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Because Liver Means Life

By Author: Masuma Linjavi
Total Articles: 54

In a Liver Transplant Surgery, the malfunctioning liver of the patient is replaced by a healthy liver from the donor. Organ transplant is the last resort for the treatment of an ailment. Only well trained Hepatobiliary surgeons and associated medical team are licensed to perform the operation. Depending upon the complication level and severity, surgery can take as long as 18 hours or may be wrapped up in 4 hours.

What are the TYPES of liver transplant?

A healthy, functioning liver can be harvested from a brain dead donor for the same purpose. This is known as Cadaveric or Deceased Donor Liver Transplantation. However, a large majority of liver transplants use a portion of the liver from a living donor for the transplant since the liver has a high regenerative property. This is known as Living Donor Liver Transplantation.

A major advancement in pediatric liver transplantation was the development of reduced size liver transplantation, in which only a portion of an adult liver is used for an infant or small child.
In Split liver transplantation, one donor liver is used as a transplant for two recipients. In children, 20% of donor's liver is used. Both of these techniques are attributed to the high regenerative (full growth from a small portion) capacity of the organ.

Auxiliary Liver Transplant uses a partial left or right lobe from the donor which acts as temporary support for the recipient's injured liver, which remains in place. Once the native liver recovers, immunosuppression is withdrawn and the graft is either surgically removed or is allowed to atrophy (wilt, die and dissolve) naturally.

Furthermore, only the portion or the lobe of the liver affected by a tumor or any other complication may surgically be removed while the healthy section remains in the patient's body. This has sped up the recovery process and shortened the patients' stay in the hospital by 5 to 7 days.

Another option is receiving a liver from a donor after cardiac death (DCD). This is a person who has suffered devastating and irreversible brain injury and may be near death but does not meet formal brain death criteria. In these cases, the family has decided to withdraw care. When the patient's heart stops beating, the organs are recovered for the purpose of donation.

Liver cell transplantation is an emerging procedure, consisting of infusing mature adult hepatocytes in the portal system of the recipient. It aims to correct inborn errors of liver metabolism, bridge unstable patients to transplantation, or even allow a bridge to recovery in fulminant liver failure.

What are the RISKS involved?

Bile duct leaks, internal bleeding and clotting, rejection and mental confusion are some of the risks associated with Liver Transplant. Or in the long run, the underlying liver disease may recur in the new liver under certain circumstances. Moreover, the immunosuppressive medications given to the patient to promote acceptance of the new organ by the body given to the patient may cause allergies. These anti rejection medications can cause a variety of side effects, including Bone thinning, Diabetes, Diarrhea, Headaches, High blood pressure and High cholesterol
Because anti rejection drugs work by suppressing the immune system, they also increase the risk of infection. Hence, antibiotic treatment may be needed often.

A generally accepted range of the risk of dying as a result of a living donor liver segment removal is between 0.2 to 2.0%, based on currently available literature. The risk of mortality is less in transplant centers with impeccably experienced and trained hepatologists and hepatobiliary surgeons. Hence, consider availing treatment from a center where patient inflow is high.

What after the surgery? POST-OPERATIVE CARE

After the transplantation is done, allograft function, airway, breathing and neurological functions are tested. The patient is checked for the presence of active bleeding. Reversibility of anesthesia is noted. Certain diagnostic tests like coagulation profile, liver enzymes, biochemical profile and drug level assessment are performed.

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