The liver is one of the most important organs of our body, which undertakes the most tasks. The liver has the main task in performing many functions, from digestion to immunity, from nutrient storage to removal of wastes in the body and blood coagulation. The failure of the liver to function due to various diseases is called liver failure. Liver transplantation is the only solution for liver failure after a certain stage.
What is Liver Transplantation?
Liver transplantation, or liver transplantation as it is medically called, can be performed from a cadaver or a living donor. Most of the liver transplantations are performed due to cirrhosis. When liver transplantation is performed with a successful operation at the right time, the success rate is quite high.
Liver transplantation, for patients whose liver does not work enough and who need organ transplantation; It is the transplantation of a liver taken from a cadaver or a living donor who has brain death. Liver transplantation, which is a life-saving treatment in end-stage liver failure or acute liver failure cases, is performed by general surgery units.
In addition to chronic liver failure and cirrhosis, which is the most common cause of this condition, liver transplantation may also be necessary for the treatment of some hereditary and metabolic diseases. In order to perform the operation, the patient's poorly functioning liver must be completely removed. The liver part (right or left lobe) suitable for the patient's weight is taken from the donor and transplanted.
Due to the ability of the liver to regenerate itself in transplantations from living donors, the donor does not experience any insufficiency after liver transplantation. It is one of the most complicated and tiring types of operations among the operations performed by general surgery units. For this reason, it should be performed in fully equipped hospitals by a transplant team specialized on this subject. Liver transplantation, which is not just an operation; It includes a sensitive process that may require various treatments and meticulous measures before and after transplantation, and in which follow-up is also very important.
About Florence Nightingale Hospitals Liver Transplant Center For detailed information: Liver Transplantation Center
Who Is Liver Transplantation for?
Liver transplantation, which is most commonly applied in liver failure, is the treatment of both acute and chronic failures. It is a necessary procedure. Acute liver failure, which develops suddenly in the short term due to the use of various drugs or as a result of fungal diseases, may progress rapidly and make liver transplantation necessary. In addition, liver transplantation is the only solution for chronic liver failure that develops due to nutritional problems, liver cancers, infection or carrier of hepatitis B and C viruses, biliary tract diseases, excessive alcohol use, excessive iron accumulation in the body (hemochromatosis) and cirrhosis. .
Liver transplantation can also be used in the treatment of rare congenital metabolic diseases. If the life expectancy of patients with end-stage liver cirrhosis is less than one year, liver transplantation is recommended. Considering factors such as the type of disease, the patient's age and health status, this process may need to be taken earlier, especially in patients with a living donor. Although it is a difficult process and requires a serious operation, liver transplantation has a high success rate of 75-80% if it is performed on time.
How is Liver Transplant Performed?
A living donor with the same blood group as the patient or a cadaver who has donated organs and is suitable for liver transplantation is required to perform the procedure. In cadaveric transplantations, patients waiting for transplantation are put in the queue by considering the urgency of the patient's condition and the age factor. In patients with a voluntary living donor, the transplant process can be planned at the appropriate time.
Liver transplantation can be performed from all individuals whose blood group is the same as the patient and who have the appropriate health condition for transplantation. The fourth degree of consanguinity between the patient and the donor increases the success rate of transplantation. Before the operation, intensive research is carried out on the donor, and it is examined whether there is any situation that prevents the donor from giving his liver, especially for living donors. diabetes, heart and kidney diseases, hypertension, some psychological diseases and various infectious diseases, and those who have not completed the age of 18 cannot be donors.
If there is no adverse event, an operation plan is made and the patient is usually hospitalized a few days before the operation. Medical examinations of the patient are also carried out in great detail and many examinations and diagnostic tests are performed in terms of suitability for the operation. Since it is an operation that requires blood stock, a certain amount of blood must be prepared before the transplant operation. For this reason, relatives of the patients may be asked to donate blood. When the transplant day comes, the donor and the patient are operated simultaneously in different operating rooms. First of all, the donor's surgery is started and after it is seen that there is no anatomical defect related to the liver, the recipient operation is started.
A part of the liver is taken from the living donor in accordance with the weight of the patient and placed in the place of the removed liver of the patient. While the surgical procedures continue in the recipient patient, the donor's operation is completed and the donor is taken to the intensive care unit and kept under follow-up.
