Liver Transplantation

Liver transplantation is the only and definitive treatment option in acute liver failure, end-stage liver failure (cirrhosis) with irreversible liver damage and some cancers of the liver. The best known treatment method for patients with liver failure is liver transplantation. Every day, many people around the world get the chance to live with liver transplantation and return to their healthy active lives.

Liver transplantation is the only and definitive treatment option in acute liver failure, end-stage liver failure with irreversible liver damage and some cancers of the liver. Liver transplantation is performed in two ways: “cadaver transplant” and “living related donor transplant”.

It is the type of transplantation that can be performed after the families of people with brain death donate their organs. In order to transplant from cadaver, it is necessary to show with some examinations that the person whose organ was removed does not have any infectious disease, cancer or liver disease.
The liver, which was removed under appropriate conditions and protected in special protection fluids, should be transferred to the patient within 24 hours at the latest.
Unfortunately, due to low organ donation rates in our country, there are long waiting lists for liver transplants from cadavers.
For this reason, it is extremely important that patients and their relatives who are on the cadaver organ waiting list keep their telephone (preferably mobile phone) with them 7/24.

It is a form of transplantation from living donors who do not have health and legal problems in the removal of a part of the liver. In order for this process to be performed, there must be a blood bond up to the 4th degree between the recipient and the donor. In cases where there is no kinship but a voluntary basis is in question, it is obligatory to obtain the approval of the ethics committees structured within the Health Directorates. With all the tests performed on the volunteer, it must be shown that there is no harm in donating a piece of his liver.
In the examinations carried out; It should be clarified by looking at the blood evaluations of the donor that there is no additional disease hindering organ donation. In the second stage, it is checked whether the liver has appropriate vascular and biliary tract anatomy, whether there is enough liver for the recipient and donor, and whether the liver is fatty with imaging methods. It is usually necessary to take the left side of the donor’s liver for child patients, and the right half of the donor’s liver for adult patients.

The patient is placed on the waiting list for transplantation from the cadaver, or if there is a willing relative with matching blood type, the person is evaluated for donation and the transplant is planned. For the recipient candidate, it does not make any difference in terms of preparation whether the transplant is from a cadaver or a living donor. There is a similar preparation process. After determining the blood group, biochemical analysis is performed to determine the progress of cirrhosis. This grade is expressed as the MELD score; impaired jaundice is measured with a mathematical value calculated with values such as bleeding tests, kidney tests. As cirrhosis progresses, these values deteriorate and the MELD score increases.
If the calculated MELD score is 10 and above, it means that it is a candidate for liver transplantation. When the score reaches 15 and above, the patient’s registration can be placed on the national cadaver liver waiting list, with a system authorized and monitored by the Ministry of Health. Advanced stage patients with complaints such as varicose bleeding, unconsciousness and abdominal fluid accumulation on the basis of cirrhosis and patients with liver tumors are listed in the upper ranks according to the severity of the disease with additional points.
Before the patients are included in the list, they are subjected to other clinical examinations (heart, lung, endocrine system, psychiatry, etc.) and additional clinical tests (respiratory tests, cardiac ultrasound, endoscopy, etc.) determine whether they are suitable for liver transplantation.
The main goal in these examinations is to prove that the patient’s liver is problematic enough to require transplantation and that other organ systems are resistant to problems that may occur during or after the transplant surgery.
The recipient candidate, whose preparations are completed, proceeds in a few ways, considering the MELD score and accompanying problems:

The primary purpose in these examinations is to prove that the patient’s liver is dysfunctional enough to need transplantation and that other organ systems are resistant to problems that may occur during or after the transplant surgery.
The recipient candidate, whose preparations are completed, has to run through several procedures, taking into account the MELD score and accompanying problems:

It is an indescribable feeling that people who are donors for liver transplantation can bring a loved one back to life. Despite this feeling, the thought of donating a piece of the liver can cause some uneasiness at first. However, the thing that should not be forgotten at this point; The donor’s liver starts to grow rapidly immediately after surgery and can reach its former size after about 3 months. Likewise, the part transplanted to the patient who underwent liver transplantation grows and returns to normal sizes within 3 months.
For a person who decides to become a liver donor, it is checked whether a suitable donor is available after detailed evaluations beforehand. Organ donation is not accepted if any risk or suspicion is detected in terms of the recipient or donor.

