Liver Transplant

The liver is the body's largest internal organ, weighing about 3 pounds in adults. It is located below theLIVER TRANSPLANTATION diaphragm on the right side of the abdomen.

The liver performs many complex functions in the body, including:

Produces most proteins needed by the body.
Metabolizes, or breaks down, nutrients from food to produce energy, when needed.
Prevents shortages of nutrients by storing certain vitamins, minerals and sugar.
Produces bile, a compound needed to digest fat and to absorb vitamins A, D, E and K.
Produces most of the substances that regulate blood clotting.
Helps your body fight infection by removing bacteria from the blood.
Removes potentially toxic byproducts of certain medications.

Reasons

Liver transplantation is considered when the liver no longer functions adequately (liver failure). Liver failure can occur suddenly (acute liver failure) as a result of infection or complications from certain medications or it can be the end result of a long-term problem. The following conditions may result in liver failure:

Chronic hepatitis with cirrhosis.
Primary biliary cirrhosis (a rare condition where the immune system inappropriately attacks and destroys the bile ducts causing liver failure).
Sclerosing cholangitis (scarring and narrowing of the bile ducts inside and outside of the liver causing the backup of bile in the liver which can lead to liver failure).
Biliary atresia (malformation of the bile ducts).
Alcoholism.
Wilson's disease (a rare inherited disease with abnormal deposition of copper throughout the body, including the liver, causing it to fail).
Hemochromatosis (a common inherited disease where the body is overwhelmed with iron).
Alpha-1 antitrypsin deficiency (an abnormal accumulation of alpha-1 antitrypsin protein in the liver, resulting in cirrhosis).
Liver cancer.

Candidates for Liver Transplant

Evaluations by specialists from a variety of fields are needed to determine if a liver transplant is appropriate. The evaluation includes a review of your medical history and a variety of tests. Many healthcare facilities offer an interdisciplinary approach to evaluate and to select candidates for liver transplantation. This interdisciplinary healthcare team may include the following professionals:

Liver specialist (hepatologist).
Transplant surgeons.
Transplant coordinator, usually a registered nurse who specializes in the care of liver-transplant patients (this person will be your primary contact with the transplant team).
Social worker to discuss your support network of family and friends, employment history, and financial needs.
Psychiatrist to help you deal with issues, such as anxiety and depression, which may accompany the liver transplantation.
Anesthesiologist to discuss potential anesthesia risks.
Chemical dependency specialist to aid those with history of alcohol or drug abuse.
Financial counselor to act as a liaison between a patient and his or her insurance companies.

Tests

You will need to bring all of your previous doctor records, X-rays, liver biopsy slides and a record of medications to your pre-evaluation for a liver transplant. To complement and to update previous tests, some or all of the following diagnostic studies are generally performed during your evaluation.

Computed tomography, which uses X-rays and a computer to generate pictures of the liver, showing its size and shape.
Doppler ultrasound to determine if the blood vessels to and from your liver are open.
Echocardiogram to help evaluate your heart.
Pulmonary function studies to determine your lungs' ability to exchange oxygen and carbon dioxide.
Blood tests to determine blood type, clotting ability, and biochemical status of blood and to gauge liver function. AIDS testing and hepatitis screening are also included.

If specific problems are identified, additional tests may be ordered.

There are two types of liver transplant options: living donor transplant and deceased donor transplant.

Living donor.

Living donor liver transplants are an option for some patients with end-stage liver disease. This involves removing a segment of liver from a healthy living donor and implanting it into a recipient. Both the donor and recipient liver segments will grow to normal size in a few weeks.

The donor, who may be a blood relative, spouse, or friend, will have extensive medical and psychological evaluations to ensure the lowest possible risk. Blood type and body size are critical factors in determining who is an appropriate donor.

Recipients for the living donor transplant must be active on the transplant waiting list. Their health must also be stable enough to undergo transplantation with excellent chances of success.

Deceased Donor.

In deceased donor liver transplant, the donor may be a victim of an accident or head injury. The donor's heart is still beating, but the brain has stopped functioning. Such a person is considered legally dead, because his or her brain has permanently and irreversibly stopped working. At this point, the donor is usually in an intensive-care unit.

The identity of a deceased donor and circumstances surrounding the person's death are kept confidential.

BRIEF ABOUT THE PROCEDURE

For an orthotopic transplantation, a segment of the inferior vena cava attached to the liver is taken from the donor as well. The same parts are removed from the recipient and replaced by connecting the inferior vena cava, the hepatic artery, the portal vein and the bile ducts.

In a situation where the afflicted liver may recover, a heterotopic transplantation is performed. The donor liver is placed in a different site, but it still has to have the same connections. It is usually attached very near the original liver, and if the original liver recovers, the donor shrivels away. If the original liver does not recover, it will shrivel, leaving the donor in place.

Liver transplants usually take from six hours to 12 hours. During the operation, surgeons will remove your liver and will replace it with the donor liver. Because a transplant operation is a major procedure, surgeons will need to place several tubes in your body. These tubes are necessary to help your body carry out certain functions during the operation and for a few days afterward.

During the operation, a tube will be placed through your mouth into your windpipe (trachea) to help you breathe during the operation and for the first day or two following the operation. The tube is attached to a ventilator that will expand your lungs mechanically. A nasogastric tube will be inserted through your nose into your stomach. The N/G tube will drain secretions from your stomach, and it will remain in place for a few days until your bowel function returns to normal. A tube called a catheter will be placed in your bladder to drain urine. This will be removed a few days after the operation. Three tubes will be placed in your abdomen to drain blood and fluid from around the liver. These will remain in place for about one week.

In most cases, the surgeon will place a special tube, called a T-tube, in your bile duct. The T-tube will drain bile into a small pouch outside of your body so it can be measured several times daily.

The other Organ Transplant Procedures are

HOSPITALS FOR LIVER TRANSPLANTATION

Few Major Hospitals for Liver Transplantation are

DESTINATIONS FOR LIVER TRANSPLANTATION

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