Transplant ( transplant ) liver
Gastroenterology / / May 11, 2016
transplant (or a transplant) liver is surgery to replace the diseased liver to a healthy.Usually after a successful transplant people have fully working (healthy) liver.
liver functions are numerous, there are about 400 each day, including:
- the production of bile, which plays an important role in digestion;
- Creating proteins (promote blood clotting);
- Removing or neutralizing bacteria, drugs and toxins, blood purification;
- Preservation of sugar, fat, iron, copper and vitamins in the body.
When a liver transplant
- Anomalies of the biliary tract. most common cause of liver transplants in children is biliary atresia.
- Cirrhosis. most common cause of liver transplantation in adults is cirrhosis.Cirrhosis - a scarring of the liver, which prevents it from working properly and may lead to liver failure patients.For example, in cirrhosis, when the liver is regressing to the terminal stage (this is the last, the fourth stage of the disease, in which the patient falls into a stu
most common causes of cirrhosis are:
- Long-term infection with hepatitis B or hepatitis C;
- Long-term alcohol abuse;
- Autoimmune hepatitis;
- Hepatic vein clot (thrombosis);
- Damage to the liver from poisoning or drugs;
- Problems with the drainage system of the liver (biliary tract) - for example, primary biliary cirrhosis (PBC - slowly progressive autoimmune disease of the liver) or primary sclerosing cholangitis (PSC - a chronic cholestatic disease of unknown etiology of the liver that occurs due to inflammation of the liver bile ducts and is accompanied by the development of painand dyspeptic syndromes, leading to the development of biliary cirrhosis, portal hypertension and liver failure, also can affect the gallbladder and pancreatic ducts).
- Metabolic copper or iron (hemochromatosis and Wilson's disease).
- Liver cancer. Patients with cancer of the liver, which has not yet spread beyond the liver limits, are also candidates for transplantation (when the cancer swept several organs of the patient, usually a liver transplant he did not produce, as the case in medical practice is considered "bad").
Priority is given to patients who have no liver transplant are likely to die.
Unfortunately, patients awaiting liver transplantation, much more than accessible and usable for organ transplants.Patients may consider themselves candidates living donor liver transplantation.
If you want to be tested in several transplant centers to make the right choices and determine what is best for you:
- take an interest in each of the centers, as transplants per year are performed to find out the percentage of survival after transplant recipients;
- compare figures from different transplant centers;
- ask what support groups they have available, and what kind of transport and housing conditions they offer to patients.
If the team to transplant (transplant - any organ, tissue, or portion of the body that are used for transplantation to replace the damaged parts of the body) considers you a good candidate for a liver transplant, then you will include in the list of pending transplant.
list and your place in the queue based on a number of factors.Key factors include:
- type your liver problems;
- how serious your illness;
- percentage probability that the transplant will be successful.
amount of time you spend waiting for their turn on the list, as a rule, is not a decisive factor in obtaining a fast liver (perhaps with the exception of children).
liver transplantation is not recommended for patients who have:
- Some infections - for example, such as tuberculosis or osteomyelitis;
- Difficulty taking medications several times a day throughout his life;
- Diseases of the heart, lungs, liver, or other life-threatening diseases;
- cancer of any organ;
- infection - such as hepatitis, are considered to be active;
- Smoking, alcohol or drug abuse.
risks and complications of liver transplantation
Risks for any anesthesia are:
- breathing problems;
- drug reactions;
Risks for any surgery are:
- a heart attack or stroke;
liver transplant and management after surgery carry major risks.There is an increased risk of infection because the patient has to take medicines to prevent rejection, which as a side effect, suppress the immune system.Signs of infection following:
Who can be a donor liver
Donor (from the Latin the donor, from dono - «I give" - an object who gives something to another object, called an acceptor or recipient;. In medicine - a person who gave his blood fortransfusions or organs for transplantation to another person - the recipient of blood or body), who died recently and had no liver damage.This type of donor is called a cadaveric donor.
Sometimes a healthy person can donate part of his liver to a patient who observed serious damage to this organ, incompatible with life.For example, someone from the parents can give part of his liver child, if any at all health indicators recognized as quite healthy (for example, it is contraindicated for transplantation of the human liver, even many years ago had undergone any of the types of hepatitis, or a human, suffering or sufferingwhen any of a blood disease, and so on).This type of donor is called a living donor.The liver - an organ that can regenerate, so the donor liver is restored to full size within a few weeks after surgery.This procedure gives excellent results for patients, but there are some risks to the donor.
Demands of living donor liver:
- Age 18 years or older.
- The donor should be a relative up to the 4th degree of kinship.
- Matching blood group of the donor and recipient.
- healthy structure and function of the liver and other donor systems.
donor liver is transported in chilled salt water or a special saline solution that ensures the safety and soundness of the body for up to 8 hours.In compliance with the donor and the recipient (from the Latin recipiens -. Receives, accepts, a person who transplanted organ, tissue or other body cells for the purpose of blood transfusion, transplantation of the heart, etc., the patient received a blood transfusion from a donoror undergo surgery organ transplant from a donor) will certainly carry out the necessary tests.One of the most important conditions for a match in both blood group and rhesus.Also take into account the individual characteristics of both organisms.For example, the donor liver should not be affected by alcohol.
healthy liver is removed from the donor's body through a surgical incision in the upper abdomen.The liver is transferred to the patient's stomach (called receiver), which needs it, and is attached to the blood vessels and bile ducts.The operation can take up to 12 hours.Often at the same time to the recipient must be a large amount of blood, which he receives through transfusion.
