MEDICAL SECOND OPINION

Liver Transplant

Medicana Health Group serves patients who need organ transplant surgery with superior healthcare services at organ transplantation units of Medicana International Ankara, Bahçelievler, Çamlıca, and Medicana International Istanbul Hospitals – all certified by the Ministry of Health.

Medicana Health Group is among the essential healthcare facilities that support organ donation and transplantation.

Medicana Bahçelievler, Medicana Çamlıca, Medicana International Istanbul, and Medicana International Ankara hospitals and their specialists perform successful transplant surgeries.

What is liver transplant surgery?

Most patients requiring liver transplantation are cases with hepatic cirrhosis.

Recently, the view has been recognized that a patient with end-stage hepatic cirrhosis and a life expectancy below one year is a candidate for liver transplantation, and such a patient is (or should be) recommended for transplantation. Half of patients with such conditions die secondary to the disease or complications.

The success rate is over 80% in liver transplantations performed promptly.

Organ transplantation is the only treatment method for patients with chronic organ failure. Death is inevitable for those patients if organs cannot be supplied.

If transplant surgery is carried out before the patient deteriorates or overall health becomes unstable, the surgical risks decrease, and the length of life is prolonged; for late transplantations, survival shortens, and costs rise. Therefore, appropriate timing and patient selection are critical.

The surgery poses a high risk due to the poor overall health of patients and the complexity of the surgery. The risk can further increase if the disease that requires a liver transplant is severe. Patients are already exhausted in all aspects, and most patients have end-stage diseases. However, death is inevitable if surgery is not performed. Therefore, liver transplant surgery is a hope for a new life. Liver transplant surgery requires recipients and donors with the same blood type. Although a liver from a donor with a different blood type is transplanted in emergencies, it should be considered as the last option due to the complexity of the surgery.

A piece of liver that does not threaten the donor's life but helps the recipient's survival is obtained from a related donor or the whole liver of the deceased donor is used for the transplantation.

On the contrary to kidney transplant surgery, the diseased liver is completely removed, and the donor liver is placed. Liver transplant surgery is the most complex and bloody surgical procedure in the field of general surgery. The process takes about 8 to 18 hours. A very crowded, well-trained, and qualified team is required for the procedure. Suppose the liver will be obtained from a living donor. In that case, the recipient and the donor are concomitantly transferred to different operating theaters, and the donor's liver is obtained. In contrast, the diseased liver is removed, and the donor's liver is transplanted to the recipient.

Patients are postoperatively transferred to the intensive care unit. Following several days of treatment, the donor will be healthy enough to be discharged. Meanwhile, the recipient is transferred to the patient room after vital functions in the intensive care unit are monitored and stabilized.

All transplant patients are started on general medication treatments and immunosuppressive medications postoperatively. After the doses of those medications are adjusted and the patient adapts to the new lifestyle, the patient is discharged to home.

Similar to all patients who undergo organ transplant surgery, liver transplant patients should take immunosuppressive agents for the rest of their life. Those medications should ensure that the body's defense system does not reject the donor organ and that the donor organ functions properly. If the medicines are not used or used irregularly, the defense system starts attacking this foreign liver, resulting in loss of the organ or even death.

The principal aim of liver transplant surgery is to ensure an everyday and active life beyond the restoration of health. Patients come together with their families, engage in working and school life, travel safely, and vacation.

End-stage liver disease not only deteriorates overall health but also ends reproduction, fertility, and sex life. Sexual functions are restored after liver transplant surgery, women start menstruating, and pregnancy and childbearing are possible. All international standards are met for organ transplant surgeries in our country. Our success rates are above 80-90% in transplantations of essential organs, such as liver and kidney.

However, all organ transplant surgeries require a donor. Since family bonds are influential in our country, all family members volunteer to donate organs. Unfortunately, not all donor organs match the recipient, and severe health problems that contraindicate organ donation can be identified in donors; organ donation fails in many cases.

On the other hand, many organs, such as the heart, lungs, and pancreas, cannot be obtained from living donors. The first prerequisite of being a donor is that organ donation should not cost the health and life of the donor. As is the case all around the world, the source of the organ should be cadaver donors with diagnosed brain death rather than voluntary living donors. The organ donation rates in our country need to catch up to the target rates. Since the increased incidence of chronic diseases boosts the need for organ donation, the increase in the number of cadaver organs is too slight to meet this requirement.

