The liver is one of the most important organs of our body. The main role of the liver in fulfilling many functions, from digestion to immunity, from nutrient storage to removal of waste from the body and blood clotting. Failure of the liver due to various diseases is called liver failure. After a certain stage, the only solution for liver failure is liver transplantation.
What is Liver Transplant?
Liver transplantation, or as it is called liver transplantation, can be performed from a cadaver or a living donor. Most of the liver transplantations are performed for cirrhosis. When liver transplantation is performed with a successful operation at the right time, the success rate is very high.
Liver transplantation, for patients whose liver is not working sufficiently and who need organ transplantation; It is the transplantation of a liver taken from a brain-dead cadaver or a living donor. Liver transplantation, which is a life-saving treatment in end-stage liver failure or acute liver failure cases, is performed by general surgery units.
Apart from 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 for the operation to be performed, the patient's inadequately 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.
Since the liver can regenerate itself in transplantation from a living donor, the donor does not experience any failure after liver transplantation. It is one of the most complicated and tiring operations among the operations performed by general surgery units. For this reason, it should be performed in fully equipped hospitals by a specialized transplantation team. Liver transplantation, which is not just an operation; It covers a sensitive process that may require various treatments and meticulous precautions before and after the transplant, and follow-up is also very important.
Who is Liver Transplant Applied to?
Liver transplantation, which is most commonly used in liver failure, is a procedure that may be necessary for the treatment of both acute and chronic failure. 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 require liver transplantation. In addition, liver transplantation is the only solution for chronic liver failure that develops due to nutritional problems, liver cancers, infection or carriage of hepatitis B and C viruses, diseases of the biliary tract, 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, it is recommended that patients undergo liver transplantation. Considering factors such as the type of disease, the age of the patient and the health condition, 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 done on time.
How is Liver Transplant Done?
In order for organ transplantation to be performed, a living donor with the same blood type as the patient or a cadaver who donated an organ and suitable for liver transplantation is required. In transplantations to be made from cadavers, patients waiting for transplantation are put in order, considering the characteristics such as urgency of the patient's condition and age factor. In patients with a volunteer living donor, the transplant process can be planned at the appropriate time.
Liver transplantation can be performed from all individuals who have the same blood type as the patient and have the appropriate health condition for transplantation. The fourth degree of kinship between the patient and the donor increases the success rate of the transplant. 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 donating his liver, especially for living donors. People with diabetes, heart and kidney diseases, hypertension, some psychological diseases and various infectious diseases and those who are under 18 cannot be donors.
If there is no problem, the 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 a very detailed manner, and many examinations and diagnostic tests are performed in terms of compliance with the operation. Since it is an operation that requires blood stock, a certain amount of blood should be prepared before the transplant surgery. Therefore, blood donation may be requested from the relatives of the patients. When the day of transplant arrives, the donor and the patient are taken into operation in different operating rooms at the same time. First of all, the donor's surgery is started and after it is seen that there is no anatomical disorder regarding the liver, the recipient operation is started.
A portion of the liver is taken from the living donor in accordance with the patient's weight and placed in the patient's removed liver. While the surgical procedures continue on 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 Transplant Surgery Last?
Liver transplantation surgery is one of the most challenging surgeries known. These surgeries, which take an average of 6-8 hours, may take up to 18 hours in some cases. Having a multidisciplinary and experienced healthcare team that has received advanced training in the field of liver transplantation is very important for the success of the operation. The transplant procedure should be performed in full-fledged healthcare facilities with a multidisciplinary understanding, which include all medical units that may need their opinion and support 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 other features that must be found in the health institution where the transplant will be performed. After the transplantation process is completed, the patient is taken to the intensive care unit, just like the donor. If the operation has passed without any problems, the donor will be able to recover and be discharged usually within a few days or at most 10 days after the treatments.
If the patient is kept in intensive care unit after organ transplantation until his vital functions reach normal balance, he is taken to the service and his/her treatment continues here.
What are the Donor's Risks in Liver Transplant?
Donor risks in liver transplantation are one of the most frequently asked issues regarding this operation. In general, the risk of loss of life in the donor person is 0.5% or less after the liver transplantation operation. This is a very low risk. However, after the start of the liver transplantation operation, it may be possible to terminate the operation due to any negativity seen in the donor.
After the incision is opened, the incision can be closed again and the surgery can be terminated in cases such as observing excessive fatty tissue in the liver, detecting anatomical disorders, detecting masses in the abdomen, or in case of any complications encountered. For this reason, as stated above, the operation of the recipient patient is not started until it is understood that there is no structural problem regarding the liver removal from the donor.
Binary 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 applications such as a new operation or blood transfusion, before the operation. In addition, as in all operations, there are the possibility of minor infections in wound areas, digestive problems such as constipation and gas pain, and temporary complications such as nausea and vomiting due to anesthesia.
Since the liver is an organ that can renew itself, the donor liver, a 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 is very low after smooth operations.
How Does the Process Work for the Recipient After Liver Transplantation?
The patient, who is followed up in intensive care for a while after the transplant, and then taken to the service, is discharged after approximately 10 days of treatment, after being informed about the issues that need attention at home. As with other organ transplants, there is organ rejection (rejection risk) for the patient after liver transplantation.
In order to prevent this situation, patients should use immunosuppressive drugs (immunosuppressive drugs) for life. In some cases, signs of organ rejection can be observed despite medications. The presence of rejection findings can be investigated by liver biopsy. Generally, these types of exacerbations are treatable as a result of the intervention performed at the right time. The risk level of the surgery for the patient varies according to the health status of the patient.
Patients in need of organ transplantation generally consist of individuals with advanced stage liver failure, who can be defined as seriously ill and whose body reserves are exhausted. Considering that liver transplantation is a large-scale operation, it can be said that the operation risk is completely dependent on the severity of the patient's condition. Survival rates for patients with liver transplantation from a living donor appear to be higher than for patients transplanted from a cadaver.
However, since there may be effects such as shorter waiting time for transplantation in patients who are transplanted from a living donor and patients waiting to be transplanted from a cadaver more heavily in this process, research on this subject continues. During organ transplantation, large vessels are cut and stitched in the recipient patient. For this reason, there is a possibility of serious bleeding in patients.
The possibility of infection, which is another surgical operation risk, can be quite dangerous for organ transplant patients. The infections seen in these patients can be severe 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 the life span and quality of life after liver transplantation. This issue is directly related to the performance of the operation at the right time and the success of the operation. In addition, many factors such as the special conditions of the patient and other accompanying diseases may lead to individual differences. Generally, after a successful liver transplant performed by an experienced team, approximately 75% of the patients have a life expectancy of over five years.
Regular use of medications that should be used for life after liver transplantation, which is not just a transplant, and not interrupting the controls that should be performed at intervals recommended by the physician have an important effect on prolonging the healthy life span.
If you are preparing to have a liver transplant, it is useful to show the necessary sensitivity to the recommendations given by your physician in order to overcome this process in a healthy way. If you have any liver disease, you can help prevent liver failure or detect it at an early stage by having your routine checks done on time. In addition, by donating organs and directing people around you to donate organs, you can become a life hope for patients awaiting transplantation.