Liver transplantation

 Liver transplantation

Dr. Thomas Strzel, father of liver transplants, performed the first successful liver transplants, in 1968, in Denver Colorado, USA. In the early 80's, a new drug extracted from the fungus was introduced as a treatment - cyclosporine. The use of cyclosporine led to a three-fold increase in survival rate in patients who had liver transplantation, which called for a composite panel of experts called the National Health Center to approve liver transplants as a recommended treatment for patients with cirrhosis of liver in Its final stages.

Each year, more than 10,000 liver transplants are performed worldwide. The wave of increase in the number of annual liver transplants is currently limited due to the shortage of organs for transplantation. Liver transplantation is performed on patients suffering from terminal liver disease as a result of acute or chronic hepatitis. Chronic liver infections may lead to cirrhosis. These infections are caused by several factors:

Infection caused by hepatitis viruses (type B or C):

Hepatitis B - tends to re-infect the transplanted liver in 70% of cases, if no preventive treatment is given. Recurrence of the disease may cause loss of a transplanted organ. To prevent recurrence of the disease, the patient receives a passive immunization, in addition to an anti-viral medicine - Lamivudine, a drug that inhibits the replication of the virus. This combination prevents recurrence of the disease in 90% of patients.

Hepatitis C virus - the rate of disease recurrence after the procedure is 80% -90%. No immunization for this virus reaction has yet been developed. Recurrent disease in a transplanted organ is mild in most patients. In some of them, the disease may progress to cirrhosis after 5-10 years.

Addiction to alcohol:

The world's leading cause of terminal liver disease and the need for a liver transplant.

Other factors that can cause terminal liver disease include: medication, genetic factors, autoimmune diseases, damage to the bile ducts inside and outside the liver, fat accumulation in liver cells and primary liver cancer.

Patients with terminal liver disease (cirrhosis) should be sent to organ transplantation centers immediately when complications related to liver disease arise, such as secondary bleeding that comes from the upper digestive system, fluid accumulation in the abdominal cavity (ascites) and brain damage due to accumulation. Toxins.

The surgery is divided into three stages: removing the patient's liver, connecting the new liver to the blood vessels, and connecting the bile ducts.

The treatment that is given after surgery aims to reduce infection, and mainly includes treatment with drugs designed to prevent rejection of the transplanted organ. They suppress the immune system and thus prevent rejection of the transplanted liver. Medicines such as cyclosporine and tacrolimus suppress the immune system and are given to the patient throughout the life of the transplanted organ. Steroids may be added to it, which also aims to prevent transplant rejection.

Medicines that suppress the immune system have many side effects: kidney toxicity, high blood pressure, neurological symptoms, high blood lipid levels and diabetes.

The life rate of a transplanted organ reaches 80% - 90%, and the death rate may reach 10% in adults in the first year. After that the average annual death rate is around 3% per year. Five years after surgery, the survival rate is 70%.

Over the past decade, methods have been developed to transplant a liver lobe from a living donor, which is either an adult donor or an adult donated to an adult. While a child requires about a third of an adult's liver, an adult requires half of the liver. The survival rate of a transplanted organ in the future is high and reaches about 80% - 90% in the first year.

Another method developed to overcome severe organ shortages is to perform two simultaneous transplants from the same donor, with a method called split-liver transplantation. According to this method, a liver from a dead donor is split into two parts: the left lobe is implanted in a child, while the right lobe is implanted in the body of an adult.

A liver transplant is not performed in the following cases:

 Active infectious disease, carcinogenic disease outside the liver, pulmonary hypertension, severe heart or lung disease, and active infection with HIV.

The age of candidates for liver transplantation should not exceed 65 due to the limited number of donors. As for the age of donors, it has been shown that it is possible to benefit only from the livers of those under the age of 60. In recent years there has been an increase in the number of patients waiting for a liver transplant in the world, and there is also an increase in the waiting period for transplantation.

To perform a liver transplant, it is necessary to have a match in blood type and liver size between the donor and the recipient. Implant quality is a major factor affecting the success of the surgery. Liver transplantation is a combined procedure due to the physiological changes that result from liver disease that occur during the stage of surgery when there is no liver.

Possible immediate complications from a liver transplant:

General bacterial infection, acute rejection of transplantation, viral infection, thrombosis and occlusion of blood vessels in areas where connections were made and bile ducts leakage.

Complications that appear at a late stage, include:

Viral and fungal infection, recurrence of primary disease in transplantation, chronic and acute transplant rejection, narrowing of the bile ducts, emergence of benign and malignant tumors, rapid arteriosclerosis as well as cerebrovascular accident (CVA).