There is no age-related limitation for organ donation; the principle is that the donor and organs are healthy, and the donor survives a healthy life after the organ donation. The person may donate organs at any phase of the life, or family members of the deceased may donate organs. Donating organs at all hospitals where organ transplant surgeries are performed, and institutions affiliated with the Ministry of Health is possible.

What are indications of Liver Transplant?

Some hereditary abnormalities, excessive use of alcohol and medication, cancer, or viruses leading to hepatitis may induce irreversible damage in the liver. In this case, the liver shrinks and hardens, and lumps of varying sizes develop, resulting in cirrhosis. Cirrhosis can cause fatal results, including but not limited to bleeding, jaundice, ascites, infections, and accumulation of toxic wastes in the body, as well as coma. In the end, the only choice is a liver transplant. Who can donate a liver for liver transplant surgery? The liver is obtained from patients who are diagnosed with "brain death" in the intensive care unit and have already donated organ(s).

What Is The Age Limit For Living Liver Donors?

The donor should be above 18 and below 55, and comorbidity is a contraindication for donation.

What Should The Recipients Avoid?

They should avoid crowded areas and air pollution in general. They should stay away from smoking areas and from people with influenza infections. Hand-shaking and cheek-kissing are not recommended.

How Will Liver Tumors in Recipients Affect The Outcome?

Recurrence risk is shallow for tumors smaller than 3 cm in diameter. If the diameter of a particular tumor is above 5 cm or if the total diameter of more than one tumor is above 8 cm, transplantation cannot be carried out. If The Recipient Has Hepatitis B and Hepatitis C,

Does It Relapse In the Transplant Liver?

Hepatitis B will not relapse by 95% when immunoglobulins are used. Hepatitis C will relapse. However, it will cause problems in the liver in the very long term.

How Long Is It Necessary to Use Medications After Liver Transplant Surgery? Based on our up-to-date knowledge, it is required to use drugs for ten years.

What is frequency of follow-up visits after liver transplant surgery?

The patient should present for follow-up visits and blood tests twice a week in the first two weeks, once a week in the subsequent three months, once every two weeks until the end of the first year, and at monthly intervals.

What is the size of the liver excised to be transferred to the recipient?

For adult recipients, the right lobe is taken. It accounts for approximately 60% of the liver. For some adult patients, the left lobe can be taken (%40). The left lateral segment is taken for pediatric recipients (%20).

Does Liver Transplant Meet the Requirements of the Recipient?

Based on calculations made on the liver of the donor's donor, the liver transplanted is large enough to meet the recipient's needs; as expected, the liver left in the donor's body should also be sufficient to meet the donor's needs. If these criteria are not met, transplant surgery will not occur.

Does the Transplanted Liver Regenerate Itself?

Similar to the donor's liver, the piece of liver transplanted to the recipient will achieve a standard size in a 6- to 8-week period. The weight of the liver accounts for 2% of total body weight in a healthy person. For example, the liver should weigh 1500 g for a human weighing 75 kg.

What Is the Risk of the Surgery For Donor?

The worldwide accepted risk is around 1%.

Does the Liver Left in the Body of the Donor Regenerate Itself? 

Yes, the liver will achieve full size of normal liver in 6 weeks if no problem occurs.

When Can A Donor Engage in Routine Daily Life Activities?

The patient can be discharged on Day 10 if no problem occurs in the postoperative period, while they may engage in routine daily life activities in 1 month. However, they cannot do any sports for three months.

What Kind of Long-Term Health Conditions Do Donors Face?

They will not face any health problems; very rarely, some cases suffer from jaundice and atherosclerosis of arteries supplying blood to the liver secondary to intraoperative complications, resulting in permanent sequelae. However, the risk of such complications is below 1%. Blood type compatibility for donor and recipient blood type compatibility is required. 0 Rh(-) is the blood type of general donor and AB Rh (+) implies the blood type of general recipient. For example, for an A Rh(+) recipient, the blood type of the donor can be A Rh(+), or for an A Rh(-) recipient, the donor can be 0 Rh(+) or 0 Rh(-). How long does the surgery take?
The living donor liver transplant surgery takes about 6 to 8 hours. The donor surgery takes about 3 to 5 hours. The Living donor should be healthy in all aspects. However, persons with controlled hypertension and thyroid hormone deficiencies can be considered donor candidates after they are assessed and approved by an internist. The donor should quit smoking and alcohol consumption for at least ten days before the surgery.

Should the Living Donor be a relative?

Under our country's organ transplant legislation, the donor should document that they are a relative of the recipient up to the fourth degree.

Created at 11.10.2023 06:55
Updated at 22.05.2024 05:52
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