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Liver Transplant 

The liver performs many critical functions, including the metabolism of drugs, the removal of so-called foreign and toxic substances from the blood (for example, the clearance of ammonia and bilirubin from the blood), and the synthesis of many important proteins and enzymes (such as factors necessary for blood clotting). In addition, the liver is the only organ in the body that can renew itself after most of it has been removed. As a matter of fact, more than half of the liver, which works like a factory in the body, is transplanted without impaired liver function or other serious damage.can be obtained from the donor. Since chronic liver failure is a very important life-threatening health problem, liver replacement is the only option. A liver piece taken from a living or cadaver is attached to the person and the patient can regain a healthy life. However, it is very important that this procedure is performed by an experienced team in a fully equipped hospital.

Contents

  • What is a liver transplant? 

  • In which diseases is liver transplantation applied?

  • How is liver transplant performed? 

  • Liver transplant prices

  • Frequently asked questions about liver transplant 

What is a liver transplant?

A liver transplant is an operation that replaces a patient's diseased liver completely or partially with a healthy liver from another person.

 

Liver transplantation is the only treatment for chronic liver failure. It means replacing a sick liver with a healthy liver. Cirrhosis is the most common liver transplant disease group in the world. This is followed by some congenital diseases and some liver tumors.

 

Liver transplantation should be performed by an experienced team in a fully equipped hospital. Liver transplantation is not just a surgical procedure. For the preparation and post-transplant follow-up process, the center; From the operating room to the laboratory, from the imaging units to the intensive care, from the inpatient floors to other branches, it is very important that the department is of high quality and that it works together.

How is liver transplant performed?

Organs are needed for organ transplantation, and the source of organs is people. The appropriate organ for transplantation can be obtained from deceased people or living donors from among the relatives of the patient. If the relatives of people who have died under intensive care conditions (brain death) decide to 'donate organs', the lives of many patients are saved with those organs. Liver transplantation with organs donated in this way is called “cadaveric liver transplantation”. Since the number of organ donations is not sufficient, most of the patients die while waiting for a new liver. As a solution to this, it is possible to save the patient's life by taking a part of his liver from another living thing (may be a relative of the patient). This is called a living liver transplant. To this end, a relative of the patient's own blood group volunteers for such an operation. The person who is a donor candidate undergoes intensive examinations and evaluations. If there is no obstacle to liver giving; The liver part (right or left) suitable for the patient's weight is taken from the donor and replaced with the patient's liver.

The purpose of liver transplantation is to return the person to a normal, active, productive life. It is aimed that both the patient and the donor return to their pre-operative performance. Liver transplantations performed in our center have reached numbers above the success rates accepted in the world.

FREQUENTLY ASKED QUESTIONS ABOUT LIVER TRANSPLANTATION

What are the conditions to become a liver donor?

  • First of all, the donor should donate the liver freely, without any pressure.

  • Persons under the age of 18 cannot be a liver donor.

  • The donor must be a 4th degree relative. Ethics committee approval must be obtained from the Provincial Health Directorate for the degree of kinship after the 4th degree.

  • The blood group of the recipient and the data must be matched.

  • Donor The donor must not have a history of systemic disease.

  • The donor must have healthy liver and kidney function.

  • The donor must not be over 60 years old.

Who can't get a liver transplant?

There are many patients with cirrhosis and decompensated liver disease, but not all patients are suitable candidates for liver transplantation. A patient should be able to recover from surgery and possible post-operative complications, take medications that prevent infections reliably, attend regular check-ups, comply with laboratory tests, and never engage in activities that may damage the liver. A liver transplant is not performed if the person has any of the following conditions:

  • People with alcohol or substance use

  • People with advanced lung and heart disease

  • HIV patients

  • Massive liver failure: Liver transplantation is not performed in a situation where brain edema is very severe.

  • Severe, uncontrolled psychiatric patients

  • Cancer that has spread outside the liver

  • Severe pulmonary hypertension (mean pulmonary artery pressure greater than 50 mmHg)

  • Systemic or uncontrollable infection

  • Serious, irreversible medical illness that limits short-term life expectancy

What are the diseases in which liver transplantation is applied in children?

According to the statistics, children make up 10 percent of liver transplants. Turkey, which ranks first among the countries with the highest number of pediatric liver transplants in the world, shares the first place with England. Liver transplantation in children is a delicate surgical procedure and good follow-up after transplantation is essential. Although many diseases affect the liver, not all liver diseases require a transplant. Diseases that damage the liver in children and can lead to transplantation include:

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Chronic End Stage Liver Disease

  • Biliary atresia

  • Autoimmune Hepatitis / Sclerosing Hepatitis / Overlap syndrome

Liver-specific genetic/metabolic diseases

  • Causes chronic liver damage/failure

Alpha-1-antitrypsin deficiency

Familial cholestatic syndromes eg. PFIC1 2 or 3

Allagille syndrome

Cystic Fibrosis Liver Disease

Tyrosinemia

  • Metabolic liver diseases; causes damage to other organs such as the brain and kidney.

