Gastroenterology

Liver Transplantation Treatment

Hepatic Transplantation

Liver transplantation is the therapeutic option of choice for acute and chronic end-stage liver disease. A liver transplant is considered when the liver no longer functions adequately (liver failure). Liver failure can happen suddenly (acute liver failure) as a result of viral hepatitis, drug-induced injury or infection.

What is Liver Transplantation?


Liver is the largest organ of our body. It helps in digesting food, storing energy, and removing poisons from our body. If our liver fails, we can approach our doctor for treatment. Doctors do liver transplants when other treatments can’t keep a damaged liver working. 
A liver transplant is an operation that replaces a patient's diseased liver with a healthy liver from another person.

 

Liver Anatomy and Function

The liver is an essential organ. The liver serves many critical functions including metabolism of drugs and toxins, removing degradation products of normal body metabolism and the synthesis of many important proteins and enzymes.
Blood enters the liver from two channels, one of them is the hepatic artery and the other is the portal vein, bringing nutrients and oxygen to liver cells. Blood leaves the liver via the hepatic veins which drain into the inferior vena cava which enters the heart immediately. The liver forms bile, a liquid that helps dissolve fat and eliminate metabolic waste and toxins via the intestine. Each hepatocyte makes bile and discharges it into microscopic channels that join to form bile ducts

Who Needs a Liver transplant?

Liver transplantation surgically replaces a failing liver with one that is healthy. At this time, transplantation is the only cure for liver insufficiency or liver failure because no device or machine can reliably perform all of the functions of the liver. People who require liver transplants usually have one of the following conditions.
Acute Liver Failure
Acute liver failure, also known as a fulminant hepatic failure, occurs when a healthy liver suffers a massive injury resulting symptoms of liver insufficiency. Any number of things can lead to acute liver failure but the most common causes are acetaminophen overdose, viral infections, ingestion of a toxin such as poisonous mushrooms.
Chronic liver failure/ Cirrhosis
The liver has a unique ability to repair itself in response to injury. Cirrhosis is a situation when scar tissue replaces healthy liver tissue. This stops the liver from working normally. Cirrhosis is a long-term (chronic) liver disease. The damage to your liver builds up with time.


Causes of Chronic Liver Injury 

Viral Hepatitis
•    Hepatitis B: Hepatitis B infection scores for 5% of liver transplants performed in the United States of America.
•    Hepatitis C: This is the most common virus resulting in liver transplantation in the United States, affecting nearly 50% of all liver transplant recipients.
Alcoholic Liver Disease
Liver failure due to high alcohol abuse is the second most common indication for liver transplantation.Page Image
Genetic Liver Disease
•    Hemochromatosis: It is excess iron deposition in the liver
•    Wilson's disease: It is abnormal copper metabolism 
•    Glycogen storage disease: It is an inherited metabolic disorder
•    Tyrosinemia: It is a disorder of tyrosine metabolism

Who Are Not Candidates for a Liver Transplant?

There are many people with liver disease (who want a liver transplant) but not all are appropriate candidates for liver transplantation. A patient must be able to survive the operation and the potential post-operation difficulties and must take the medicines that prevent rejection and infections and frequently visit a clinic and have laboratory tests, and not engage in activity that would injure the liver in any way, such as drinking alcohol. The conditions listed below are generally considered to be absolute contra-explanations to liver transplantation.
•    Severe medical illness that limits short-term life expectancy
•    Cancer outside of the liver
•    Uncontrollable infection 
•    Alcoholic or Drug addict
•    Severe, uncontrolled psychiatric disease

Types of Organ Donors

Brain dead organ donors
Most livers which used for transplantation are obtained from patients that are brain dead. Brain death is usually due to a stroke or trauma to the head from blunt injury. The trauma has stopped all the brain functions although other organs including the liver may continue to function normally.
Cardiac death organ donors
Sometimes a patient suffers a devastating brain injury and carries a dull neurological prognosis but fails to meet the strict proof defining brain death in that there is still detectable brain function. In these circumstances, the patient's family may decide to withdraw medical support with the intention of allowing the patient to die. In this scene, death is not defined by brain death but rather cardiac death. Organ donation can be performed after cardiac death but, again, only if the family gives consent.
Living Donors
Each person has only one liver and would die without it functioning, it is possible to donate a part of the liver for transplantation into another person. The segmental anatomy allows surgeons to create grafts of varying size, depending upon the recipient's requirement for liver tissue. The partial livers in both the persons, donor, and the receiver will grow again to provide a normal liver function for both individuals.

The Liver Transplant Operation
A liver transplant involves the removal of the liver from donor and removal of the diseased liver from the patient and implanting the new organ. The liver has several connections that must be re-established for the new organ to receive blood flow and to eject bile from the liver. The exact method of connecting these structures varies depending on donor and anatomy or the patient’s anatomic issues and, in some cases, the patient’s disease.

Rejection

Rejection in medical science is a term that is applied to organ dysfunction caused by the patient’s immune system reacting to the transplanted part. Injury to the liver is usually mediated by immune cells. Rejection typically causes no symptoms; patients do not feel anything different. The first sign is usually abnormal laboratory test results. A liver biopsy is performed when rejection is suspected. The tissue is analysed and inspected under the microscope to determine the pattern of liver injury and also to look for the presence of immune cells.
Acute cellular rejection occurs in about half of all liver transplant patients within the first year after transplantation with the highest risk period within the first four to one and a half month of transplantation. Once the patient is diagnosed, treatment is generally very effective. The first line of treatment is usually high dose corticosteroids.
The second step of rejection treatment is the preparation of strong antibodies. This is believed that the liver has the unique ability to regenerate itself.
Chronic rejection occurs in 7% all transplants. The strongest risk factor for the development of chronic rejection is repeated acute rejection or refractory acute rejection. Liver biopsy shows loss of bile ducts and annihilation of small arteries.

Outcomes

Usually, outcomes of liver transplantation are good, but outcomes vary significantly depending on the indication for liver transplant as well as factors associated with the donor and acceptor. The overall patient survival one year after liver transplant is 89%. Patient survival five years after liver transplant is 75%.
 

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