Liver transplant

Jul 10, 2012 , Zuzana Boučková

transplantace-jater.jpg - kopie
transplantace-jater.jpg - kopie
Liver transplantation is an surgery that is needed in case of liver malfunction. It follows that it is a life-saving surgical operation. After a successful liver transplant the patient must follow pharmacological treatment that impairs the immune system of the body. For treatment are used so-called immunosuppressives that dampens the immune system in order to avoid rejection of the donated organ by recipient.

Liver transplant

The liver is necessary vital organ as it is centre of metabolic processes and the largest gland in our body. In addition, the liver significantly contributes to the removal of toxic and waste substances, creates important components in the blood and serves as a storehouse of various essential substances. It is necessary to proceed to liver transplant in a situation when liver malfunction occurs that can not be satisfactorily adjusted by the other type of treatment. Liver transplantation is unequivocally life-saving surgery.

Selection of patients for liver transplant

Liver transplantation is one of the very complex surgeries. The first successful liver transplantation was performed in 1967 by a surgical team led by Dr. Thomas Starzl of Denver, Colorado, United States. Not every patient with liver malfunction is suitable for undergoing this operation. For the inclusion in transplant list is necessary to meet certain criteria and vice versa contraindications can not be present. Contraindication means the state of patient's condition which prevents the realization of a therapeutic intervention. The indications for the surgery include final stage of some long term liver diseases seriously affecting its function, sudden failure on the basis of liver cells death, injuries and tumours. There is a relatively large amount of contraindications, therefore, to name but a few:

  • severe heart diseases
  • diseases affecting larger number of organs
  • recent complications caused by increased blood clotting
  • sepsis
  • alcohol or drug addiction
  • uncooperative patient
  • Liver transplant procedure

  • Liver for transplantation is obtained from a donor who is an individual with proven brain death. Donors must be identical to recipients in major blood groups, i.e. A, B, 0. Also the difference in weight of these persons should not be more than 1/5. Nowadays is performed orthotopic transplantation in which the liver is removed from the patient's abdomen and is replaced by the donor's organ. It is placed at the same location as the previous liver, and the donor's liver is successively connected to all blood vessels and bile ducts that were disconnected from the previous liver. The patient is during the entire operation in a state of anesthesia. The course of operation should be relatively fast, since the liver can not be outside the body for longer than 6-9 hours. After surgery is the patient moved to intensive care unit where is the patient closely monitored for several days. If no serious problems occur is the patient transferred to classical department for the next 3-4 weeks. Even after leaving hospital is the patient forced to use very carefully prescribed medications so-called  immunosuppressants. These have the function of suppressing immune system of body to prevent the recognition of new organ as foreign tissue. Then there would have come to the destruction of liver by the cells of immune system. This process is called graft rejection.

Prognosis of liver transplantation

In the most cases, successful liver transplantation results in significant improvement in quality of patient's life. In a large number of patients means liver transplant the chance of long term survival. The problem is in rediscovering of the disease that occurs due to liver failure, especially viral hepatitis C or cancer of this organ. The number of suitable donors is also insufficient, what doctors try to solve with the discovery of new methods in which, for example, they acquire part of an organ from living donors.

Life after liver transplant

Liver function can not be yet replaced in any way so in some serious diseases is liver transplantation necessary. After liver transplantation should the patient count with certain restrictions.

  • Dietary regimen after liver transplantation is important because the weight in majority of patients after liver transplant is increasing. It is primarily due to improved health status after transplantation, therefore, also in increased appetite. Likewise, some medications increase appetite and storage of lipids. Accordingly is recommended healthy, and especially varied diet with plenty of fruit and vegetables. Mainly in the first weeks after transplantation is important to receive increased amount of proteins. Also, fibre should be the part of daily diet. We should be cautious with salting, smoked foods or fatty meat.
  • Physical activity is important for maintaining fitness, mental and physical wellbeing. Therefore, after the surgical wound is healed, is recommended to pursue the sport. However, it is advisable to consult with your doctor about exercise.
  • Protection against infection is a very important issue which the patient after transplantation should not forget. It should be kept in mind that the use of immunosuppressive drugs reduces the function of natural immune system. Thus, susceptibility to infections increases. Therefore, vaccination  against certain infectious diseases such as hepatitis is recommended. Furthermore, it is regular hand washing, limited contact with sick people and not to be vaccinated with live vaccines.
  • Sexual life after liver transplant returns to normal. Women can even conceive. It is necessary to remember that immunity of the patients after liver transplant is reduced, and therefore it is possible to easily transfer infections through saliva, or transmission of sexual diseases.

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