very low in tumors smaller than 3 cm in diameter. Transplantation is not performed if a single tumor is over 5 cm in diameter or over 8 cm in total in the presence of more than one tumor.
How Long Should Drugs Be Used After Liver Transplantation?
According to current information, it is necessary to use drugs for 10 years.
How Often Follow-up is Made After Liver Transplantation?
Control and blood tests should be done twice in the first two weeks, once a week for 3 months, once every two weeks until the end of the first year, and then once a month.