Familiarity with liver transplantation
Liver transplantation is now the best treatment for many chronic liver diseases that have reached the end stage and no other treatment is possible for them.
Many of these patients suffer from complications such as jaundice, fluid accumulation in the abdomen, gastrointestinal bleeding, recurrent infections, or liver cancer.
Liver transplants were first successfully performed in 1967 by Dr. Thomas Starsel in Colorado. In our country, there are several liver transplant centers in Shiraz, Tehran, Shiraz, Isfahan, Mashhad and Kerman.
In our country, the most common causes of liver transplantation are: hepatitis B, autoimmune diseases and advanced stages of fatty liver disease.
Patients suffering from complications of chronic liver disease are referred to transplant centers. At the center, patients are carefully evaluated by transplant team physicians to ensure that the patient will benefit from a liver transplant and will be able to tolerate surgery.
It is possible to receive liver from a brain-dead or living donor. A living person can donate 65 to 70% of their liver. The liver has an amazing regenerative power and returns to its original volume after 6 months. Even the liver donor with brain death can be divided into two parts to connect one liver to two people.
Liver transplant surgery is a very complex surgery. In this operation, the patient’s liver must first be removed from the person’s body, because the new liver is in its original place. This in itself means removing the patient’s liver from the potentially dangerous stages of the operation, which can sometimes be accompanied by extensive bleeding.
In the next step, the new liver is transferred to the patient’s circulatory system. It then flows to the liver. This stage is also sometimes associated with dangers. Because the liver has sometimes been without blood supply for hours before this stage, it poses different risks to the patient as various toxins are released into the patient’s bloodstream. An experienced surgical and anesthesia team that is able to deal with these risks is essential.
After the operation, the patient will be transferred to the intensive care unit and then to the transplant department. The transplant team should carefully evaluate the patient for liver function, transplant rejection, and other complications such as infections. To prevent rejection, these patients must use rejection drugs or immunosuppressive drugs for the rest of their lives. Therefore, patients should be constantly on the transplant team. The chance of liver transplant success in the first year after transplantation is about 85 to 90% and in the fifth year after transplantation 70 to 75%.
Dr. Reza Saidi Firoozabadi – Transplant surgeon
Another article: What you need to know about liver transplantation
Liver transplantation is a major surgery that can save your life. Maintaining a new liver is an important task that will help maintain and improve your quality of life. The liver does several important things in the body:
– Help digest food
– Cleansing the body of toxins
– Making different proteins in the body
– Helps to coagulate blood by making coagulation factors
– Storing sugar as an energy source
– Storage and use of vitamins
– Making immune materials to defend the body
Severe liver damage is known as cirrhosis. Cirrhosis causes several problems:
– Liver failure, in this case the liver is unable to perform its functions.
Port hypertension, due to liver damage, blood is not able to pass through the liver. So he tries to bypass the liver. This leads to fluid buildup in the abdomen (ascites) and varicose veins around abdominal organs such as the esophagus.
Primary liver cancer: The liver of these patients is prone to liver cancer.
Some of the symptoms of cirrhosis include yellowing of the skin or eyes, forgetfulness, dizziness or coma (encephalopathy), tiredness, weakness or muscle wasting, itching, bleeding due to blood clotting disorders, accumulation of fluid in the limbs or abdomen (ascites), bleeding. From esophageal or anal varices.
Unfortunately, there is no cure for advanced stages of cirrhosis except liver transplantation.
The doctor first introduces the patient to a liver transplant specialist and the necessary evaluations for liver transplantation begin immediately. At this stage, the transplant team will make various evaluations to determine if the transplant will help you. Several tests must be performed. This stage sometimes lasts a few days or weeks.
A) At this stage, the person is examined and evaluated by a liver specialist, transplant surgeon and other physicians.
B) The nurse coordinating the blood test will request various photographs of the patient.
C) The person will be evaluated for previous infections, especially tuberculosis. Based on the results of these tests, it is sometimes necessary for an infectious disease specialist to see the person.
D) The person will receive different vaccines.
E) Because liver transplantation is a major surgery, the patient will be evaluated for heart and lung disease. ECGs and heart tests are done in all patients and the cardiologist will see the patient.
C) Psychological assessments
The patient’s psychological evaluation is as important as the physical evaluation. The psychiatrist usually talks to the person to make sure he or she is fully aware of the transplant problems. The support of friends and family will help a lot in this direction.
G) nutritional assessment; Nutritionists will give pre- and post-transplant recommendations to the patient.
H) Insurance ratings
Liver transplantation is a costly task. A member of the patient transplant team will talk about this. The initial costs of the liver transplant will be covered by the government. But there is also the cost of medications and subsequent problems.
G) Evaluation in the Liver Transplant Committee
After all the evaluations, the liver transplant committee decides whether the person is eligible for the transplant. If eligible, the person will be placed on a liver transplant list. Sometimes a person’s illness is not yet severe enough to require a transplant. In this case, the patient will not be included in the list, but will be constantly monitored by the transplant team to be included in the list if necessary. Sometimes the patient may be so ill that he or she is unable to tolerate a liver transplant and is therefore not listed.
