Liver Transplantation by Jennelyn Celario

1. What is Liver Transplantation?

2. Liver transplantation is surgery to remove a diseased liver and replace it with a healthy one. This kind of surgery has been done for more than 38 years. Many people have had liver transplants and now lead normal lives. When a patient receives a liver transplant, his or her entire liver is removed. It is then replaced by either a complete new liver or a portion of a healthy liver.

3. What are the reasons for needing a Liver Transplant?

4. Liver transplantation is needed for patients who are likely to die because of liver failure. Many diseases can cause liver failure. The most common is cirrhosis which is the scarring and death of liver cells. Cirrhosis caused by hepatitis C is the most common reason for liver transplants.

5. Other conditions that may ultimately require a liver transplant include: - Diseases of the bile ducts, including biliary atresia, primary biliary cirrhosis and primary sclorosing (PSC), which can cause liver failure if there is a backup of bile in the liver. - Some inherited diseases, such as Wilson Disease in which dangerous levels of copper build up in the body, and hemochromatosis, where the liver is overwhelmed by iron. - Primary liver cancer or cancer that affects only the liver - Alcoholism which can cause cirrhosis

6. In adults, the most common reason for liver transplantation is cirrhosis. Cirrhosis: - is caused by many different types of liver injuries that destroy healthy liver cells and replace them with scar tissue. - can be caused by viruses such as hepatitis B and C, alcohol, autoimmune liver diseases, buildup of fat in the liver, and hereditary liver diseases. In children, the most common reason for liver transplantation is biliary atresia. Bile ducts: - which are tubes that carry bile out of the liver, are missing or damaged in this disease, and obstructed bile causes cirrhosis. Bile helps digest food. - Other reasons for transplantation are liver cancer, benign liver tumors, and hereditary diseases. Sometimes the cause of liver disease is not known.

7. Liver transplants can help adults and children.

8. What is the donor operation like?

9. The donor operation is done through an incision in the upper abdomen. If the LDLT recipient is a child, only a portion of the left part of the liver is removed from the donor: about 25% of the donor's total liver.

10. If the LDLT recipient is an adult, a larger portion of the liver needs to be removed from the donor, usually the right portion of the liver: about 60% of the donor's total liver.

11. The blood vessels supplying the portion of the liver to be removed are separated out, the liver itself is divided, and the portion to be transplanted is removed. This portion is brought into a separate operating room for the recipient, where the transplant is then performed. The donor operation takes 6 to 8 hours.

12. Liver Transplant Symptoms : People who have liver disease may have many of the following problems: - Jaundice - Yellowing of the skin or eyes - Itching - Dark, tea-colored urine - Gray- or clay-colored blood movements - Ascites - An abnormal buildup of fluid in the abdomen - Vomiting of blood - Tendency to bleed - Mental confusion, forgetfulness

13. Where Does a Liver for a Transplant Come From? There are two types of liver transplantation options: living donor transplantation and cadaveric transplantation.

14. Living donor - Living donor liver transplants are an option for some patients with end-stage liver disease. This involves removing a segment of liver from a healthy living donor and implanting it into a recipient. Both the donor and recipient liver segments will grow to normal size in a few weeks. - The donor, who may be a blood relative, spouse or friend, will have extensive medical and psychological evaluations to ensure the lowest possible risk. Blood type and body size are critical factors in determining who is an appropriate donor. - Recipients for the living donor transplantation must be active on the transplant waiting list. Their health must also be stable enough to undergo transplantation with excellent chances of success.

15. Cadaver In cadaveric liver transplantation, the donor may be a victim of an accident or head injury. The donors heart is still beating, but the brain has stopped functioning. Such a person is considered legally dead, because his or her brain has permanently and irreversibly stopped working. The heart continues to beat because the donor is attached to a respirator. The respirator delivers an adequate supply of oxygen to all vital organs. At this point, the donor is in an intensive-care unit. The identity of a cadaveric donor and circumstances surrounding the person's death are kept confidential.

