LIVER TRANSPLANT - WHEN AND HOW IT IS DONE
The liver is your body's largest internal organ. It performs complex functions that your body needs to survive. When your liver no longer functions normally because of disease, infections, or complications, you may need a new, healthy liver.
A liver transplant is the surgical replacement of a diseased liver with a healthy liver from a donor. It's a recommended treatment for patients suffering from end-stage liver disease and liver failure.
Liver transplantation is a lengthy and thorough process. Various evaluations and testing are performed by an interdisciplinary transplant team before and after, to ensure your safety throughout the procedure and your best chances of recovery.
A liver transplant is a surgical procedure to remove a damaged or diseased liver and replace it with a healthy liver from a donor. Liver transplant is usually reserved as a last resort if you have severe complications from end-stage liver disease.
There are two types of liver transplants:
- Living-Donor Liver Transplant: A healthy living donor, most often a family member, may donate a part of their liver. This method is an alternative to being placed on a waiting list for a donor before receiving a transplant.
- Deceased-Donor Liver Transplant: In most cases, the healthy liver replacement comes from a recently deceased donor.
All parts of a deceased donor's liver can be transplanted, whereas your transplant surgeon can use only portions of a living donor’s liver. This doesn’t affect the functions of your liver. The liver is the only organ that can regenerate lost or injured tissue.
After surgery, your donor’s liver will grow back to its normal size, and the part transplanted into you will also grow to average size soon after.
Your liver is a vital organ of your body that performs several essential functions. When your liver no longer functions properly, you may need a transplant.
Liver failure can either be an acute liver failure from infections or complications from medication or chronic liver failure.
Chronic or long-term liver failure occurs at end-stage liver disease. It’s a life-threatening disease that various liver conditions can cause:
- Autoimmune hepatitis, your body’s immune system attacks your liver, causing hepatitis
- Sclerosing cholangitis, inflamed and scarred bile ducts in and outside your liver
- Liver cancer
- Wilson's disease, excess copper build-up in tissues
- Biliary atresia, blocked bile ducts
- Alcoholic liver disease, alcohol damage to your liver
- Biliary cirrhosis, diseased bile ducts in your liver
The symptoms of advanced liver disease include:
- Jaundice, a yellow coloring of the skin and eyes
- Nausea, vomiting, and loss of appetite
- Clear, dark brown urine
- Mental confusion
- Bloody stool
- Clay-colored stools
- Coughing up blood
- Ascites, fluid in your abdomen
- Weight loss
- Bruising and bleeding easily
- Edema, swelling in your legs and feet
The donation process of a liver can take up to 6 months. A donor must undergo a series of physical exams, diagnostic tests, and mental health assessments before being chosen.
Living donors must be evaluated based on liver donor criteria before they may be considered for the transplant.
- Willingness: Your liver donor must donate voluntarily. Your donor must be competent to decide without any coercion.
- Age: Most transplant clinics require donors to be between the ages of 18 and 60. Younger donors are preferred because older donors are more likely to have health issues.
- Blood type: Your donor’s blood type must be compatible with yours. Both you and your potential donor can be tested through blood typing.
- Physical health: Your donor must be in good physical shape. They must disclose their medical history to the transplant specialist. A high blood pressure, lung disorder, or cancer can cause complications or transplant failure.
- Diagnostic tests: Your donor must pass the evaluation protocol for potential donors. This includes imaging tests, laboratory tests, special studies, and other tests deemed necessary.
- Mental health: Before your donor can donate an organ, they must be evaluated by a psychiatrist, social worker, or psychologist. Transplant centers routinely reject potential donors who have significant psychiatric issues.
- Living-donor team evaluation: After passing the above criteria, your donor will be required to meet with an interdisciplinary healthcare team for further evaluation. The team usually comprises a hepatologist, transplant coordinator, finance coordinator, social worker, living donor advocate, and nutrition expert.
A living-donor transplant or deceased-donor transplant generally follows the same process.
Because a liver transplant is a major surgery, an intravenous (IV) line and catheters will be placed to monitor your heart rate and blood pressure and to get blood samples. A catheter is also placed into your bladder to drain urine.
For the operation, you will be placed lying on your back. An anesthesiologist administers general anesthesia to keep you sedated throughout your procedure. Once the surgical site is sterilized, your transplant surgeon makes a long incision on your right side, just under your ribs, and extending to the left edge.
They carefully separate your diseased liver from nearby organs. The arteries and veins supplying your liver are clamped to stop blood flow. Your surgeon then removes your diseased liver.
The surgical technique used to remove your liver will depend on your specific case. When your surgeon implants the healthy liver, they connect your blood vessels and bile ducts to allow blood flow and prevent the liver cells from dying.
Your incision is stitched or stapled closed and you will be transferred to the intensive care unit (ICU) for recovery.
