Liver Transplantation - information about the procedure - operation

Liver Transplantation - information about the procedure - operation

Liver Transplantation - an OPERATION to replace a diseased LIVER with a donor liver as a treatment for end-stage LIVER FAILURE. Following liver transplantation, most people are able to return to full and active lives though must continue taking medications to suppress rejection of the donor liver (IMMUNOSUPPRESSIVE THERAPY).

Surgeons performed the first successful liver transplantation in the United States in 1967. The risk of organ rejection curtailed transplantation as a permanent treatment for liver failure, however, until the advent of the immunosuppressive medication cyclosporine in 1979. Cyclosporine and its contemporary counterparts (such as tacrolimus, which debuted 10 years later) have made transplantation a viable, long-term solution. In 2004 doctors added the monoclonal antibody basiliximab to the immunosuppressive arsenal, reducing rejection to about 10 percent. Surgeons now perform more than 5,500 such operations each year, with liver transplantation as a therapeutic solution limited only by the availability of donor organs.

Donor livers are either cadaveric (harvested from donors after death) or living-donor segment (a living person donates part of his or her healthy liver). Living-donor segment transplantations are possible because the liver has the unique ability to regenerate. After a living donor segment transplantation, the donor’s liver eventually restores itself to full size and function. Ideally, the segment implanted in the recipient does the same. This regenerative capability means, too, that livers transplanted into children will grow as the child grows.

There are two basic types of liver transplantation:

  • orthotopic liver transplantation (OLT), in which the surgeon removes the diseased liver and replaces it with the donor liver
  • heterotopic liver transplantation (HLT), in which the surgeon leaves the person’s own diseased liver (the native liver) in place and attaches the donor liver (or liver segment) in a “piggyback” fashion

Donor organs must match BLOOD TYPE and, for OLT, body size. With HLT body size is less important because the surgeon can select a liver segment of the appropriate size. The surgery to transplant a liver takes between 4 and 12 hours in most circumstances. Recovery includes up to three weeks of hospitalization and several months for full recuperation. Most people are able to return to regular activities including exercise, work, sexual activity, and eating habits.

The risks of liver transplantation include bleeding, INFECTION, and rejection of the donor liver. Rejection may occur within days of the transplant or at any time after recovery, though IMMUNOSUPPRESSIVE MEDICATIONS reduce the likelihood. Symptoms of rejection include JAUNDICE, NAUSEA, FEVER, and PAIN. These symptoms require immediate medical attention to salvage the transplant.

CONDITIONS FOR WHICH LIVER TRANSPLANTATION IS AN OPTION
acute (fulminant) LIVER FAILURE AMYLOIDOSIS
autoimmune HEPATITIS BILIARY ATRESIA
chronic liver failure CIRRHOSIS
glycogen storage disease HEMOCHROMATOSIS
hepatitis B/hepatitis C hepatotoxic liver failure
LIVER DISEASE OF ALCOHOLISM noncancerous LIVER tumors
PRIMARY BILIARY SCLEROSIS PRIMARY SCLEROSING CHOLANGITIS
WILSON’S DISEASE  

See also ORGAN TRANSPLANTATION; SURGERY BENEFIT AND RISK ASSESSMENT.

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The Gastrointestinal System

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