Liver transplant list
You will be on the transplant list after all the evaluations have been done and the liver transplant committee has confirmed that the transplant is in your best interest. Your status on this list depends on the severity of your illness. Your financial, economic, and job and social status do not play a role in your position on this list.
Be sure to contact your doctor regularly and take your medications while you are on the waiting list for a transplant. Be sure to follow the diet and inform your doctors at the transplant center about any changes.
When the right liver is not found for you, the transplant team will inform you. Make sure that the transplant team has all your contact numbers so that they can contact you immediately.
Liver transplantation is performed in two ways:
Transplantation: In this case, the liver is taken from a person with brain death, which is removed from the body and placed on ice to cool until it is transplanted to the recipient. Liver
The donor must match the recipient in terms of size and blood type.
Transplantation from a living person: In this method, part of the liver of a living person is transplanted to a recipient.
When a suitable liver was found
The recipient should refuse to eat or drink
– Go to the transplant center immediately
Sometimes the quality of the liver may not be good and surgery may not be performed
– The receiver will be transferred to the operating room. After general anesthesia, several tubes will be attached to him. During the operation, doctors monitor the condition of the heart, blood pressure, and so on.
A large incision is made in the upper abdomen, the liver is completely removed from the body and a new liver will be transplanted. This will take 4 to 6 hours.
After the operation
After the operation, the patient will be transferred to the intensive care unit and his condition will be monitored regularly. After regaining consciousness, the breathing tube comes out of the patient’s mouth to breathe on its own. As the patient’s condition improves, he will be transferred to the ward. There he will gradually eat and walk. The patient will be bled daily for the necessary tests. Sometimes a liver x-ray is needed. In the early days after surgery, many medications are given to the patient. Sometimes reoperation is needed because of bleeding, poor liver function, and blood clots in the liver.
Discharge from the hospital
When the patient gradually recovers, that is, the liver is functioning properly and the person is able to eat and walk, he will be discharged from the hospital. On average, a person will be hospitalized for 8 to 14 days. Prior to discharge from the hospital, the transplant team will be trained in medication, dressing changes, and signs of infection. If you have any questions, you should contact the medical team immediately. Contact numbers will be provided to the patient.
It is necessary to observe the following points after performing the transplant operation:
Stay away from patients, especially those who have a fever or cough
– Regular hand washing and hygiene
See a doctor right away if you have any abnormal symptoms such as fever, cough, heartburn, vomiting, diarrhea, blisters and plague.
– Walk slowly
– Avoid eating uncooked foods
– Timely use of drugs. Any changes in medications should be monitored by the medical team. No new or herbal medicine should be taken without a doctor’s advice.
– In case of severe vomiting or diarrhea, the absorption of drugs in the body will be impaired. Therefore, the medical team should be notified immediately.
Weekly and monthly tests will be performed on the patient for rapid diagnosis and treatment of transplant complications. Test results should be reported to the medical team immediately. Important complications after liver transplantation include:
1- Rejection of the transplant – Since the liver does not originally belong to the recipient, the body naturally intends to reject or reject it. Therefore, the patient should take anti-transplant drugs for the rest of his life. These drugs reduce the risk of rejection by weakening the body’s immune system. But sometimes the rejection of the link happens. Rejection of a transplant does not mean the loss of a transplanted organ, and fortunately in most cases it can be treated with medication. Detection of link rejection is by sampling. It is necessary to start treatment as soon as possible.
2- Recurrence of the primary disease – Sometimes the primary disease that has damaged the liver may also damage the transplanted liver. Fortunately, in many cases this complication can be treated, but rarely will it need to be transplanted again.
3- Infections – Infections are common in transplant patients due to the use of anti-transplant drugs that weaken the body’s immune system. Unfortunately, these infections often do not have loud symptoms. Therefore, any symptoms and abnormalities should be reported to the medical team immediately so that evaluation and treatment can begin immediately.
4- Cancers – Due to the use of anti-transplant drugs, transplant patients may develop cancer, especially skin cancer. The medical team should be notified of any abnormal moles or symptoms.
5- Medications – Taking anti-transplant drugs makes a patient more susceptible to infection, high blood pressure, diabetes, high cholesterol and lipids, osteoporosis and obesity.
The transplant team will evaluate and treat the patient in this regard.
Transplanted liver care
Liver transplantation gives the patient a chance to live again, so the new liver must be taken care of. Avoid unhealthy eating habits such as excessive consumption of sugars and fats if you have had a liver transplant. Get physically active. Keep in touch with your medical and nursing team and report any abnormal symptoms immediately. Take your medication regularly.
Dr. Reza Saidi Firoozabadi – Transplant Surgeon
Dr. Saber Firoozi – Specialist in Liver and Transplantation
Dr. Montazeri – Physician of the transplant team
Ms. Yousefi – Nurse and coordinator of the transplant team