ВТОРОЕ МЕДИЦИНСКОЕ ЗАКЛЮЧЕНИЕ
Liver Transplantation

What is Liver Transplantation?

The vast majority of patients requiring liver transplantation are patients with liver cirrhosis. 

Currently, it is accepted that all patients with end-stage liver cirrhosis with a life expectancy of less than 1 year are candidates for liver transplantation, and transplantation is recommended (or should be recommended) for these patients. Because half of the patients in this condition die within a year due to this disease or its complications. 

There is a success rate of over 80% in liver transplants performed on time. 

Organ transplantation is the only treatment for patients with chronic organ failure. When organs are not found, death is inevitable for these patients. 

If the transplantation is done before the patients deteriorate, meaning that before their general condition deteriorates, the risk of surgery decreases and their life expectancy is longer, but it gets shorter in late transplantation, and the costs increase as well. Therefore, appropriate timing and appropriate patient selection are very important. 

It is a risky surgery due to the poor general condition of the patients and the size of the surgery. This risk may increase with the severity of the disease requiring liver transplantation. Patients are often exhausted in every way, and many are in a very serious condition. However, if surgery is not performed, it is inevitable to lose the patients. Liver transplantation means hope for a new life for these patients. 

Liver transplantation is performed between donors and recipients of the same blood types. Although liver transplantation can be performed even among people whose blood types do not match in order to save lives in very urgent conditions, in practice it can only be considered as a last resort due to the size of the surgery. 

Liver transplantation can be done from a piece of liver taken from a relative that is small enough to not endanger the life of the donor, but large enough for the recipient to live, or from a liver donated from a person who has had brain death. 

Unlike kidney transplantation, in the surgery, the diseased liver is completely removed and replaced with a healthy liver. Liver transplantation is the largest and bloodiest operation in general surgery. Its duration is around 8-18 hours. It is performed by a very crowded and well-trained team. 

If the liver to be transplanted is to be taken from a living donor, the recipients and donors are taken to separate operating rooms at the same time. While a piece of healthy liver is taken from the healthy donor in one room, the diseased liver is removed in the other room, and then the liver piece from the donor is placed in. 

After the operation, the patients are taken to the intensive care unit. The donor recovers well to be discharged after a few days of treatment. The transplanted patient, on the other hand, is taken to the service after they regain their vital functions in the intensive care unit, where their treatment continues. 

In addition to general drug treatments, immunosuppressive drugs are given to all post-operative transplant patients. After adjusting the doses of these drugs and ensuring the adaptation of the patient to the new lifestyle, they get discharged and sent home. 

Like all organ transplant patients, liver transplant patients also use drugs that suppress the immune system for life. Preventing the organ from being expelled by the body's defense mechanism and maintaining its function and vitality depends entirely on this drug treatment. If the drug is not used or used irregularly, the immune system immediately starts a war against this foreign liver and this results in the loss of the organ and perhaps life. 

The main purpose of liver transplantation is to return the person to a normal, active and productive life, beyond rehabilitating them. People can return to their families, jobs, schools, travel safely, and take a vacation. 

In end-stage liver disease patients, besides having a poor health; reproductiveness, fertility and sexual life come to an end to a large extent, as well. After liver transplantation, sexual functions return, women begin to menstruate again, pregnancy and childbirth become possible. 

In our country, organ transplants are performed at world standards. Success rates in transplants of important organs such as liver and kidney are over 80-90%. 

However, all organ transplants require a donor. In our country, where family ties are very strong, all of patients' relatives volunteer to donate organs. Unfortunately, every donor's organ is not suitable for every recipient, serious health problems occur in donors that prevent organ donation, and organ obtaining cannot be performed in many cases. 

Moreover, many organs such as heart, lung and pancreas cannot be obtained from living donors. The first condition of being a donor is that organ donation does not cost the health and life of the donor. 

As in around the world, the main source of organ obtaining should be cadavers rather than volunteer donors. Organ donation in our country is far below the desired level. While the increase in chronic diseases increases the need for organs, the increase in the number of cadaver donors is far from responding to this. 

