What is liver transplant surgery?
Most patients requiring liver transplantation are cases with hepatic cirrhosis.
Recently, the view is recognized that patient with end stage hepatic cirrhosis and life expectancy below 1 year is candidate for liver transplantation and such patient is (or should be) recommended transplantation. Half of patients with such condition die secondary to the disease or complications.
Success rate is over 80% in liver transplantations which are performed in timely manner.
Organ transplantation is the only treatment method for patients with chronic organ failure. Death is inevitable for those patients if organ cannot be supplied.
If transplant surgery is carried out before the patient deteriorates or overall health becomes instable, the surgical risks decrease and the length of life prolongs; for late transplantations, survival shortens and costs rise. Therefore, appropriate timing and patient selection are very important.
The surgery poses high risk due to poor overall health of patients and complexity of the surgery. The risk can further increase, if the disease that requires liver transplant is severe. Patients are already exhausted in all aspects and most patients have end stage diseases. However, death is inevitable, if surgery is not performed. Therefore, liver transplant surgery is a hope for a new life.
Liver transplant surgery requires recipients and donors with same blood type. Although a liver from a donor with different blood type is transplanted in emergencies, it should be considered as last option due to complexity of the surgery.
A piece of liver that does not threat life of the donor, but helps survival of the recipient is obtained from a related donor or whole liver of the deceased donor is used for the transplantation.
On the contrary to kidney transplant surgery, the diseased liver is completely removed and the donor liver is placed. Liver transplant surgery is the most complex and bloody surgical procedure in the field of general surgery. The procedure takes about 8 to 18 hours. A very crowded and well trained and qualified team is required for the procedure.
If the liver will be obtained from living donor, the recipient and the donor are concomitantly transferred to different operating theaters and the donor liver is obtained, while diseased liver is removed and next, the donor liver is transplanted to the recipient.
Patients are postoperatively transferred to the intensive care unit. The donor will be healthy enough to be discharged following several days of treatment. The recipient is transferred to the patient room after vital functions are monitored and stabilized in the intensive care unit.
All transplant patients are postoperatively started on general medication treatments and immunosuppressive medications. After doses of those medications are adjusted and the patient adapts to the new life style, the patient is discharged to home.
Similar to all patients who undergo organ transplant surgery, liver transplant patients should take immunosuppressive agents for the rest of the life. Those medications should be used in order to ensure that the donor organ is not rejected by defense system of the body and the donor organ functions properly. If the medications are not used or used irregularly, the defense system starts attacking this foreign liver, resulting in loss of the organ or even death.
The principal aim of the liver transplant surgery is to ensure normal and active life beyond restoration of health. Patients come together with their families, engage in working and school life, travel safely and take a vacation.
End stage liver disease not only deteriorates overall health, but it also ends reproduction, fertility and sex life. Sexual functions are restored after liver transplant surgery; women start menstruating and pregnancy and childbearing are possible.
All international standards are met for organ transplant surgeries carried out in our country. Our success rates are above 80-90% in transplantations of important organs, such as liver and kidney.
However, all organ transplant surgeries require a donor. Since family bonds are very strong in our country, all family members volunteer to donate organ. Unfortunately, not all donor organs match the recipient or severe health problems that contraindicate organ donation can be identified in donors and organ donation fails in many conditions.
On the other hand, many organs, such as heart, lung and pancreas, cannot be obtained from living donors. The first prerequisite of being a donor is that organ donation should not cost health and life of the donor.
As the case all around the world, source of the organ should be cadaver donors with diagnosed brain death rather than voluntary living donors. The organ donation rates in our country are far behind the target rates. Since increased incidence of chronic diseases boosts the need to organ donation, the increase in number of cadaver organs is too small to meet this requirement.
There is no age-related limitation for organ donation; the principle is that the donor and organs are health and the donor survives a healthy life after the organ donation.
The person may donate organs at any phase of the life or family members of the deceased may donate organs.
It is possible to donate organ at all hospitals, where organ transplant surgeries are performed, and institutions affiliated to Ministry of Health.
What are indications of Liver Transplant?
