If not so long ago the news about organ transplantation was perceived as something fantastic, today this method of surgical treatment is spoken of as one of the most effective, giving hope to hopeless patients. Meanwhile, it is important for the patient himself and his relatives to realize the whole danger of such an intervention, the importance of careful preparation for it and the importance of changing lifestyle in the future. Liver transplantation is a radical treatment for fatal diseases. The operation is performed if there is vital evidence, in the case when there is no doubt that without organ transplantation the patient is doomed to death.
Importance of Organ Transplant
As you know, the human liver is a gland that performs important physiological functions. Doctors call it a kind of "filter" of the body, which neutralizes and removes harmful and toxic substances, allergens, metabolic products, excess hormones from the body. It is the liver that plays a fundamental role in metabolic processes, including the synthesis of cholesterol, bile, bilirubin and enzymes for digesting food. Iron maintains a carbohydrate balance in the body and is actively involved in blood formation processes. If the removal of the spleen, one of the kidneys and even the pancreas as a whole does not deprive a person of a chance of a full existence, then he cannot stay without a liver - this will inevitably lead to death.
The failure of the liver to perform its functions can be triggered by a number of dangerous diseases. In a healthy person, substances are produced in the body that stimulate the regeneration of the gland, but with extensive damage to the organ, they lose their effectiveness. A liver transplant in such cases is the only chance to save the patient's life.
In which cases a transplant of iron
The main indication for the operation is any fatal disease or its stage, in which the organ ceases to perform vital functions for the body. In Russia, a liver transplant is performed in the case of:
- intrauterine malformations of the gland;
- inoperable malignant tumor ;
- in the last stages of progressive oncology of a diffuse type;
- in acute liver failure.
Most diseases that affect the tissues of this gland cause cicatricial changes in its structure, which subsequently affects its performance and negatively affects the functionality of other organs and systems.
With cirrhosis, liver transplants are most often used. This pathology is characterized by an irreversible process of replacing healthy fibrous tissue. Cirrhosis can be of several types:
- alcoholic (occurs against the background of prolonged abuse of alcohol);
- viral (is the result of infection with hepatitis C virus, B);
- stagnant (develops as a result of hypoxia and venous stasis);
- primary biliary (has a genetic nature of origin).
With the development of cirrhosis, life-incompatible complications very often arise in the form of hepatic encephalopathy, ascites, and internal bleeding. As a rule, the presence of the diagnosis of liver cirrhosis itself is not the main condition for an organ transplant. The decision on gland transplantation is made in case of rapid progression of liver failure. Against the background of a sudden increase in symptoms, they begin to conduct a more active search for a donor.
Contraindications for surgery
However, here we must not forget that transplantation of any organ should be performed in the absence of any obstructive factors, including liver transplantation. Do surgery for relative contraindications? It is difficult to answer this question unequivocally, since the doctor, making a decision about a transplant, takes into account a number of individual characteristics of the patient's body. Relative contraindications include:
- drug and alcohol addiction;
- elderly age;
- portal vein thrombosis;
- obesity;
- consequences of other operations carried out.
A negative decision on a donor liver transplant will become in the case of severe functional disorders of the central nervous system, acute heart and respiratory failure. The chronic form of dangerous infectious diseases (tuberculosis, HIV) is another solid no in the issue of transplantation. As a rule, the idea of engrafting a donor organ is rejected even with extensive patient metastases. If a liver transplant is necessary for cirrhosis, which has a hepatitis etiology, the patient is placed in the queue for surgery only after treatment for a viral infection.
Who can become a donor
As you know, donating your organ or tissue to a recipient is possible only on a voluntary basis. At the same time, a number of requirements are presented to the organ donor, if at least one of them does not comply, transplantation becomes impossible. A person who is ready to give part of his body should:
- Undergo a comprehensive medical examination, which confirms the absence of contraindications for liver transplant surgery.
- Have biocompatibility with the recipient (a person in need of a donor organ).
- Undergo additional procedures to verify the likely consequences after tissue removal.
- Sign transplant consent documents.
Gland transplant from a relative
For a liver transplant in Russia, a donor is allowed to become an adult in good health who wants to give part of his own organ to a relative or other recipient. Most often, blood relatives (parents, children, brothers, sisters) act as a donor. The main condition is a suitable blood type and adult age. It is believed that a liver transplant of a donor who is a relative is the best option. This type of transplantation of part of the gland has several advantages:
- The waiting period of the donor liver is immeasurably reduced. In the general queue, most recipients expect a suitable organ for several months, and sometimes years. But most often, in order to save the patient’s life, a liver transplant with cancer or cirrhosis must be done immediately.
- It is possible to thoroughly prepare both the recipient and the donor for the operation.
- Organ transplantation from a living donor is preferable to transplantation from a deceased person.
- The likelihood of survival is increased due to the simultaneous removal and transplantation of material.
- From the psychological side, the recipient more easily perceives organ implantation from a person with whom there is a blood-blood relationship.
The natural ability to regenerate ensures a gradual restoration of the liver in both participants in this complex manipulation. Iron grows to normal size, provided that at least a quarter of its initial mass is retained.
Posthumous transplant
Organ donation may be posthumous. In this case, the gland is taken from a person with a fixed brain death (mainly after incurable craniocerebral injuries). The laws of a number of modern states prohibit the collection of organs from a deceased person.