Transplant surgery typically takes up to 6 to 12 hours depending on your condition.
A liver transplant requires you to stay in the hospital for several days. In the ICU, your transplant team will monitor you for your heartbeat, blood pressure, oxygen level, and other readings. They also perform liver function tests to check if your new liver is functioning correctly.
After you've gained stability, you may be transferred to the transplant recovery area where you'll spend the next 10 to 14 days recovering. Regular check ups and weekly blood tests are performed by a transplant team to check for signs of complications.
Your doctor also prescribes immunosuppressive medicine. These are anti-rejection drugs to prevent your immune system from attacking your new liver.
Gradually, you’ll be able to move around for longer periods and increase your solid food intake. If you’re fit to go home, your transplant team will provide specific instructions on how to take care of yourself at home.
Recovery from liver transplant surgery can take up to 6 months.
From the diagnosis to the operation, the entire process of liver transplant is a physically and emotionally exhausting process. That’s why your transplant coordinator may suggest a few ways to help you on your road to recovery.
A well-balanced diet can help you recuperate and maintain a healthy liver. Your interdisciplinary healthcare team usually includes a nutritionist to evaluate your nutritional needs.
All liver transplant patients are advised to follow the following nutrition guidelines:
- Diet low in cholesterol
- Avoid alcohol
- Eat up to 5 servings of fruits and vegetables daily
- Avoid grapefruits (inhibits immunosuppression drugs)
After your treatment, physical activity and exercise should become a part of your daily routine to maintain your overall health and well-being.
Start off small by walking every day and tracking your progress. Over time, you can decide whether you can add more activities to your routine.
Bicycling, swimming, and other physical activities can also become part of your exercise plan. Take the time to discuss the best exercises with your transplant team and always check in with them when adding new exercises.
Immunosuppressants or anti-rejection drugs are prescribed after your operation. Your doctor will provide you with a medicine treatment plan that has to be strictly followed. Your doses will start off small but increase depending on how your body responds.
Anxiety before and after your transplant is common.You may need your family, friends, and even coworkers as a support system to help you through the process.
Aside from that, you can join a liver transplant program support group to get everything off your chest. Most patients who join support groups are able to ask questions, set realistic goals, and manage their expectations. It’s a great way to come to terms with life after transplant.
Social workers specializing in rehabilitation and recovery services can also help you discuss your employment and financial options.
Organ rejection and infection are the two most common complications of a liver transplant.
- Rejection: Your immune system is built to combat and protect you from foreign bodies. Most of the time, your immune system cannot distinguish between a donated liver and alien substances like viruses or bacteria.
The immune system sees your new liver as a threat that it needs to eliminate. This is called a Chronic Rejection Episode.
Organ rejection can occur within the first year of transplantation. Immunosuppressive medications are taken indefinitely to prevent your immune system from attacking the new, healthy liver.
- Infections: Infections after a liver transplant are not very common. Anti-rejection medications tone down your immune system, leaving your body vulnerable to infection. So, using these medications increases the risk of infection.
However, with continual use, the risk decreases. Your chances of developing an infection also decrease as your body gets adjusted to your new liver. Infections can be successfully treated if they occur.
Normally, around 75% of patients who have a liver transplant survive for at least 5 years.
Your odds for long-term survival depend on your health before surgery. Live-donor transplants have a better survival rate. Deceased-donor transplant recipients often spend months to years on waiting lists for a liver donor before settling.
As long as you consistently take your immunosuppressant drugs as prescribed and make the necessary lifestyle changes, you have a greater chance of enjoying a long and happy life decades after your liver transplant.
Who is not eligible for a liver transplant?
You do not usually qualify for an organ transplant if you are 65 years old or older. Patients with diabetes, severe obesity, uncontrollable infections like HIV, or aggressive malignancies like bile duct carcinoma are also ruled out.
How painful is a liver transplant surgery?
Like any internal organ surgery, a liver transplant may cause pain. This is because the incision made affects your nerves. During your transplant, you will be placed under general anesthesia for the entire procedure to minimize any pain and discomfort as much as possible.
What side effects should I expect after my liver transplant?
Medications after transplant may cause mood changes, hair loss or growth, elevated blood sugar, elevated blood pressure, nausea, headache, diarrhea, weakness, and kidney dysfunction. The side effects usually diminish with time.
Will my liver disease return after a transplant?
Certain liver diseases may return after a transplant. If you are at high risk, the transplant team will actively monitor your health and your condition over time.
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- Liver transplantation: history, outcomes, and perspectives
- Long-Term Survival After Liver Transplantation in 4,000 Consecutive Patients at a Single Center
- Liver Transplant - What to Expect
- Liver Transplant: Definition and Facts
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- Who can donate a liver?
- Liver Transplant Surgery
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