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Liver
transplantation is a wonderful life-saving surgery, but this
complicated procedure
can raise a lot of questions for someone learning about it
for the first time.
The information
provided does not constitute medical advice and it should
not be relied upon as such. The New York Center for Liver
Transplantation (the Center) does not engage in the practice
of medicine. The Center, under no circumstances, recommends particular
treatments for individuals and, in all cases, recommends
that you consult your physician before pursuing any course
of treatment.
What does the liver do?The liver,
the largest organ in the body, can be found behind the ribs
in the right upper abdomen. The functions of the liver include:
- Stores vitamins, sugars, fats and other nutrients from
the food we eat
- Builds chemicals that the body needs to stay healthy
- Breaks down harmful substances, like alcohol and other
toxic (poisonous) chemicals
- Removes waste products from the blood
- Makes sure that the body has just the right amount
of other chemicals that it needs
Although
the liver can regenerate itself, there are illnesses that can
cause permanent damage to the liver. Liver transplantation
is a possible treatment for a patient whose liver no longer
functions well and whose life is threatened.
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What is
a liver transplant?
A liver transplant is the replacement of the patient liver with one that has
been donated by someone else. The donated liver can be obtained in two ways:
- Some families decide to donate
the organs of a loved one who has died. The main matching
requirements are that the donor be of a compatible blood
type and the donor liver be an appropriate size for the potential
recipient. Unfortunately there are not enough donors for
every waiting recipient. The
choice of who gets a new liver depends on how critically
ill the patient is.
- Because the liver can regenerate itself, it is possible
that a living donor can give a part of their liver to a recipient. Both
the segment that was donated and the remaining section of
the donor liver will grow to normal size within a short period
of time. Parents, siblings and other relatives may be able
to donate organs to family members. Unrelated donors may
also donate a portion of their liver if they prove to be
a match for the recipient.
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When is
a liver transplant considered?
If all other forms of treatment have been unsuccessful, and there is a high
risk of death because the liver is not functioning, the patient has end stage
liver disease. At this point, liver transplantation is considered. Although
there are many diseases that have been treated with liver transplants, there
are several common ones treated with this procedure:- Chronic
viral hepatitis B and C
Cirrhosis due to hepatitis C is the leading cause for
liver transplantation
- Alcohol related liver disease
Alcoholism is a common cause of end stage liver disease.
To be considered for transplantation, patients suffering
from alcoholism must have a psychological evaluation and must prove
they have stopped drinking for six months. There must also
be a strong indication the patient will continue to avoid
alcohol
after transplant because a transplanted liver will become
severely damaged by alcohol just like the old one.
- Autoimmune hepatitis
- Primary sclerosing cholangitis
- Primary biliary cirrhosis
- Steatohepatitis
- Liver disorders inherited or present at birth
- Drug induced liver damage
- Biliary artresia
The most common cause of liver failure in children is
biliary atresia, often found at birth. The bile ducts that
carry bile
from the liver to the intestine fail to develop. The bile
backs up in the liver and causes damage.
- Cancer
A primary liver cancer or hepatoma is
a cancer that develops first in the liver. When a primary
liver cancer is identified
early, a liver transplant will be performed. However, many
cancers begin other places in the body and then spread
to the liver — these cancers are not treated
by liver transplantation.
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Can anyone
get a liver transplant?
No. Liver transplant is major surgery and not everyone can survive it. In some
cases, the doctor might decide that a liver transplant won't work. Some things
that might prevent a patient from getting a liver transplant are:
- Having advanced cancer of the liver
- Having another kind of cancer in the past 3 to 5 years
- Having severe heart, lung or kidney disease
- Having advanced HIV disease (AIDS)
- Severe hardening of the arteries
- Continuing use of alcohol or illegal drugs
- Being at high risk of using drugs or alcohol again
after the surgery
- Being unable to follow doctor's instructions, like
taking medicine when needed
- Having too little support from people at home to care
for the patient after the operation
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What are
the risks?
Before surgery, the patientÕs liver disease can cause complications
that can make liver transplantation surgery unacceptable.
After surgery, one of the major risks is not having any liver function for
a short time. Bleeding and infections are also risks at this time. Over a lifetime,
patients are tracked to watch for signs that the body is rejecting the new
liver. One year
survival rates for liver transplant recipients are 85.3% -
88.1%.
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What are the side effects?
Drugs are used to treat or prevent the bodyÕs rejection of
the new liver. These drugs can make a patient more open to
infection. Cortisone drugs produce some
fluid retention, puffiness of the face, and a risk of osteoporosis due to loss
of calcium. The use of immunosuppressants can lead to high blood pressure,
kidney damage and the growth of body hair. Careful regulation of these drugs
can help with some of the potential side effects.
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What are the lifestyle changes?
Most patients experience positive changes in lifestyle compared to living with
end stage liver disease. However the following are simple changes a patient
may need to become used to:
- Exposure to infections is dangerous for transplant
recipients and should be avoided. Illness should be reported
to the doctor immediately.
- Monthly blood tests with local physician and semi-annual
checkups at the transplant center are required.
- Patients should maintain a balanced, low-salt diet.
- Within a year after a successful liver transplant most
patients are able to return to fairly vigorous physical exercise.
- Women who conceive have to be monitored carefully because
of a higher incidence of premature births.
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What can I do to keep healthy
before and after a liver transplant?
- Make sure you follow your doctor's advice to try to
treat your liver disease
- Eat well-balanced, healthy meals
- Lose weight, if your doctor tells you to
- Do not use alcohol or illegal drugs
- Get treatment for your substance abuse problem if you
need it
- Get treatment for any mental illness or behavioral
problems
- Get treated for any other health problems (diabetes,
blood pressure, cholesterol)
- Stop smoking or chewing tobacco
- Talk to your doctor before you use any other prescription
or over the counter medicine
- Talk to your doctor before using any vitamins,
supplements or natural or herbal remedies
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