Liver transplantation

From ArticleWorld

Liver transplantation is a medical operation that involves replacing a malfunctioning, diseased liver with a healthy one. Liver transplantation is always allograft.

The first such operation on humans was done in 1963, but the process itself remained experimental throughout the 1970s. Only in the 1980s, when cyclosporine was introduced by Sir Roy Calne, did the liver transplantation become more mainstream, with an improved success rate. At this moment, the typical one-year survival rate is of about 88%. However, liver transplantation operations are less common than they could be, due to a severe lack of donors, despite development of living-donor liver transplantation.

Indications

The procedure of liver transplantation can be done for any receiver with a severe (or worsening) affection that may (or has) caused irreversible liver dysfunctions. The receiver should not have any other clinical problems that may impair a liver transplant -- like active septic infections, HIV or other immunodeficiencies, metastatic cancer outside the liver or severe heart affections.

Operation

The first phase of liver transplantation operations consists of filtering bile acid and bilirubin through MARS-dialysis.

The procedure of the transplant itself are similar to those of any other organ transplantation. The surgeon will perform a large incision in the abdomen, and remove the malfunctioning liver, while its functions are left in the duty of various supporting machines. In most cases, along with the liver, the retrohepatic portion of the inferior vena cava is removed. The new liver is put into place, and connections with the inferior vena cava, portal vain and hepatic artery are restored. The biliary anastomosis is reconstructed. The body functions are monitored and, if they are stable, the receiver is closed and moved for post-operatory care.

The procedure is slightly different when liver transplant is performed in children. In their case, a portion of the liver of an adult (usually a parent) is used for transplant, leaving the hepatic tissue to develop normally. This was a major advancement that allowed for many lives to be saved, as the number of child-age donors is very low.

Risks

Risks in case of a liver transplant are very high, since the liver is a vital part of the organism. Immunosupressives are used, but they must be carefully managed because a liver infection may be fatal, as the immune system is weakened by the operation. However, acute rejection is less common (and less severe) than in other cases. The long-term survival rate is quite high, with most of the deaths occurring in the first three months after the operation.