Urea cycle disorders

OTC deficiency

MSUD

Hyperoxaluria

Crigler-Najjar Syndrome

Glycogen Storage disease

Acute Liver Failure

  • Viral hepatitis

  • Hepatic Drug toxicity (acetomenophine, NSAIDs, others)

  • Genetic/Metabolic diseases: Wilsons disease, fatty acid oxidation disorders, certain mitochondrial disorders

  • Autoimmune Hepatitis

  • Neonatal Hemochromatosis

Primary unresectable (operable) liver tumors

  • hepatoblastoma

  • embryonal sarcoma

  • Hemangioendothelioma

  • hepatocellular carcinoma

Can any liver be implanted in any human?

For liver transplantation, first of all, the blood groups of the patient and the donor must be suitable. Then, the examination of the donor candidate begins. This process; It consists of social, psychological and medical evaluations. medical evaluation; blood and urine tests, investigation of infectious diseases, radiological examinations and taking the opinions of other medical units (cardiology, chest diseases, etc.). Many factors such as the amount of liver needed by the patient, the general health of the donor candidate, whether the liver can be divided appropriately, and the structure of the bile ducts play a role in the realization of the surgery between the patient and the donor candidate.

Is liver transplant risky?

​This risk varies with the severity of the disease requiring liver transplantation. These patients are generally in very severe condition, with exhausted all kinds of reserves. On the other hand, liver transplantation is one of the largest known surgeries. "Severe patient + major surgery" is the most important factor that increases the risks. In addition, while the liver is changing, the largest veins of the body are cut and stitched, and serious unwanted bleeding may occur in these veins. Sometimes the newly inserted liver may not work well in the body it is attached to. Infections can cause serious problems in these patients whose immune system is suppressed.

What happens during a liver transplant?

Surgical procedures during a liver transplant may vary depending on your general condition and the practices of your medical team. Even at the last stage, surgery may be canceled due to incompatibility of the donor organ or other complications. Usually liver transplant follows this process:

  • You will be asked to take off your clothes and provide an apron to wear.

  • An IV (intravenous) line will be started in your arm or hand. Other tubes (catheters) will be placed in your neck and wrist. Or they can be placed under your collarbone or in the area between your abdomen and thigh (groin), they are used to check your heart and blood pressure and to take blood samples.

  • You will lie on your back on the operating table.

  • A catheter will be placed in your bladder to drain the urine.

  • After you are numbed, the anesthesiologist will insert a tube into your lungs. This is so that you can help your breathing with a machine (a ventilator). The anesthesiologist will continue to check your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

  • The skin over the surgical area will be cleaned with a sterile (antiseptic) solution.

  • The doctor will make an incision just below the ribs on either side of your abdomen. The incision will lie flat over the breastbone for a short distance.

  • The doctor will carefully separate the diseased liver from nearby organs and structures.

  • Connected arteries and veins will clamp to stop blood flow to the diseased liver.

  • Different surgical methods can be used to remove the diseased liver and implant the donor liver. The method used will depend on your particular situation.

  • The diseased liver will be removed after it has been cut from the blood vessels.

  • Your surgeon will check the donor liver before placing it in your body.

  • The donor liver will be connected to your blood vessels. Blood flow will begin to your new liver. The surgeon will check for any bleeding where there are stitches.

  • The new liver will connect to your bile ducts.

  • The incision will be closed with sutures or surgical staples.

  • A drain may be placed at the incision site to reduce swelling.

  • A sterile bandage or dressing will be applied.

What is tissue rejection?

Our body's immune system recognizes its own cells and does not react to them. However, when someone else's cells (blood, organ...) enter the body, he immediately realizes that these cells are foreign, and he takes up arms against them and seeks ways to expel this foreigner from the body. Microbes entering the body are treated in a similar way. This reaction of the body, which damages the transplanted organ, is called tissue rejection. Tissue rejection is a reaction that can be seen at any time in organ and tissue transplants and causes the transplanted tissue or organ to become useless (death) if it is detected early and precautions are not taken. In order to prevent tissue rejection, organ transplant patients use drugs to minimize this effect of the immune system for life. This is called immunosuppression. Despite these drugs, tissue rejection sometimes develops. It is possible to recognize this by the deterioration of the functions of the newly implanted liver and the detection of findings of tissue rejection in the liver biopsy. This type of flare-up is usually treated smoothly and everything returns to normal.

Should liver transplant recipients take medication for life?

As with kidney transplant  and whole organ transplant patients, liver transplant patients also use drugs to suppress the immune system for life. This is the basic condition for treatment success. If the drug is not used or if there is an irregular use, the immune system immediately starts a war against this foreign organ and this may end with the loss of life of the organ.

Questions about appointments?

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You'll find answers to questions about the appointments process, scheduling, referrals and more.

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See Frequently Asked Questions here.

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