LIVER TRANSPLANT

The liver performs many critical functions, including the metabolism of drugs, the purification of the blood of foreign and so-called toxic substances (for example, the removal of ammonia and bilirubin from the blood), and the synthesis of many important proteins and enzymes (such as factors necessary for blood clotting). The liver is also the only organ in the body that can regenerate itself after most of it has been removed. In fact, more than half of the liver, which works like a factory in the body, can be removed from a donor for transplantation without impaired liver function or other serious damage. Since chronic liver failure is a major life-threatening health problem, liver replacement is the only option. A piece of liver taken from a living person or cadaver is implanted and the patient can regain a healthy life. However, it is very important that this procedure is performed by an experienced team in a fully equipped hospital.

WHAT IS A LIVER TRANSPLANT? 

A liver transplant is an operation that completely or partially replaces a patient's diseased liver with a healthy liver from another person.

A liver transplant is an operation that completely or partially replaces a patient's diseased liver with a healthy liver from another person.

Liver transplantation should be performed by an experienced team of specialists in a fully equipped hospital. Liver transplantation is not only a surgical procedure. For the preparation and post-transplant follow-up process, it is very important that the center's departments, from the operating room to the laboratory, from imaging units to intensive care, from inpatient floors to other branches, are of high quality and work together.

IN WHICH DISEASES IS LIVER TRANSPLANTATION PERFORMED?

The liver failure condition for which liver transplantation is performed occurs in two forms: acute and chronic.

Acute liver failure can develop over days and weeks. The most common causes are mushroom poisoning and the use of certain medications. Chronic liver failure can be caused by cirrhosis hepatitis B and C, biliary tract diseases, certain nutritional disorders, certain genetic diseases, excessive alcohol use, a hereditary problem called hemochromatosis (a disorder that causes the body to absorb and store too much iron) or metabolic diseases. In this case, liver transplantation can restore the person to a healthy life.

HOW IS A LIVER TRANSPLANT PERFORMED? 

Organ transplantation requires organs and the source of organs is people. Organs suitable for transplantation can be obtained from deceased people or from living donors among relatives of the patient. When relatives of people who have died in intensive care (brain death) decide to donate their organs, many patients' lives are saved with those organs. Liver transplantation using organs donated in this way is called “cadaveric liver transplantation”. Since the number of organ donations is not sufficient, most patients die while waiting for a new liver. As a solution to this, it is possible to save the patient's life by taking a part of the liver from another living person (it can be a relative of the patient). This is called living liver transplantation. For this purpose, a relative from the patient's own blood group volunteers for such an operation. The donor candidate undergoes intensive examinations and evaluations. If there is no impediment to donating liver, a part of the liver (right or left) that is suitable for the patient's weight is taken from the donor and the patient's liver is replaced.

The aim of liver transplantation is to return the person to a normal, active and productive life. Both the patient and the donor are aimed to return to their preoperative performance. Liver transplants performed in our center have reached numbers above the success rates accepted in the world.

FREQUENTLY ASKED QUESTIONS ABOUT LIVER TRANSPLANTATION 

What are the requirements to become a liver donor

• First of all, the donor must donate the liver of his/her own free will, without any pressure.
• People under 18 cannot be liver donors.
• The donor must be related up to the 4th degree. After 4th degree of consanguinity, ethics committee approval must be obtained from the Provincial Health Directorate.
• The blood type of the recipient and the donor must match.
• The donor must not have a history of systemic disease.
• The donor must have healthy liver and kidney function.
• The donor should not be over 60 years of age.

Who cannot have a liver transplant?

De nombreux patients souffrent d'une cirrhose et d'une maladie hépatique décompensée, mais tous ne sont pas des candidats appropriés pour une transplantation hépatique. Un patient doit être capable de se remettre d'une intervention chirurgicale et d'éventuelles complications postopératoires, de prendre de manière fiable des médicaments pour prévenir les infections, de se rendre régulièrement à des examens de contrôle, de se soumettre à des tests de laboratoire et de ne jamais s'engager dans des activités qui endommagent le foie. La transplantation hépatique ne peut être réalisée si une personne présente l'une des conditions suivantes

• People with alcohol or substance abuse
• Alkol veya madde bağımlılığı olan kişiler
• HIV patients
• Massive liver failure: Liver transplantation in a situation where brain edema is very extreme
• Severe, uncontrolled psychiatric patients
• Cancer that has spread outside the liver
• Severe pulmonary hypertension (mean pulmonary artery pressure greater than 50 mmHg)
• Systemic or uncontrolled infection
• Serious, irreversible medical illness that limits short-term life expectancy

What are the diseases for which liver transplantation is performed in children?