Some hereditary abnormalities, excessive use of alcohol and medication, cancer or viruses leading to hepatitis may induce irreversible damages in the liver. In this case, liver shrinks and hardens, and lumps with varying size develop, resulting in occurrence of cirrhosis. Cirrhosis can cause fatal results, including but not limited to bleeding, jaundice, ascites, infections and accumulation of toxic wastes in the body as well as coma. In the end, the only choice is liver transplant.
Who can donate liver for liver transplant surgery?
The liver is obtained from patients who are diagnosed with “brain death” in intensive care unit and have already donated organ(s).
What Is The Age Limit For Living Liver Donors?
The donor should be above 18 and below 55 years of age, and comorbidity is a contraindication for donation.
What Should The Recipients Avoid?
They should avoid from crowded areas and air pollution in general. They should stay away from smoking areas and from people with influenza infections. Hand-shaking and cheek kissing are not recommended.
How Will Liver Tumors in Recipients Affect The Outcome?
Recurrence risk is very low for tumors smaller than 3 cm in diameter. If the diameter of a particular tumor is above 5 cm or if the total diameter of more than one tumor is above 8 cm, transplantation cannot be carried out.
If The Recipient Has Hepatitis B and Hepatitis C, Does It Relapse In the Transplant Liver?
Hepatitis B will not relapse by 95% when immunoglobulins are used. Hepatitis C will relapse. However, it will cause problems in the liver in the very long term.
How Long Is It Necessary to Use Medications After Liver Transplant Surgery?
Based on our up-to-date knowledge, it is required to use drugs for 10 years.
What is frequency of follow-up visits after liver transplant surgery?
The patient should present for follow-up visit and blood tests twice a week in the first two weeks, once a week in subsequent three months, once in two weeks until the end of the first year and at monthly intervals thereafter.
What is the size of the liver excised to be transferred to the recipient?
For adult recipients, the right lobe is taken. It accounts for approximately 60% of the liver. For some adult patients, left lobe can be taken (%40). The left lateral segment is taken for pediatric recipients (%20).
Does Liver Transplant Meet Requirements of the Recipient?
Based on calculations made on donor liver, the liver is transplanted in size enough to meet the needs of the recipient; as expected, the liver left in donor body should also be sufficient to meet the needs of the donor. If these criteria are not met, transplant surgery will not be carried out.
Does the Transplanted Liver Regenerate Itself?
Similar to the liver of the donor, the piece of liver transplanted to the recipient will achieve a normal size in a 6- to 8-week period. Weight of liver accounts for 2% of total body weight in a healthy person. For example, the liver should weigh 1500 g for a human with body weight of 75 kg.
What Is the Risk of the Surgery For Donor?
The worldwide accepted risk is around 1%.
Does the Liver Left in Body of Donor Regenerate Itself?
Yes, the liver will achieve full size of normal liver in 6 weeks, if no problem occurs.
When Can A Donor Engage in Routine Daily Life Activities?
The patient can be discharged on Day 10, if no problem occurs in postoperative period, while they may engage in routine daily life activities in 1-month period. However, they cannot do any sports for 3 months.
What Kind of Long-Term Health Conditions Do Donors Face?
They will not face any health problems; very rarely, some cases suffer from jaundice and atherosclerosis of arteries supplying blood to liver secondary to intraoperative complications, resulting with permanent sequel. However, the risk of such complications is below 1%.
Blood type compatibility for donor and recipient
Blood type compatibility is required. 0 Rh(-) is the blood type of general donor and AB Rh (+) implies the blood type of general recipient. For example, for A Rh(+) recipient, blood type of the donor can be A Rh(+),or for A Rh(-) recipient, the donor can be 0 Rh(+) or 0 Rh(-).
How long does the surgery take?
Living donor liver transplant surgery takes about 6 to 8 hours. The donor surgery takes about 3 to 5 hours.
Living donor should be healthy in all aspects. However, persons with controlled hypertension and thyroid hormone deficiencies can be considered as donor candidate, after they are assessed and approved by an internist. The donor should quit smoking and alcohol consumption for minimum 10 days before the surgery.
Should Living Donor be a relative?
Pursuant to organ transplant legislation of our country, the donor should document that s/he is a relative, up to 4th degree, of the recipient.