There is no general age to be an organ donor, it is essential that the person and the organs are healthy and that their health does not deteriorate after organ donation. 

While the person can donate organs in their health, donations can also be made by the family in cases of brain death. Organ donations are accepted in all hospitals and institutions affiliated to the Ministry of Health. 

In Which Situations Is Liver Transplant Necessary?

Some hereditary anomalies, excessive alcohol and drug use, viruses that cause cancer or hepatitis can initiate irreversible damage to the liver. In this case, the liver hardens and shrinks, large and small swellings occur on it and cirrhosis develops. Cirrhosis of the liver is a condition that can lead to fatal results such as bleeding, jaundice, accumulation of fluid in the abdomen (ascites), infection and accumulation of toxic wastes in the body and coma. Ultimately, the only option is a liver transplant. 

How Does the Liver Required for Transplantation Obtained?

It is performed in intensive care units by removing the liver of the patients that are confirmed to be brain dead whose organs are donated. 

What is the Age Limit for Live Liver Donors?

It is necessary to be older than 18 years old and less than 55 years old, and accompanying health problems prevent being a donor. 

What Kind of Compatibility Is Needed Between the Donor and the Receiver?

Blood type compatibility is required. 0 Rh (-) is the universal donor, AB Rh(+) is the universal receiver. For example, A Rh (+) for an A Rh (+) recipient, 0 Rh (+) and 0 Rh (-) for an A Rh (-) recipient can be a donor. 

What is the Risk of Surgery for the Donor?

The accepted risk in the world is around 1%. 

When Do Donors Return to Their Normal Lives?

Cases with a problem-free course are discharged around 10 days and return to their active lives in 1 month. They cannot do sports for 3 months. 

What Kind of Health Problems Do Donors Have in the Long Term?

They do not experience any health problems, and very rarely, permanent sequelae may occur as a result of complications such as jaundice and occlusions in the veins that feed the liver due to complications during surgery. However, this probability is less than 1%. 

How Much of the Liver Is Taken for Transplantation to the Recipient?

For adult recipients, the right lobe is taken. This part of the liver is about 60%. In some adults, the left lobe can be removed (40%). For child recipients, a piece called the left lateral segment is taken (20%). 

Does the Liver Remaining in the Donor Regenerate Itself?

Yes, it reaches its full size in 6 weeks in unproblematic cases. 

Does the transplanted liver meet the needs of the recipient?

With the calculations made for the donor, the liver is taken in a size that will meet the needs of the recipient. Naturally, the remaining liver in the donor should be sufficient. If these criteria are not met, the transplant cannot be performed. 

Does the transplanted liver regenerate itself?

The transplanted liver reaches the required size in 6-8 weeks, as in the donor. In a normal person, the liver is about 2% of body weight. For example, a 75 kg person should have a liver of 1500 gr. 

If the Recipient Has Hepatitis B and Hepatitis C, Will It Recur in the New Liver?

With the use of hepatitis B immunoglobulin, 95% of the time it does not relapse, but hepatitis C relapses. However, the problem occurs again in the liver in a very long time. 

What Should Donors Be Protected From?

In general, they should avoid very crowded environments and air pollution. They should stay away from smoking environments and those who have a flu infection. Shaking hands and kissing on the cheeks is not recommended. 

How Does Presence of Liver Tumor in Recipients Affect the Outcome?

Tumors smaller than 3 cm in diameter have a very low chance of recurrence. Transplantation is not performed if the diameter of a single tumor is over 5 cm or if there are multiple tumors with a size of more than 8 cm in total. 

How Long Is Medication Used After Liver Transplantation?

According to current information, it is necessary to use drugs for 10 years. 

How often is follow-up done after liver transplantation?

Checkups and blood tests should be done twice in the first two weeks, once a week for 3 months, once every two weeks until the end of the first year, and then once a month. 

Liver Transplantation Centers 

Medicana International Ankara 

Organ Transplantation Center 

Prof. Dr. Ali Kagan Gokakin 

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