16. Which Tests Are Required Before Getting a Liver Transplant? You will need to bring all of your previous doctor records, X-rays, liver biopsy slides and a record of medications to your pre-evaluation. To complement and to update previous tests, some or all of the following diagnostic studies are generally performed during your evaluation. If specific problems are identified, additional tests may be ordered. - Computed tomography, which uses X-rays and a computer to generate pictures of the liver, showing its size and shape. - Doppler ultrasound to determine if the blood vessels to and from your liver are open. - Echocardiogram to help evaluate your heart. - Pulmonary function studies to determine your lungs' ability to exchange oxygen and carbon dioxide. Blood tests to determine blood type, clotting ability, and biochemical status of blood and to gauge liver function. AIDS testing and hepatitis screening are also

17. What Happens When They Find a Match? When an organ has been identified for you, a transplant coordinator will contact you by telephone or by pager. Make sure that you do not eat or drink anything once you have been called to the hospital. The transplant coordinator will notify you of any additional instructions. When you arrive at the hospital, additional blood tests, an Electrocardiogram and a chest X-ray will generally be taken before the operation. You also may meet with the anesthesiologist and a surgical resident. If the donor liver is found to be acceptable you will proceed with the transplant. If not, you will be sent home to continue waiting.

18. During Surgery: Liver transplant surgery takes between six and 12 hours. During the operation, doctors remove the diseased liver and replace it with the donated liver. Most patients stay in the hospital for up to three weeks after surgery. The surgeon will disconnect your diseased liver from your bile ducts and blood vessels before removing it. The blood that flows into your liver will be blocked or sent through a machine to return to the rest of your body. The surgeon will put the healthy liver in place and reconnect it to your bile ducts and blood vessels. Your blood will then flow into your new liver.

20. After Surgery: - You will stay in the hospital for an average of 1 to 3 weeks to be sure your new liver is working. You will take medicines to prevent rejection of your new liver and to prevent infections. Your doctor will check for bleeding, infections, and rejection. During this time you will start to learn how to take care of yourself and use your medicines to protect your new liver after you go home. - In the hospital, you will slowly start eating again. You will start with clear liquids, then switch to solid food as your new liver starts to work. - Liver transplants are performed in many centers across the country. The healthy liver is obtained from a donor who has not suffered liver injury. The healthy liver is transported in a cooled saline solution that preserves the organ for up to 8 hours. This time allows for testing to determine if the blood and tissue of the donor match the recipient. The diseased liver is removed through an incision in the upper abdomen. The new liver is put in place and attached to the patient's blood vessels and bile ducts. The operation can take up to 12 hours and may require blood transfusions.

21. - Patients require hospital care for 1 to 4 weeks after liver transplant, depending on the degree of illness. After liver transplantation, patients must take immunosuppressive medications for the rest of their lives to prevent immune rejection of the transplanted organ.

22. What Complications Are Associated With Liver Transplantation? - Two of the most common complications following liver transplantation are rejection and infection.

23. Rejection: Your immune system works to destroy foreign substances that invade your body. The immune system, however, cannot distinguish between your transplanted liver and unwanted invaders, such as viruses and bacteria. Therefore, your immune system may attempt to attack and destroy your new liver. This is called a rejection episode. About 70% of all liver-transplant patients have some degree of organ rejection prior to discharge. Antirejection medications are given to ward off the immune attack.

24. Infection: Because antirejection drugs that suppress your immune system are needed to prevent the liver from being rejected, you are at increased risk for infections. This problem diminishes as time passes. Not all patients have problems with infections, and most infections can be treated successfully as they occur.

25. What are the side effects of a liver transplant? The most common side effects are caused by the drugs that treat or prevent rejection. These side effects can include: - fluid retention - raised blood pressure - headaches - diarrhea - nausea

26. Blood tests will show if the new liver is being rejected.

27. Eating a healthy diet and taking the medications are part of taking care of your new liver.

28. Indications: Liver transplantation is potentially applicable to any acute or chronic condition resulting in irreversible liver dysfunction, provided that the recipient does not have other conditions that will preclude a successful transplant. Metastatic cancer outside liver, active drug or alcohol abuse and active septic infections are absolute contraindications. This has been changing recently. Advanced age and serious heart, pulmonary or other disease may also prevent transplantation. Most liver transplants are performed for chronic liver diseases that lead to irreversible scarring of the liver.