Liver Transplant
By Must4care
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Liver transplantation or hepatic transplantation is the replacement of a diseased liver with the healthy liver from another person (donor)(allograft). Liver transplantation is a treatment option for end-stage liver disease and acute liver failure, although availability of donor organs is a major limitation. The most common technique is orthotopic transplantation, in which the native liver is removed and replaced by the donor organ in the same anatomic position as the original liver. The surgical procedure is complex, requiring careful harvest of the donor organ and meticulous implantation into the recipient. Liver transplantation is highly regulated, and only performed at designated transplant medical centers by highly trained transplant physicians and supporting medical team.
Liver transplantation surgically replaces a failing or diseased liver with one that is normal and healthy. At this time, transplantation is the only cure for liver insufficiency or liver failure because no device or machine reliably performs all of the functions of the liver. People who require liver transplants typically have one of the following conditions. •
Acute Liver Failure •
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Acute liver failure, also known as fulminant hepatic failure, occurs when a previously healthy liver suffers massive injury resulting in clinical signs and symptoms of liver insufficiency. Any number of things can lead to acute liver failure but the most common causes are acetaminophen (Tylenol®) overdose, viral infections (known or yet unknown virus),
Chronic Liver Failure •
The liver has a remarkable ability to repair itself in response to injury. Nevertheless, repeated injury and repair, typically over many years and even decades, scars the liver permanently. The end stage of scarring is termed cirrhosis and corresponds to the point where the liver can no longer repair itself.
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Gastrointestinal Bleeding •
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Fluid Retention •
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In liver failure, low albumin levels force fluid out of the bloodstream, which cannot be re-absorbed. Fluid therefore accumulates in tissues and body cavities, most commonly, in the abdominal cavity, which is termed "ascites.
Encephalopathy •
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As the liver becomes increasingly scarred, the resistance to portal blood flow increases leading to increased pressure in the portal venous system. This portal hypertension necessitates alternative routes for blood to return to the heart
Failure of the liver to clear ammonia and other toxins from the blood allows these substances to accumulate. These toxins result in cognitive dysfunction that ranges from disturbed sleep-wake cycle patterns to mild confusion to coma.
Jaundice •
In liver failure, bilirubin is not cleared from the body and bilirubin levels increase in the blood. The skin and all tissues of the body will then assume a yellow color.
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Viral Hepatitis Hepatitis B: Hepatitis B infection accounts for 5% of all liver transplants performed in the United States but accounts for a larger proportion of liver transplants in other parts of the world, especially Asia and Australia / New Zealand. • Hepatitis C: This is the most common indication for liver transplantation in the United States, affecting nearly 50% of all liver transplant recipients. •
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Alcoholic Liver Disease •
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Liver failure due to alcohol abuse is the second most common indication for liver transplantation in the United States.
Metabolic Liver Disease •
Non-alcoholic steatohepatitis (NASH): Deposition of fat within liver cells may result in inflammation that injures and scars the liver.
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Autoimmune Liver Disease • • •
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Autoimmune hepatitis (destruction of the liver by the patient's own immune system) Cholestatic Liver Diseases Primary Biliary Cirrhosis (PBC) (destruction of small bile ducts within the liver) Primary Sclerosing Cholangitis (PSC) (destruction of bile ducts inside and outside the liver). Seventy percent of patients with PSC also suffer from ulcerative colitis, an autoimmune disorder of the colon. Neonatal sclerosing cholangitis (infection and scarring of the bile ducts in the liver of an infant) Biliary atresia (absence of bile ducts outside the liver) Caroli's disease (abnormality of the bile ducts within the liver)
Genetic Liver Disease Hemochromatosis: excess iron deposition in the liver • Wilson's disease: abnormal copper metabolism • Tyrosinemia: a disorder of tyrosine metabolism •
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Vascular Liver Disease •
Budd-Chiari syndrome is thrombosis (clotting) of the hepatic veins which leads to poor blood flow though the liver
Donor & Receiver (Patient) Most Essential thing of Liver Transplant.
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Brain Dead Organ Donors •
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Cardiac Death Organ Donors •
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Most livers used for transplantation are obtained from patients that are brain dead. Brain death is usually due to a large stroke or massive trauma to the head from blunt injury (for example, impact to the head from a motor vehicle or a motorcycle accident) or penetrating injury Sometimes a patient suffers a devastating brain injury and carries a dismal neurological prognosis but fails to meet the strict criteria defining brain death in that there is still detectible brain function. In these circumstances, the patient's family may decide to withdraw life-sustaining medical support with the intention of allowing the patient to die
Living Donors •
Although each person has only one liver and would die without it, it is possible to donate a portion of the liver for transplantation into another individual. The segmental anatomy (see figure below) allows surgeons to create grafts of varying size, depending upon the recipient's requirement for liver tissue. The partial livers in both the donor and the recipient will grow to provide normal liver function for both individuals
A liver transplant involves the removal of and preparation of the donor liver, removal of the diseased liver, and implantation of the new organ. The liver has several key connections that must be re-established for the new organ to receive blood flow and to drain bile from the liver. The structures that must be reconnected are the inferior vena cava, the portal vein, the hepatic artery, and the bile duct. The exact method of connecting these structures varies depending on specific donor and anatomy or recipient anatomic issues and, in some cases, the recipient disease •
Surgical Complications •
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As with any surgical procedure, complications related to the operation may occur, in addition to the many possible complications that may happen to any patient who is hospitalized Hepatic artery thrombosis Portal vein thrombosis or clotting of the large vein Biliary complications Bleeding
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Immunosuppression
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Rejection