How Many Hours Does Liver Transplantation Take?
Liver transplantation surgery is one of the most challenging operations known. These surgeries, which take an average of 6-8 hours, can take up to 18 hours in some cases. The presence of a multidisciplinary and experienced healthcare team with advanced training in liver transplantation is very important for the success of the operation. Transplantation should be performed in full-fledged health institutions with a multidisciplinary approach, where all medical units whose opinion and support may be needed during the operation.
Imaging units with state-of-the-art devices, an operating room with sufficient technical equipment and a qualified intensive care unit are some of the other features that should be present in the health institution where the transplant will be performed. After the completion of the transplantation process, the patient is taken to the intensive care unit, just like the donor. If the operation went smoothly, the donor usually takes a few days or a maximum of 10 days after the treatments. He recovers and can be discharged.
If the patient is kept in the intensive care unit after organ transplantation until his vital functions reach normal balance, he is taken to the service and his treatment is continued here.
What are the Risks of the Donor in Liver Transplantation?
The risks of the donor in liver transplantation, This is one of the most frequently asked questions about the operation. In general, the risk of loss of life in the liver transplantation operation in the donor is 0.5% and below. This is a fairly low risk. However, after the liver transplantation operation has been started, there may be a possibility that the operation will be terminated due to any negativity seen in the donor.
In cases such as excessive fat in the liver, detection of anatomical disorders, detection of masses in the abdomen after the opening of the incision, or any complications encountered, the operation cannot be continued and the opened incision can be closed again and the operation can be terminated. For this reason, as mentioned above, the operation of the recipient patient is not started until it is understood that there is no structural problem regarding the removal of the liver from the donor. Bile leakage and bleeding are among the rare complications that may be encountered after the donor's surgery. Although there are very rare cases, the donor is informed about these risks, which may require a new operation or applications such as blood transfusion, before the operation. In addition, as in all operations, there are the possibility of minor infections in the wound areas, digestive problems such as constipation and gas pain, temporary complications such as nausea and vomiting due to anesthesia.
Due to the fact that the liver is a self-renewing organ, the donor liver, part of which has been removed after the operation, can reach its normal size in about 6 weeks. For this reason, the probability of a long-term problem for the donor after uneventful operations is very low.
How Does the Process Work for the Recipient After Liver Transplantation?
After the transplant, the patient followed in the intensive care unit for a while and The patient, who was taken to the service afterwards, received approximately 10 days of treatment. After the process, he is informed about the issues that need attention at home and he is discharged. Just like in other organ transplants, there is organ rejection (risk of rejection) for the patient after liver transplant.
To prevent this situation, patients should use lifelong immunosuppressive drugs (immune-suppressive drugs). In some cases, signs of organ rejection can be observed despite medications. The presence of rejection signs can be investigated by liver biopsy. These types of exacerbations are usually treatable as a result of timely intervention. The risk level of the surgery for the patient varies according to the patient's health status.
Patients in need of organ transplantation generally consist of individuals with advanced liver failure, who can be defined as severely ill and whose body reserves are depleted. Considering that liver transplantation is a large-scale operation, it can be said that the risk of operation comes to the fore entirely depending on the severity of the patient's condition. Survival rates appear to be higher for patients who have had a liver transplant from a living donor than for patients who have had a liver transplant from a cadaveric donor.
However, since there may be effects such as the shorter waiting period for transplantation in patients who have received transplantation from a living donor, and the fact that patients waiting for transplantation from a cadaver may become more severe in this process, research on this subject continues. While performing organ transplantation, large vessels are cut and sutured in the recipient patient. For this reason, there is a possibility of serious bleeding in patients.
The possibility of infection, which is another risk of surgical operation, can be quite dangerous for patients with organ transplants. Infections seen in these patients may have a severe course due to the immunosuppressive drugs used. Therefore, it is very important to act in line with the recommendations given by the healthcare team regarding the risk of infection.
Another curious issue regarding liver transplantation is life expectancy and quality of life after liver transplantation. This issue is directly related to both the realization of the operation at the right time and the success of the operation. In addition, the patient's special conditions�
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