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Transplant
Education
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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 patient's 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 body's 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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