The engraftment of a donor gland from a person with a fixed brain death implies an emergency operation. The commission determining the transplant candidates urgently revises the waiting list and appoints the recipient. The patient is taken to a clinic where a liver transplant is done, preparation is carried out and the operation is started. From the moment of withdrawal to the beginning of manipulation no more than 6 hours should pass.
For a child
A separate topic is child donation. It is possible to transplant a liver to a child, but only an adult is entitled to donate part of his liver. In addition, when selecting a donor, one should take into account the size of the organ for the best survival rate.
Thus, only half of one of the hepatic lobes is transplanted to a recipient who has not reached the age of 15, while adult patients always have whole lobes.
Types of transplantation
The main methods by which a liver transplant is performed are only three:
- orthotopic;
- heterotopic;
- resumption of removal of bile.
The first one was most widespread. It implies the complete removal of a diseased organ of a person, and a donor gland or its share is placed in its place. After transplantation, the liver should take its natural physiological place in the space under the diaphragm. A similar operation is performed in eight cases out of ten. The procedure lasts from 8 to 12 hours, is carried out in stages.
Heterotopic transplantation is an operation during which the affected organ is not removed from the patient’s body. A new liver (its share) is transplanted to the place of the spleen or one of the kidneys, followed by attachment to the vascular system. The removal of the gland is carried out with part of the inferior vena cava only if the whole liver with the corresponding fragment of the blood vessel is transplanted. The intersection of arteries and bile duct leading to the organ. Blood circulation is maintained by shunt using special pumps.
The third variant of transplantation: a donor liver is transplanted without a gall bladder. To restore normal excretion of bile from the body, the surgeon connects the bile ducts of the patient and the transplanted organ. At first, drainage will work at the junctions. Once the level of bilirubin in the blood stabilizes, it will be removed.
Preparation for surgery
Surgical execution of transplantation is associated with a number of technical difficulties, therefore, sufficient time is required for preparation before liver transplantation. By the way, rehabilitation will require a much longer period.
The patient on the waiting list must be ready at any time for an emergency transplant. The patient needs:
- Completely abandon bad habits.
- Follow the diet and recommendations of your doctor.
- Avoid weight gain.
- Regularly do exercises, get elementary physical activity.
- Take medications from the preparatory course.
A potential recipient should always be in the access zone, be in touch and have collected things, documents in case of urgent surgery. The smallest changes in health and physical condition should be reported to the attending physician.
Before a direct liver transplant, the patient should undergo an emergency examination, which includes:
- blood analysis;
- electrocardiography;
- oncotests;
- Ultrasound of the internal organs.
In addition, the patient is sampled injected into the body of the tissue of the donor for prophylactic purposes in order to exclude the rejection of the gland after transplantation. To increase the chances of survival, a healthy organ is removed simultaneously with a hepatectomy in the patient. If this condition cannot be met, the donor gland is kept refrigerated at a temperature not exceeding 0 ° C.
Rehabilitation period
The answer to the question of what are the chances of recovery in a person who has undergone a liver transplant, and how much they live with a donor organ, is possible only after the rehabilitation period. Any type of transplantation is one of the most complicated surgical interventions, requiring a lot of time to recover.
The patient spends the first week after surgery in the intensive care unit, since this period is the most dangerous for the patient. After a liver transplant, a number of complications can occur:
- Primary liver failure. A “foreign” organ does not immediately begin to fulfill its functions, therefore, intoxication of the body is possible. Gland tissues undergo necrosis. In severe cases, an urgent second liver transplant is necessary. If this is not done, the patient will die.
- Bleeding.
- Peritonitis.
- Portal vein thrombosis.
- Tissue infection, accompanied by an inflammatory process.
- Organ rejection.
The last of these is the normal response of the recipient's immune system to a foreign body. As a rule, rejection is stopped by suppressing the immune response using immunosuppressants. The patient will have to take these drugs for a long time, until the new organ has taken root completely. As soon as the risk of rejection is reduced, the dosage is reduced.
According to reviews, a liver transplant causes the patient to radically change his lifestyle. Mandatory conditions for the patient are:
- Hepatologist regularly monitors during the first year after transplantation.
- Periodic ultrasound, clinical blood and urine tests.
- Compliance with diet (recommended diet number 5).
- Inadmissibility of high physical exertion.
A patient with a suppressed immune system needs to be protected from viruses that can become deadly for him due to the temporary inability of the body to resist diseases of an infectious nature. It is important to understand that the risk of organ rejection accompanies the patient until the last days, and without the use of immunosuppressants, the probability is equal to 99%. Despite this, most patients who have successfully undergone surgery and the postoperative period manage to live a full life, raise children, work and lead a life.
How many live after a liver transplant
In Russia, operations on transplantation of internal organs are carried out according to federal programs. The Ministry of Health sends the patient to one of the centers of transplantology, where he undergoes a detailed examination. After that, his data is entered on the waiting list. When the turn comes up and a suitable donor is found, the patient will be operated on. By the way, for those who want to get iron from a relative, there is also a queue.
As already mentioned, the prognosis of life for patients undergoing a liver transplant can be given only after rehabilitation. Over one year, up to 90% of recipients live. A five-year survival threshold is overcome by about 85%, and a fifteen-year threshold by no more than 60%. The best survival results are observed in patients who received the liver from a living donor. Complete donor organ restoration takes place in just a few months, since in most cases the lobe of the gland is removed using a minimally invasive laparoscopic method.