At this point, in order for a person to be a liver donor, they must have the following features.

• The donor must be over 18 years old.
• Depending on the general health of the donor and recipient, the donor must be younger than 60 years old.
• The donor person should make his / her donation on a voluntary basis.
• There should be a blood tie up to the 4th degree between the donor candidate and the recipient. In our country, while the approval of the ethics committee is not required for blood ties up to the 4th degree, it is necessary to obtain the ethics committee approval from the Provincial Health Directorate in the degree of kinship after the 4th degree.
• In the absence of blood ties, there should be no financial link and the approval of the ethics committee should be obtained.
• Donor and recipient must have the same blood group (same or zero group)
• The donor should not have a history of systemic disease.
• It is preferred that s/he does not have chronic hepatitis and his body mass index is not over 30.

• People with incompatibility of AB0 blood group (Except in emergencies),
• Those over the age of 60 and under 18,
• Non-volunteers,
• Overweight people,
• People with psychiatric disorders,
• Alcoholism and substance addicts,
• People diagnosed with cancer,
• Chronic hepatitis (viral, autoimmune, metabolic, cryptogenic) patients,
• AIDS patients,
• Those with heart, lung and neurological diseases,
• Uncontrolled Diabetes patients,
• Those with bleeding disorders, fatty liver biopsy, Liver volume insufficiency,
• Pregnant women

The person who will be a liver donor must be completely healthy. It is also extremely important and necessary that there is no additional disease or infectious disease and that the liver is not fatty. In right lobe transplants, approximately 60-70 percent of the donor liver is transplanted to the recipient. Therefore, while a sufficiently large liver should be obtained for the recipient, at least 30-35 percent of the left lobe liver should remain for the donor. In both the donor and the recipient, the liver reaches its former size in 3 months. In some cases (fatty liver, previous hepatitis B infection, etc.), a liver biopsy from the donor may be required.

Patient’s Blood Type         From whom he/she can be transplanted?

0                                                 0

A                                                A,0

B                                                B,0

AB                                             0, A, B, AB

The preparation process, which starts with blood type and biochemical tests, continues with radiological radiograms and consultations, as well as additional tests required by them. What needs to be understood is that liver disease is severe enough to require transplantation, and it is shown that other body systems are healthy enough to survive such an operation.
It should not be forgotten that the liver, unlike other organs, does not have an artificial support system (such as dialysis in the kidney, pump in heart-lung problems, etc.) that can take its place in its deficiency.

It is a good idea to have a ready-made suitcase at home to meet your daily needs; thus you won’t waste any time before going to the hospital. Particularly if you are on the cadaveric organ waiting list, you should always have your phone with you.
Some tests will be performed when you arrive at the hospital. After a general physical examination, you will be asked to give urine and blood specimens.
Your physician and anesthesiologist will talk to you to inform you about the surgery process and the risks that you may encounter. You will be asked to sign a form that you consent to the operation.

Surgical Wound Care
The wound should be kept clean using antiseptic soap. If you see any redness, swelling or fluid formation in the wound, you should inform your doctor immediately.

Caring for a Bile Stent
If you have a stent placed to drain bile, the skin in the area where the stent entered may become infected. To prevent this;

• Clean the area around the stent with sanitizer- soap.
• Avoid violent movements that could damage the wound or dislodge the stent.

If you encounter any of the following problems with the bile stent, you should contact your doctor immediately

• Redness of the skin around the biliary stent,
• Warming in the biliary stent area, discharge from this area,
• Breaking of the suture attached to the biliary stent,
• A change in visible length of the biliary stent.

Monitoring of Fever
If you feel feverish, shiver, or feel discomfort, or if you feel pain in any part of your body, be sure to check your temperature. This may be the first sign of infection or the rejection process If you have a temperature above 38 degrees for more than a day, you should contact your organ transplant team or doctor immediately. Do not use any medication without your doctor’s permission.

Blood Pressure and Heart Rate Monitoring
Your nurse will teach you how to measure your blood pressure and heart rate. It is important to know your normal blood pressure and heart rate. So if you see a difference in values, you can report this to your doctor.

