Definition
The removal of a diseased liver and replacement with a healthy liver from a donor who has died. In some cases, a portion of the liver of a living, related donor may be used.
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Parts of the Body Involved
* Abdomen
* Liver
* Blood vessels and bile ducts attached to the liver
Reasons for Procedure
A liver transplant is done to treat end-stage liver failure, which may be caused by:
* Cirrhosis
* Hepatitis A , B , and C ; autoimmune causes
* Alcoholic liver disease
* Primary biliary cirrhosis
* Primary sclerosing cholangitis
* Acute liver failure
* Congenital defects (such as biliary atresia)
* Liver tumors ( cancerous or benign)
* Metabolic defects (such as Wilson's disease)
* Poisoning or drug-induced damage
Risk Factors for Complications During the Procedure
* Infancy
* Smoking
* Obesity
* Poor nutrition
* Recent or chronic illness
* Use of certain medications
* Serious heart, lung, or kidney disease
* Diabetes
* Cancer
* Infection ( osteomyelitis , tuberculosis )
* Liver disease caused by alcoholism
What to Expect
Prior to Procedure
Because of a shortage of donors, you may be on a transplant list for some time. You may need to carry a pager or cellular phone at all times so that the transplant team can reach you if a donor liver becomes available.
Your doctor will likely do the following:
* Physical exam
* Blood test
* Chest x-ray
* Electrocardiogram (ECG, EKG) -a test that records the heart's activity by measuring electrical currents through the heart muscle
* Possibly other tests
The days before and the day of your procedure:
* Do not take aspirin or other anti-inflammatory drugs for one week before surgery, unless told otherwise by your doctor. You may also need to stop taking blood-thinning medications. Examples include clopidogrel (Plavix), warfarin (Coumadin), or ticlopidine (Ticlid). Talk to your doctor.
* Your stomach must be empty prior to surgery, so do not eat or drink anything after midnight, or once you learn a liver is available.
* You may be given an enema to clean out the intestines and prevent constipation following surgery.
* Your chest and abdomen will be shaved to prevent infection.
During Procedure
* IV fluids and medications, sedative, and anesthesia will be administered
* A tube will be inserted to help you breathe
Anesthesia
General anesthesia is used for a liver transplant.
Description of the Procedure
The surgeon makes an incision shaped like a boomerang on the upper part of the abdomen. The old liver is removed, leaving portions of major blood vessels in place. The new liver is inserted and attached to the blood vessels and bile ducts. To help with bile drainage, a tube will also be inserted in the bile duct during surgery. The skin is closed with stitches.
After Procedure
You'll be closely monitored in the intensive care unit, and will have the following devices:
* Breathing tube until you can breathe independently
* IV fluids and medication
* Bladder catheter to drain urine
How Long Will It Take?
The surgery will take several hours.
Will It Hurt?
Anesthesia prevents pain during surgery. You'll likely experience pain during recovery but you will receive drugs to relieve this discomfort.
Possible Complications
* Rejection of transplanted liver
* Excessive bleeding
* Infection
* Bile-duct obstruction or leakiness
* Allergy to anesthesia
* Complications from the antirejection drugs that must be taken for life after such a transplant (such complications can include severe infection, cancer)
* Blood clots in the major arteries
* Neurological complications, such as seizures
Average Hospital Stay
This varies and can be several weeks.
Postoperative Care
* At first you will receive fluids and nutrition intravenously, but will eventually be transitioned to a normal diet.
* You will receive physical therapy to regain muscle strength.
* Once home, you may be directed by your doctor to monitor your temperature, blood pressure, pulse, and weight.
* You will have regular follow-up visits for check-ups and lab tests.
* You will be started on drugs to suppress your immune function and therefore decrease the risk that your body will reject your new liver.
* You may be prescribed a special diet to prevent water retention and to maintain a normal weight and blood pressure.
Outcome
Recovery time varies and may depend, in part, on your overall health before the transplant. Most patients are able to return to normal or near-normal activities 6 to 12 months after transplantation.
To reduce the chance that your body will reject the donor liver, you will need to take immunosuppressive drugs for the rest of your life. These medications have potential side effects, so be sure to discuss special precautions with your doctor.
Call Your Doctor If Any of the Following Occurs
* Signs of infection, including fever and chills; you are more susceptible to infections while taking immunosuppressive medications
* Redness, swelling, increasing pain, excessive bleeding, or discharge from the insertion site
* Cough, shortness of breath, chest pain, or severe nausea or vomiting
* Cough that produces a yellowish or greenish substance
* Dry cough that continues for more than one week
* Prolonged nausea, vomiting, or diarrhea
* Inability to take prescribed medication
* Bruising
* Black stools
* Red or rusty-brown urine
* A rash or other skin changes
* Pain, discharge, or swelling at the site of the drainage tube
* Vaginal discharge, in women
* Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
* Exposure to mumps, measles, chickenpox, or shingles
* Unusual weakness or light-headedness
* Illness that requires emergency room treatment or hospitalization
RESOURCES:
American Liver Foundation
http://www.liverfoundation.org
United Network for Organ Sharing
http://www.transplantliving.org
CANADIAN RESOURCES:
Canadian Liver Foundation
http://www.liver.ca/Home.aspx
Toronto General Hospital
http://www.torontotransplant.org/patients/liver.cfm
References:
American Liver Foundation website. Available at: http://www.liverfoundation.org. .
Gee I, Alexander G. Liver transplantation for hepatitis C virus related liver disease. Postgrad Med J . 2005;81:765-771.
Liu CL, Fan ST. Adult-to-adult live-donor liver transplantation: the current status. J Hepatobiliary Pancreat Surg . 2006;13: 110-6.
Liver Transplant Program and Center for Liver Disease, University of Southern California website. Available at: http://www.surgery.usc.edu/divisions/hep/index.html .
Luu L. Liver transplants (June 30, 2006). eMedicine website. Available at: http://www.emedicine.com .
Neuberger J. Developments in liver transplantation. Gut . 2004;53:759-68.
O’Grady JG. Liver tansplantation alcohol related liver disease: (deliberately) stirring a hornet’s nest! Gut . 2006;55: 1529-31
Liver Transplant Procedure
