Liver Transplant

Liver is regarded as the most complicated and metabolically active organ in our body. However, liver can also continue functioning even when 70% of its tissue has been removed. When a liver donor donates more than half of his/her liver for transplantation, the remaining part can resume its function without any loss or serious complication. We owe this ability to the liver’s capacity for regeneration, because the liver is the only organ that can regenerate itself after the removal of more than half of its tissue.

The only organ that can regenerate itself

  • It is among the functions of the liver to synthesize all the proteins, galls and digestive enzymes in the body.
  • Weight of the liver of a person is approximately the % 2 of his/her body. That is, liver of a person with 100 kg is only 2 kg.
  • Up to % 70 of the liver can be extracted from the body. A person can survive with % 30 of the liver remaining in his/her body. 
  • Liver is an amazing organ for it has a renewal capacity. After being partially removed through the surgery, liver can restore itself to its original magnitude within 4-5 weeks.
  • If a person loses more than % 70 of his/her liver, he/she may die.
  • Tumors in other parts of the body can easily spread to the liver since the liver receives a lot of blood, therefore gets tumors easily.

What is liver transplantation?>

A liver transplant is a surgical procedure to remove a diseased or damaged liver from the body and replace it with a healthy liver from a donor. A liver transplant becomes necessary when the liver has been damaged to such an extent that it cannot perform its normal functions. This is called liver failure.

Liver Failure
Liver failure is the inability of the liver to perform its normal metabolic and synthetic function as a part of normail physiology. There are two types of liver failure;

  1. chronic liver failure:  the liver fails because of damage over many months or years
  2. acute liver failure: extensive damage to the liver happens over a short period of time

There are many medications and alternative interventions that are used, however, liver transplant is the only known solution for liver failure.

When is a liver transplantation needed?

Even when inflammations related to alcohol consumption or fatty liver disease, hepatitis infections, long-term congestions or stones of the bile ducts, certain metabolic diseases, tumours, or congenital enzyme deficiencies are present, patients can continue a normal life for a long time as long as the progress of the disease is slow. But once the liver insufficiency becomes manifest, it may lead to itching, edema in the lungs and ascites in the abdomen, severe hepatitis, bleeding and anemia. In advanced liver disease, changes in personality and behaviour may be observed. Weight loss, reduced amount of urine, and fatigue may progress to a coma. These symptoms point out that the patient’s liver cannot fulfil the body’s needs. This condition, called “liver failure”, leaves a liver transplant as the only option for the patient. 

Symptoms of the liver insufficiency?

Some of the symptoms of liver diseases are as follows: Lack of appetite, fatigue, weight loss, and intestinal problems. Drowsiness after meals and nocturnal insomnia can also signal liver problems. Changes in the skin also play an important role in the diagnosis of diseases of the liver. Itching, mildly swollen yellow stains around the eyelids, "stars" of thin veins generally observed on the upper half of the body or widened capillary veins spreading out from a center are some of the changes observed on the skin. Circulation problems, low blood pressure and disorders of sexual function are also among the symptoms of liver diseases. In disorders of the liver not related to obstruction of the gall path, jaundice or mild jaundice on the skin or in the eyes may surface.

Patients of cirrhosis suffer strong pains caused by swelling caused by acid build-up and infection of the accumulated fluid. In advanced stages of liver diseases, in addition to the above mentioned symptoms, changes in behavior and personality may also be observed. Loss of weight, decrease in the volume of urination, and acute fatigue may lead to coma. The onset of these symptoms signals the inability of the liver to meet the needs of the body, yielding liver insufficiency. And the only alternative is a liver transplant.

What are the types of Liver Transplantation?

There are two types of liver transplantations regarding the donor types: from living donors and from deceased donors (patients in intensive care units with brain death).

Being a living donor

Donating an organ sounds intense and may be a traumatic process for an individual. However, since liver can regenerate itself, during the transplant process, only a segment of donor liver is transplanted into the recipient. Therefore a living person can donate a part of his/her liver. This type of donation is known as a living donation. The liver of the donor and the portion of the liver transplanted to the recipient grow back to their full size within a few weeks.

The main advantage of a living donor transplant is its alleviation the recipient from having to wait in the waiting list from organ transplants from deceased donors. The insufficiency of the number of donations from individuals who have experienced brain death makes living donations more important for transplant patients.

Liver donations are also possible from deceased donors. This type of donation is known as cadaveric transplant. However, only Turkish citizens have a privilege to be on waiting-list for receiving liver from deceased donors.
To be a living donor you need;

  1. To be between the ages of 18-60
  2. To agree on the surgery with free-will
  3. To be a relative of the 4th degree or closer
  4. To have a blood type that matches the recipient
  5. To have a liver that has a normal structure and function

Requirements to be a living donor;

1. Blood groups of the recipient and donor should be compatible. Blood group compatibility requirements are as follows:

RECIPIENT                    DONOR
A                                  A or 0
B                                   B or 0
AB                                 A, B, AB, 0 (all blood groups may donate)
0                                   0 (only group 0 may donate)
RH factor does not matter. (-) and (+) may donate to each other.

2. The candidate liver donor must be relative of the patient or his/her spouse up to fourth degree. Accordingly;

Spouse is accepted and not qualified as 1st/2nd/3rd/4th.
First Degree Relatives: Mother-father-child
Second Degree Relatives: Sibling, grandfather, grandmother, grandchild
Third Degree Relatives: Paternal/maternal uncle, paternal/maternal aunt, cousin (child of sibling)
Fourth Degree Relatives: Children of third degree relatives.
Relatives of the spouse of the person are ranked in the same way.

3. The candidate kidney donor must have turned the age of 25, and must be mentally balanced.

4. If the candidate donor has a known health problem or is overweight, he/she must contact our facility by phone before coming to our center.

For living donors, first choice is always immediate family members such as brother,
sister, parents or children as the likelihood of blood and tissue match is higher.

Advantages of a living donor liver transplant

  1. Short waiting-time
  2. Enables the transplantation of the most suitable liver
  3. Increases the success rate of the surgical operation and the transplantation
  4. The half-livers both in donor and the recipient regenerate themselves fastly within a couple of weeks
  5. Within a few days of the operation, even before the completion of the regeneration process, the large reserve of the liver enables the half-liver to begin functioning with normal capacity

How is the suitable liver chosen?

While selecting the donor, it is of utmost importance to prevent the recipient from any possible infections. Liver recipients are at risk of hepatitis B, C, HIV and cancer. The donor must undergo a detailed health scan and take all the tests of serology.

Liver transplantation in children

Non-healing jaundice and innate blockage of the gall paths are important indicators of liver insufficiency. Even with early diagnosis and treatment, these conditions lead to cirrhosis of the liver in high percentage of affected children. This increases the need for liver transplant. Research in recent years has shown that liver transplantation in children also becomes necessary in cases of familiar hypercholesterolemia (high level of cholesterol in the blood) and hemophilia. Transplants of success also cure innate biochemical disorders. However, in child recipients, liver transplants are technically a little more difficult than those of adults.
In addition to the difficulty of identifying a donor, the dimensions of the liver must also be compatible with the child. Dimensions of the liver received from adults must first be adjusted before transplantation into the child.

All the text that is featured in contains general information.
Sunday, September 23, 2018 10:33:41 PM