Liver Transplantation

Liver Transplantation

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About Liver Transplantation

A liver transplant is an operation that replaces a patient’s diseased liver with a whole or partial healthy liver from another person. In most cases, a healthy liver will come from an organ donor who has just died.

Sometimes a healthy living person will donate part of their liver.
A liver transplant is usually reserved as a treatment option for people who have significant complications due to end-stage chronic liver disease.

Indications:

Acute liver failure (they have the highest priority): because those patients can have a complete recovery or die
Cirrhosis: not every patient with cirrhosis is a candidate. there is a score called a model for end-stage liver disease (MELD-Na score) if the patient score is 15 or higher then they are candidates for liver transplantation.
Liver neoplasms: patients with some primary liver neoplasms may be candidates for liver transplantation if the neoplasms meet specific criteria.
Metabolic disorders: severe metabolic disorders with systemic manifestations can be treated with liver transplantation. Examples: familial amyloid polyneuropathy, cystic fibrosis, primary hyperoxaluria, alpha-1 antitrypsin deficiency and many other

Contraindications:

If the patient has:

  • The cardiopulmonary disease that cannot be corrected
  • AIDS (acquired immunodeficiency syndrome)
  • Cancer outside the liver
  • Liver cancer with metastatic spread
  • Hemangiosarcoma
  • If the transplantation is not possible due to anatomic abnormalities
  • Uncontrolled infection
Before Transplantation:

Specific tests, procedures and consultations you may undergo include: tests to evaluate the cardiovascular system like ultrasound and ECG. Laboratory tests, such as blood and urine tests assess the health of your organs, including your liver. Imaging tests, such as an ultrasound of your liver and X-rays

Living-donor liver transplant:

A living-donor liver transplant is a surgery in which a portion of the liver is from a healthy living person. For adult donors, the larger right side (lobe) is removed for transplantation. For children, the smaller left lateral lobe is removed for transplantation.
Both the donor’s and recipient’s livers will regrow over the next few months.
Who can be a living donor?

  • Above 18
  • Healthy with no serious diseases
  • Not be engaged in active drug or substance abuse
  • Be able to understand the risks and benefits of living donation

Should be medically compatible (this includes the directed donation which is when the donor is relative to the patient and non-directed donation which is when the donor is a stranger to the patient)

Deceased donor liver transplantation:

this is the most common procedure when it comes to liver transplantation. Deceased donor livers come from people who have died suddenly, usually from an accident or bleed into the brain who are under 70 and were relatively healthy before the death. many studies – such as ABO blood type and HLA matching – are performed to ensure that the organs are functioning properly as well as screen for hepatitis viruses and HIV. As soon as a deceased donor is declared brain-dead, the liver is removed and placed in sterile fluid similar to fluid in body cells. It is then stored in the refrigerator. For a maximum of 24 hours before the liver is transplanted.

Liver transplantation indications in children:

When the child has a genetic disorder causing damage to the liver like Biliary atresia, Alagille syndrome, Primary sclerosing, cholangitis, Hepatoblastoma, Acute liver failure, Alpha-1-antitrypsin deficiency, Wilson disease, or other.

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