Liver transplantation has been a chance of life for patients who have developed acute or chronic liver failure. Although it varies depending on the causes, the survival outcomes of liver transplantation have improved significantly since it was first introduced in the 1960s. On average, 1- and 5-year patient survival is 86-92% and 73-76%, worldwide.
In liver transplantation, the diseased liver is almost always removed and whole or a piece of liver from a donor is attached to the same place. In kidney transplantation, the non-functioning kidneys are left in place and the new kidney is transplanted to a separate place in the groin.
There are 2 exceptional cases in which non-functioning kidneys are also removed. The first of these is polycystic kidney disease, in which the kidneys are full of cysts and reach large sizes. The reason for removal here is to make room for the new kidney to be implanted. The second is that the diseased kidney or kidneys that do not work become the focus of chronic infection. Since transplantation is not possible in the environment of infection, it is necessary to get rid of the focus first.
You have several options for this. The fastest is to take a piece of liver from a relative. He or she must be at least 4th degree blood or beech relative. This is a liver transplant from a living donor, and it is not an easy process at all. In addition to the kinship relationship between the recipient and the giver, there should be blood type compatibility, too. The donor must be healthy, over 18 years old, preferably under 55 years of age. Living donor should make a free decision. The donor's liver must be anatomically suitable to be divided into two. The reserve of liver function should be normal. Fat content in liver should be minimal. The received part should be sufficient for the receiver and the remaining part should be sufficient for the donor. The recipient should also have a life expectancy of over 70% with the transplant. It is not the right approach to take a healthy donor to such a risky procedure, even voluntarily, with a low life expectancy in the recipient.
It can take days to figure out if the recipient and donor are suitable. Both the recipient and the donor require a series of radiologic workup, blood tests, consultations. Except in cases where there is an urgent need for transplantation, such as mushroom poisoning, the preparation time may take an average of 5-10 days.
Anyone who is over the age of 18 and is mentally stable can donate his/her organs. In daily practice, filling out a donation card helps to raise awareness. It is important for your family to know how you feel about organ donation in advance. Because, even if you have signed the card stating that you are an organ donor, when a misfortune such as brain death develops, it will be necessary to obtain consent from your first-degree relatives in order to procure your organs.
Anyone over the age of 18 who is in good mental and physical health can be a living donor. If there is, it is not required an approval by spouse, but a document showing his or her awareness about the donor’s decision is needed.
There is a risk in every surgical procedure. In the process of taking a liver part (graft) from a living donor, the risk increases in parallel as the volume of the piece to be taken increases. For example, removing the right side of the liver is more risky than removing the left. The risk of losing life due to this surgery in the world is between 0.2-0.5%.
In order to prevent this, optimum features of a donor have been established. For example, the body mass index should be below 30, the rate of fatty liver should be low, and the use of birth control pills should be discontinued.
In addition, donors may develop complications such as bile leakage, bleeding, vascular occlusion, and infection that are not fatal but require long hospitalization, interventional or surgical procedures (7-15%).
Possible. However, after determining the medical suitability of the recipient and donor, their files are submitted to the approval of the Medical Ethics Committee of the Provincial Health Directorate. If approved, they are transplanted.
Whichever liver transplant center you want to have a transplant, you need to sign up for that center's cadaver organ waiting list. Thus, you will have the chance to be transplanted with the organ that can come from the national and regional cadaver organ pool. Since organ donation is very limited in our country, cadaver liver waiting times may be long for recipients on the list.
It can be said that ‘the liver has no age’. 30-40 years of survival after liver transplantation seems to be normal.
It is certain that a young liver under the same conditions will perform better than an older one. However, the young age of the donor does not mean that the liver will be in good condition. The cadaver liver of an 80-year-old donor who has taken good care of himself can be very performant. The main thing is how the deceased person treated the liver in the past, existing diseases and the medications he/she took.
The duration of recipient surgery varies over a wide period of time according to the characteristics of the patient and the graft. However, it can be said that it takes an average of 6-8 hours.
As the success of liver transplantation has increased, so has the demand for liver transplantation. However, cadaveric organ donation in our country and in the world has not been able to meet this increasing demand. The number of people who died while waiting for cadaveric organs has steadily increased. To solve this, the approach of dividing the cadaver liver into two and transplanting it into two different people (split transplantation) has been introduced. Later, the transplantation of part livers taken from living beings came to the fore. Initially, the left lateral segment or left liver was transplanted, but as the experience increased, the right liver was also removed.
Listing is done according to the patients' MELD scores. The MELD score is calculated according to the INR, bilirubin, creatinine and sodium values in the analyzes made from the blood of the patients. As the patient's condition worsens, the MELD score also increases. In short, the date you are listed does not matter in the ranking. The aim is to ensure that cadaveric grafts are transplanted to patients in poor condition who will benefit the most from transplantation. The exception that enters the list directly and from the very beginning is acute liver failure. For example, patients who suffer from acute liver failure by eating poisonous mushrooms are put at the top of the list due to their urgent liver needs.
If HCC is detected in an area other than the liver, that is, if it has metastasized, the transplant cannot be performed.
If the HCC is beyond the Milan criteria (Milan criteria = single tm ≤ 5 cm, 2-3 tm ≤3 cm, no vascular invasion and extrahepatic spread),the patient cannot be inscribed on the national cadaver organ waiting list. If the patient is treated and the cancer foci meet the Milan criteria, they can be re-evaluated and listed.
If HCC is detected outside the liver, that is, if it has metastasized, the transplant cannot be performed.
Whether or not to transplant patients with cancer beyond the Milan criteria depends on the evaluations of the transplant centers.
Maybe. If the general condition is suitable and fulfills the conditions for transplantation, there is no limit for the number of transplantation.
Goverment covers the expenses of Turkish citizens at SSI contracted transplant centers.
The first is a complete liver and the other is a piece of liver. In other words, a liver taken from a brain-dead person is almost always transplanted as a whole liver. In transplants from living donors, a part of the liver is transplanted. In terms of volume, cadaver liver is more advantageous than the part taken from a living liver.
However, we cannot control what age and history the liver from the cadaver has. The surgery is usually performed in the middle of the night, under emergency conditions, and the removed organs, including the liver, are transferred after being stored in ice for a long time (6-8 hours). In transplants from living donors, we know who the donor is, his age and health status. We have enough time to search for the most suitable donor. Transplant surgery also starts on the day and time determined by us. In addition, the storage time of the organ in ice usually does not exceed 1 hour. In terms of the quality of the liver and the controllability of the process, transplants from a living donor are more advantageous than transplants from cadavers.
There is also the issue of waiting time for transplantation. Cadaver transplant awaiters wait for different periods of time after being placed on the national cadaver waiting list, depending on their MELD scores and the number or lack of organ donation in the country. In live transplants, there is no waiting period if the recipient and donor are suitable. In terms of waiting time, transplants from living donors are much more advantageous than transplants from cadavers.
Finally, liver transplants from a living person do not contribute anything to the giver other than the emotional satisfaction it provides. On the contrary, the risks of surgery will be added to a healthy and young individual. From the point of view of the health of the donor, cadaveric liver transplants are a more rational type of transplantation that should be increased in number.
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Prof. Dr. Sedat Karademir
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