According to figures, 10 percent of liver transplants are performed by children. Turkey ranks first among the countries with the highest number of pediatric liver transplants in the world, sharing the first place with the UK. Liver transplantation in children is a delicate surgical procedure and good follow-up after transplantation is essential. Although many diseases affect the liver, not all liver diseases require transplantation. Diseases that damage the liver in children and may lead to transplantation include

Chronic End-Stage Liver Disease

• Biliary atresia
• Autoimmune Hepatitis / Sclerosing Hepatitis / Overlap syndrome

Liver-specific genetic/metabolic diseases

• Kronik karaciğer hasarına / yetmezliğine neden olu

Alpha-1 antitrypsin deficiency

Familial cholestatic syndromes e.g. PFIC1 2 or 3

Allagille syndrome

Cystic Fibrosis Liver Disease

Tyrosinemia

• Metabolic liver diseases lead to damage to other organs such as the brain and kidneys.

Urea cycle disorders

Lack of OTC

MSUD

Hyperoxaluria

Crigler-Najjar Syndrome

Glycogen Storage disease

Acute Liver Failure

• Viral hepatitis
• Hepatik İlaç toksisitesi (asetomenofin, NSAID’ler, diğerleri)
• Genetic / Metabolic diseases: Wilsons disease, disorders of fatty acid oxidation, some mitochondrial disorders
• Autoimmune Hepatitis
• Neonatal Hemochromatosis

Primary unresectable liver tumors

• Hepatoblastoma
• Sarcome embryonnaire
• Hemangioendothelioma
• Hepatocellular carcinoma

Can any liver be implanted in any person?

For liver transplantation, the blood groups of the patient and the donor must be compatible. Afterwards, the donor candidate is examined. This process consists of social, psychological and medical evaluations. Medical evaluation can be categorized as blood and urine tests, investigation of infectious diseases, radiological examinations and consultations with other medical units (cardiology, pulmonology, etc.). Many factors play a role in the realization of the surgery between the patient and the donor candidate, such as the amount of liver needed by the patient, the general health of the donor candidate, whether the liver can be divided appropriately, and the structure of the biliary tract.

Is liver transplantation risky?

This risk varies with the severity of the disease requiring liver transplantation. These patients are usually in very severe condition, with all reserves depleted. On the other hand, liver transplantation is one of the biggest operations known. “Heavy patient + major surgery” is the most important factor that increases the risks. In addition, the largest vessels of the body are cut and stitched during liver transplantation and serious unwanted bleeding from these vessels can occur. Sometimes the new liver may not work well in the body where it is implanted. In these patients with suppressed immune systems, infections can cause serious problems.

What is tissue rejection (rejection)?

Our body's immune system recognizes its own cells and does not react to them. However, when cells belonging to someone else (blood, organs...) enter the body, it immediately recognizes that these cells are foreign and takes up arms against them, seeking ways to remove the foreigner from the body. The body reacts in a similar way to microbes that enter the body. This reaction of the body that damages the transplanted organ is called tissue rejection (rejection). Tissue rejection is a reaction that can occur at any time in organ and tissue transplants and, if not recognized early and prevented, can cause the transplanted tissue or organ to become useless (dead). To prevent tissue rejection, transplant patients receive lifelong medication to minimize this effect of the immune system. This is called immunosuppression. Despite these medications, tissue rejection sometimes occurs. This can be recognized by the deterioration of the function of the newly implanted liver and the presence of signs of tissue rejection in the liver biopsy. Such an exacerbation is usually treated without any problems and everything returns to normal

Should liver transplant recipients take medication for life?

As with kidney transplant patients and all organ transplant patients, liver transplant patients are on medication to suppress the immune system for life. This is a basic condition for successful treatment. If the medication is not used or if it is used irregularly, the immune system immediately starts a war against this foreign organ, which may result in the loss of the organ or even life.