What is the indication of liver failure?
It does not usually give any symptoms in early periods, as the disease progresses, fatigue, loss of appetite, nausea and vomiting, jaundice (deep and swollen eyes), weakness, weight loss, fluid accumulation in the legs and abdomen, increased tendency to bleeding and itching can be seen. As the disease progresses and damage increases, the liver begins to fail to clear blood and body wastes and many drugs accumulate in the body. These toxic substances that increase are accumulated especially in the brain and personality-behavior changes, blurring of consciousness, forgetfulness and sleep irregularities, and at last stage loss of consciousness and coma may develop.
What is the diagnosis and treatment of liver failure?
Cirrhosis, chronic liver failure is a progressive disease. Damage from illness when the disease cannot be cured can be stopped or slowed down with some treatments. Various biochemical tests are performed with the aim of evaluating liver functions. In addition, the structure and veins of the liver are examined by imaging methods such as ultrasonography, computed tomography or MRI. Sometimes even a biopsy can be done to confirm the diagnosis of cirrhosis. In situations that cannot be cured by the means of modern medicine, it is imperative that the organ, which cannot function with liver transplantation, be replaced with a new liver. Nowadays, with a better understanding of the liver anatomy, the progress of medical and surgical treatments, if liver transplants done in time are made with 80-90% success rate.
What diseases are treated with liver transplantation?
Liver transplantation is mainly treated with the following diseases, but there are also less frequent indications.
• Chronic liver disease (B and C due to diseases such as hepatitis, alcohol and biliary cirrhosis)
• Acute liver failure (due to fungal and drug poisoning)
• Unresectable liver tumor (hepatocellular sarcoma) and some benign tumors
• Some metabolic diseases (especially in childhood)
• Severe liver injury
• Parasitic enfestations
In which stage do people need liver transplantation?
First of all, all patients with liver cirrhosis should be evaluated for transplantation.Whether the patient is appropriate for transplantation or following up are determined with some tests and conclusions obtained as a result of examinations by specialist physicians who are interested in the liver. The severity of chronic liver failure is classified between A and C and consequently B and C are considered suitable for transplantation. It is also present in patients who are in stage A and are suitable for transplantation (tumor or variceal hemorrhoids, etc.). However, it should not be forgotten; the better the condition of the patient during transplantation, the better the transplant operation is.Therefore, timing is very important and it is necessary not to be late for transplantation. In cirrhotic patients who have a high rate of losing their lives, a timely transplant surgery with an appropriate liver opens the way to survival with 80-90% success.
Who can be the liver donor?
For patients who were decided for a liver transplant, the necessary organ must be primarily through donated organs after brain death. However in the cases that demand was not met by donating after death - unfortunately in our country, many of the patients on the waiting list lose their lives because our donation rate is rather low - as in the other transplantations, there are livelihood transfers from relatives up to the fourth degree. 70% of the livers of live donors selected from fully healthy individuals can be taken to be transferred. There are advantages like the live donors and patients have a short waiting time, transplantation of the most suitable organ and performing of the operation in the most suitable place and time.
How long does liver transplant surgery last?
After all the preparations have been made, time varies depending on many factors. In live transmissions, the receiver and transmitter are operated hin separate rooms by separate teams, it is completed almost in the same time as cadaver transplants, takes an average of 4-5 hours. The one-year survival rate is almost the same in live and cadaveric transplants. However, in live-donor transplants, the rate of bile complication is 5% compared to 20%.
What should be considered after transplanting the liver?
Liver transplant recipients are using immunosuppressive drugs and medicines to protect against certain infections after surgery. Not to use of these medicines leads to serious problems. In the first months when the risk is highest after the transplantation, the patients are closely monitored at the transplantation centers. These frequent follow-up intervals are then extended. Patients can easily reach their daily needs at the end of about 1 month and provide their own needs.
Prof. Dr. Ayhan Dinckan
Yeni Yuzyil Gaziosmanpasa Hospital, Head of Organ Transplantation Department