Going home after a transplant is usually a happy and emotional event. However, anxiety and even a mild depression may accompany this feeling of happiness in the first weeks. It is important to understand that recovery is a process that takes weeks. Therefore, it should be kept in mind that it will take some time for patients and their relatives to get used to the new lifestyle. Because living with organ transplantation is a learning process that takes time. Most people are easier to handle if they are active, especially if they make determined efforts to get through the long rehabilitation period.
With the end of the first delicate phase, which lasts about three months, almost all liver transplant patients can return to their former and pre-illness lives. It is also very important to apply at home the things learned under the control of the organ transplant team in the hospital after liver transplantation. Due to the increasing responsibilities of the patients and their relatives, some changes may be needed in their lives.
Do not forget that you can contact the organ transplant team whenever you need after the transplant.

Dental Care
You should use a soft toothbrush. It is important to go to the dentist regularly every six months to prevent infections and cavities. If you do not have serious problems with your teeth, you should not go to the dentist in the first six months after surgery.

General Body Cleaning
Compliance with post-transplant hygiene rules is highly recommended. At this point, try to follow the rules below for your general body cleaning.

• Use liquid soap instead of soap bar when washing your hands.
• Change hand and face towels daily.
• Always wash hands before, after meals and after using the toilet.
• Clean your nails thoroughly with a nail brush.
• Since blood is an ideal growth medium for bacteria, female patients should change pads and tampons regularly on menstrual days.
• Since the hygienic materials used to clean the vagina can increase the risk of infection by destroying the microorganisms in the vagina, it will be sufficient to use mild soap and wash regularly with water.

Sun Exposure
Liver transplant patients have a higher risk in terms of skin cancer. To avoid the sun:

• Avoid the midday sun (from 10 o’clock to 15 o’clock) when the sun’s rays are strongest.
• As long as you are outside and not wearing sunscreen, wear a hat, long sleeves and light trousers.
• Use a high-quality sunscreen with a sun protection factor of at least 15 during the spring and summer months.
• Do not go to the solarium.
• Pay attention to your moles. If you notice that a mole is discolored or shaped beyond its limits, contact your doctor.

Nutrition and Dietetics
Regular nutrition after transplantation is extremely important. Using cortisone medication during this period will cause your appetite to increase, your blood sugar to rise, and your body to retain salt and water. For this reason, you need to consume low sugar and less salty foods. Before the transplant, it is normal to lose weight.
Points to Consider in Your Diet:

• Weigh yourself every day.
• Avoid sugary foods.
• Eat fruits or vegetables (low in calories).
• Try to drink about two liters of fluid each day. This is beneficial for your kidneys.
• Always wash and peel fresh fruit.
• Always peel soil-growing vegetables such as potatoes and boil them in boiling water.
• Cooking the vegetables in the pressure cooker will preserve the vitamins they contain.
• Do not eat cheese made from unpasteurized milk, avoid moldy cheese.
• Another side effect of cortisone is that it causes your body to store salt. Limit salt intake.

Exercise
The best type of exercise is walking. Especially, walks in nice and clean weather make you sleep better and your intestines work better. If everything goes well, you can turn to other hobbies such as tennis and jogging in as little as three months after surgery. Before starting any exercise program, you should definitely consult your doctor.

Alcohol Use
You should avoid all kinds of alcoholic beverages as alcohol can be broken down by the liver and cause liver damage.

Smoking
Stop smoking! Smoking is harmful not only for you but for everyone.

Vaccines
You should not have any living or attenuated vaccines (such as oral polio, measles). You may have dead or inactive virus vaccines such as tetanus, but you must inform your doctor without any vaccines.

Pets and Plants
Pets are normally not recommended because of the risk of infection. Potted houseplants are not recommended due to the danger of infection from soil microbes. Due to the high risk of infection, you should not engage in gardening, field and soil work during the first year of transplantation.

Immunosuppressive Drugs
The amount of immunosuppressive drugs required to protect a transplanted organ decreases after the first months after surgery. However, immunosuppressive drugs should be used for many years after liver transplantation. In no way, the amount of medication should not be reduced without the permission of a doctor.
Immunosuppressive drugs will be used for life after transplantation surgery. Because patients react differently to these drugs, each immunosuppressive regimen is tailored to the individual patient’s needs. Therefore, the amount of medication used by each patient varies.