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Liver Transplant

A liver transplant is an operation that replaces a patient's diseased liver with a whole or partial healthy liver from another person. This article explains the current indications for liver transplantation, types of donor livers, the operation itself, and the immunosuppression that is required after transplantation.

A liver transplant is an operation that replaces a patient's diseased liver with a whole or partial healthy liver from another person. This article explains the current indications for liver transplantation, types of donor livers, the operation itself, and the immunosuppression that is required after transplantation.

Many people die while waiting for a suitable liver, but after transplantation, the percentage of liver transplant recipients who survive is

  • At 1 year: 86 to 90%

  • At 3 years: 79%

  • At 5 years: 73%

Most recipients are people whose liver has been destroyed by cirrhosis (replacement of liver tissue with scar tissue), often due to hepatitis C. Other reasons for liver transplantation include primary sclerosing cholangitis (scarring of the bile ducts, causing cirrhosis), autoimmune liver disorders, and, in children, partial or complete destruction of the bile ducts (biliary atresia) and metabolic disorders.

People whose liver has been destroyed by alcoholism can receive a transplant if they stop drinking. Liver transplantation is also done for some people who have liver cancer that is not too far advanced.

Although hepatitis C and autoimmune disorders tend to recur in the transplanted liver, survival is still good.

Donors

Nearly all donated livers come from people who are brain dead and whose heart is still beating. The blood type and heart size of the donor and recipient must match. Tissue type does not always have to match exactly.

Some transplants come from living donors, who provide part of a liver. A few transplants come from people who are brain dead and whose heart has stopped beating. However, the liver from such donors is often damaged because it was not receiving blood.

Procedure

The damaged liver is removed through an incision in the abdomen, and the new liver is connected to the recipient’s blood vessels and bile ducts. Usually, blood transfusions are required.

Typically, the operation lasts 4 1/2 hours or more, and the hospital stay is 7 to 12 days.

Liver Anatomy and Function

The liver is a vital organ, meaning that one cannot live without it. The liver serves many critical functions including metabolism of drugs and toxins, removing degradation products of normal body metabolism (for example clearance of ammonia and bilirubin from the blood), and synthesis of many important proteins and enzymes (such as factors necessary for blood to clot).

Blood enters the liver from two channels, the hepatic artery and the portal vein, bringing nutrients and oxygen to liver cells, also known as hepatocytes, and bile ducts. Blood leaves the liver via the hepatic veins which drain into the inferior vena cava which immediately enters the heart. The liver makes bile, a liquid that helps dissolve fat and eliminate metabolic waste and toxins via the intestine. Each hepatocyte creates bile and excretes it into microscopic channels that join to form bile ducts. Like tributaries joining to form a river, the bile ducts join to form a single "hepatic duct" that brings bile into the intestine.


Reasons Of Liver Transplant

The liver is the largest internal organ in the human body. It performs over 500 functions and produces over 1,000 enzymes and other proteins that are essential for good health. You cannot live without your liver. When your liver has failed and transplantation is necessary, a donated liver may come from one of two sources:

  • A liver from someone who has died   
  • A portion of a liver from a living donor   

About the Liver 

The liver is located in the right upper abdomen, just below the diaphragm. Some of its most important tasks include:

  • Converting nutrients from food into important enzymes, minerals, vitamins, hormones, and other molecules that the body needs to function properly
  • Storing molecules such as glycogen (a form of stored energy for cells), vitamins, and minerals until needed for other organs
  • Breaking down harmful substances, such as alcohol and poisons, into less harmful ones
  • Producing bile, a fluid that helps the body digest fats and nutrients

The liver is the only internal organ capable of full regeneration. As little as 25% of a liver can regrow into a full liver. This regenerative property is the essence of live donor liver transplantation, a procedure in which a portion of a donor’s liver is transplanted into a recipient. Both livers will grow in size and return to normal function in a matter of weeks. 

Liver Diseases that Lead to Liver Transplantation 

A number of diseases can impair or destroy liver function to the point that a liver transplant is necessary. They include:

  • Chronic viral hepatitis (hepatitis, B, C, and D), which causes inflammation and chronic damage to the liver
  • Alcoholic liver disease
  • Acute liver failure, usually from a virus or from ingesting a poisonous substance
  • Autoimmune hepatitis, in which the body’s immune system malfunctions and destroys liver tissue
  • Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), related disease in which fat deposits accumulate in the liver
  • Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC), progressive diseases that cause liver failure
  • Hepatic (liver) tumors
  • Metabolic and genetic disorders, which are inherited and include diseases such as alpha 1 antitrypsin deficiency, hemochromatosis, Wilson's disease, and polycystic liver disease 

Facts on Liver Transplant

  • The Liver is the second most commonly transplanted major organ, after the kidney, so it is clear that kiver Disease is a common and serious problem in this country.
  • It is important for liver transplant candidates and their families to understand the basic process involved with liver transplants, to appreciate some of the challenges and complications that face liver transplant recipients (people who receive livers), and to recognize symptoms that should alert recipients to seek medical help.
  • Some basics are as follows:
    • The liver donor is the person who gives, or donates, all or part of his or her liver to the waiting patient who needs it. Donors are usually people who have died and wish to donate their organs. Some people, however, donate part of their liver to another person (often a relative) while living.
    • Orthotopic liver transplantation refers to a procedure in which a failed liver is removed from the patient's body and a healthy donor liver is transplanted into the same location. This procedure is the most common method used to transplant livers.
    • With a living donor transplant, a healthy person donates part of his or her liver to the recipient. This procedure has been increasingly successful and shows promise as an option to avoid long waiting times due to shortage of liver donors. It is also an option in children, partly because child-sized livers are in such short supply. Other methods of transplantation are used for people who have potentially reversible liver damage or as temporary measures for those who are awaiting liver transplants. These other methods are not discussed in detail in this article.
  • The body needs a healthy liver. The liver is an organ located in the right side of the abdomen below the ribs. The liver has many vital functions.
  • It is a powerhouse that produces varied substances in the body, including
  1. glucose, a basic sugar and energy source;
  2. proteins, the building blocks for growth;
  3. blood-clotting factors, substances that also aid in healing wounds; and
  4. bile, a fluid stored in the gallbladder and necessary for the absorption of fats and vitamins.
  • As the largest solid organ in the body, the liver is ideal for storing important substances like vitamins and minerals. It also acts as a filter, removing impurities from the blood. Finally, the liver metabolizes and detoxifies substances ingested by the body.
  • Liver Diease occurs when these essential functions are disrupted.
  • Liver transplants are needed when damage to the liver severely impairs a person's health and quality of life.



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