Preparing for liver transplantation
doctor refer you to a transplant center.A team of doctors doing liver transplants, certainly wish to make sure you are a good candidate for a liver transplant, and for this you have some time to visit the clinic for a few weeks or months.You will need to take a blood test and X-rays do.
If you get the liver, before the procedure you will be guided through the following tests:
- Pre-commissioning of tissues and blood donors to make sure that your body will not reject the tissue and the blood of the one who sacrificed for you his liver;
- Blood and skin tests to check you for possible infection;
- heart tests - ECG, echocardiography, cardiac catheterization, etc .;
- tests to find early cancer;
- tests that allow you to thoroughly examine your liver, gallbladder, pancreas, small intestine and blood vessels around the liver;
- Colonoscopy (depending on your age).
While you expect the liver, follow these steps:
- follow the diet, which can recommend transplant team;
- do not drink alcohol;
- do not smoke;
- keep your weight in the appropriate range, follow the exercise program that your doctor recommends;
- take all the medicines which you are registered;
- report any changes in relation to your intake of drugs and any new medical symptoms to transplant team together with your doctor can take the necessary measures and competently respond to all the appointments that have been made to you;
- make sure that the team for transplantation has all your phone numbers so they can contact you immediately as soon as you are for a healthy donor liver.Make sure that, no matter where you are, you can be contacted quickly and easily;
- all you must be prepared in advance, so you can at any time to go to the hospital.
usually surgery to liver transplantation takes between 4 to 12 hours.But the patients remain in the hospital for another two to three weeks after the operation, since such an operation is considered quite difficult.Most patients return to a normal or near-normal activity at 6 - 12 months after transplantation.Throughout his later life, patients must take immunosuppressive drugs.
- liver and the main functions of the liver
- main symptoms of liver disease
- Features toxic lesions
- liver Bilirubin: what is it?
- Diet in diseases of the liver and biliary tract
Life after liver transplantation
After receiving a liver donor you need to be kept under the supervision of your doctor.
transplant team who carried out the transplant donor liver to you, you can ask for the first three months after surgery to live as close as possible to the hospital.Also, for many years, you will have to undergo regular medical examinations, blood tests and X-rays to make a new, transplanted to you liver.
forecasts and prospects
human body, which are transplanted liver, could deprive the new body.That is, the new, the donor liver can not settle down in the body of the recipient.This means that his immune system perceives the new liver as a foreign body and tries to destroy it.
To avoid this rejection process, almost all the recipients for the sake of extending his life should take drugs that suppress their immune response and prevent rejection by the body to help someone else's liver.This is called immunosuppressive therapy.Thus, although the treatment helps prevent organ rejection, at the same time it puts people at higher risk for acquiring any kind of infection or cancer.
If you are using immunosuppressive medicine, you need to undergo regular screening (for early detection of diseases possible, which allows for early treatment, based on relief of patients and reduce mortality) for cancer.Also, these medications can cause high blood pressure, high cholesterol, increase the risk of developing diabetes.
successful transplant requires careful observation of your doctor.You should always take medication as directed.
According to statistics, the five-year survival rate after liver transplantation is about 75%.After liver transplantation, patients report improved quality of life and mental functioning.However, all patients in need of a healthy donor liver, should seek to find the best medical centers performing more than 50 transplants per year and giving the result of higher than average.
liver transplantation in patients with viral hepatitis
One of the main problems with the implementation of liver transplantation in patients with chronic (ie, not in the acute phase and in remission), hepatitis - viral relapse after transplantation.Repetition usually occurs with viral hepatitis C. However, relapses can occur with hepatitis B. Immunoglobulin HepaGam B is an approved health care in many countries the means to prevent the recurrence of hepatitis B and C after transplantation.Patients should receive periodic injections HepaGam B throughout his life.
liver transplantation for patients with primary biliary cirrhosis
Patients with primary biliary cirrhosis, in need of transplants - those who may suffer serious complications of portal hypertension (high blood pressure syndrome in portal vein caused by improper blood flowin portal blood vessels, hepatic veins and inferior vena cava, accompanied by an enlarged spleen, esophageal varices and gastric and hepatic encephalopathy, ascites, i.e., liver failure), and in which the poor quality of life and low survival without treatment.After transplantation, they have high survival rates.
liver transplantation for patients with autoimmune hepatitis
liver transplantation Prospects are also good for patients who suffer from autoimmune hepatitis, and who need a transplant.Survival - about 90% at 1 year after the operation and 70 - 80% - after 5 years after surgery.Rejection usually occurs only in those patients whose immune system is badly damaged.
liver transplantation for patients with alcoholism
Liver transplantation is usually not recommended in patients with an active addiction to alcohol or abusing drugs.