Know more about Liver Transplantation part-2

Liver Transplant

The liver has many functions, including building proteins and other substances for the body to use, removal of waste products and toxins from the blood drug metabolism and Energy storage. Liver disease causes these crucial functions to fail and when the failure is too severe to respond to medication liver transplantation may be an option.

What are the likely complications following a liver transplant?

Minor wound infection and discharge of liquefied fat is seen in about 10% of people.This will settle with little or no intervention. Major wound infection needing another surgery is extremely rare.

By now you are aware that liver transplantation involves making a lot of connections. There is an extremely small chance that these connections can become too tight or too loose. We have a very highly trained team of doctors who are able to treat them with minimally invasive techniques without resorting to another surgery.

Hepatic Artery Thrombosis (HAT) / clotting of the hepatic artery is a rare complication seen in less that 4% of the patients and portal vein thrombosis is even rarer and is seen in less than 1% of the patients. When identified, the clot will have to be removed and it will involve another surgery. In spite of all this, if we are not successful, re-transplantation will be necessary.

What is rejection?

Rejection occurs when your body’s natural defenses, called the immune system, damage the new liver. Your immune system keeps you healthy by fighting against things that don’t belong in your body, such as bacteria and viruses. After a transplant, it is common for your immune system to fight against the liver and try to destroy it.

How is rejection prevented?

To keep your body from rejecting the new liver, you will have to take medicines. These drugs such as tacrolimus, cyclosporine, steroids, sirolimus and mycophenolate mofetil are called immunosuppressants. Immunosuppressant’s weaken your immune system’s ability to reject your new liver.

Prevention

Do immunosuppressants have any side effects?

Yes. You can get infections more easily because these drugs weaken your immune system. You will need to stay away from people who are sick. These drugs may also increase your blood pressure, cause your cholesterol to rise, cause diabetes, weaken your bones and may damage your kidneys in the long run. Steroid drugs may also cause changes in how you look by causing weight gain. Your doctor and the transplant team will monitor these effects and treat you for any complications that may occur.

What are the signs of rejection?         

Doctors will check your blood for liver enzymes at the first sign of rejection. Often rejection does not make you feel ill. Sometimes rejection can cause — pain, fever, jaundice and changes in liver function tests. Often a liver biopsy is needed to diagnose rejection. For a biopsy, the doctor takes a small piece of the liver to examine under a microscope. Blood tests will show if the new liver is being rejected.Liver TissueLiving-DONOR TRANSPLANTATION What is a living donor liver transplant?

A living-donor transplant is when someone who is alive gives a part of his or her liver to a person who needs a transplant. Family members, such as parents, sisters, brothers, adult children or someone close, such as a spouse, may offer to give part of his or her healthy liver. This can be done because a healthy liver can grow new tissues. After the transplant, the liver parts of both the donor and person in need will grow and form complete organs.

How did living-donor liver transplantation begin and how common is it?

Living-donor transplants were first done in children because of the long waiting period for cadaver organs and increasing death rate on the list. It was done in children in the 1980s and is now being done in adults for the last 8 years. In India, because of a relative lack of cadaveric organs, the majority of transplants are done using living donor organs.

Liver Transplantation

What are the benefits of living donor liver transplantation?

The best reason for a living-donor transplant is that it shortens the waiting time for a liver. The timing of the surgery can be planned. The chance for a successful transplant is increased. Today, thousands of patients await liver transplantation but only a handful cadaveric organs become available every year. A living-donor transplant gives those in need an early transplant before their liver failure gets worse and their lives are in danger.

Who can become a donor?

People who want to be liver donor are carefully checked to ensure that they can

safely give a part of their liver and that their liver is healthy. The first concern is the safety of the donor as well as being sure that the graft will work for the person in need. The risks to the donor are real. Discuss this with your doctor. In general, liver donors must:Liver

There should be no pressure of any kind on a person to donate part of his liver nor should there be any money given or received.

What are the major risks in donating?

As with any major surgery, there will be pain from the incision, which will get better with time. Other risks to the donor include bleeding, infection and temporary bile leaks. Fatalities in transplantation have been reported from certain transplant centers in the world but it is rare. Most have full recoveries and are healthy. Discuss regarding risk to the donors with your transplant surgeon.

What happens during donor surgery?

The incision is in the shape of a mirror image of ‘L’. The gallbladder is always removed. The donor’s liver is split into two parts. One part is removed for the transplantation. The surgeon then closes the wound with sutures and staples. These are later removed at a follow-up visit to the surgeon’s office. The liver begins to heal and grow new tissue. It takes about 8-12 weeks for the liver to grow back to its normal size. are the donor organ options that are used for transplantation in children?

  • Reduced-size liver graft: A piece of liver is taken from a brain-dead person (cadaver donor).
  • Living-donor transplant: A piece of a liver comes from an adult living donor and is used as a transplant for a child. Over the past 10 years, nearly 1000 of these transplants have been done throughout the world. They have been just as successful as transplants of whole organs. There are some risks of adult donation for transplant to a child. These risks seem to be much smaller than the risks of a living donor transplant to an adult.

Are there technical problems in doing a transplant on a child?

Yes. It is a little more difficult because the blood vessels are very small. Also, the care after surgery must be done in ICUs that can handle such small children.

Do children get the same anti-rejection drugs as adults?

In general, children get the same type of drugs that adults get. However, children may have different side effects. Therefore, only doctors who specialise in this field should handle the follow-up of children after transplants.

What makes a transplant successful?

First, you must have good medical care. Then, families and patients should make every effort to keep in touch with their medical teams. Children who get liver transplants will need to take drugs on schedule, see their doctor often and may need more procedures. All this will help to make transplants successful and will help to give long and healthy lives to the children. So make sure you stay in touch with your transplant team and follow their advice. Ask for counseling when you have any problems.

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