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 hopeless patients a chance. Meanwhile, it is important for the patient and his relatives to be aware of the danger of such an intervention, the importance of careful preparation for it, and the importance of changing lifestyle in the future. A liver transplant is a drastic measure for the treatment of deadly diseases. The operation is performed in the presence of vital indications, in the case when there is no doubt that without organ transplantation the patient is doomed to death.
Meaning 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, products from the body.metabolism, excess hormones. 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 the carbohydrate balance in the body and is actively involved in the processes of hematopoiesis. If the removal of the spleen, one of the kidneys and even the pancreas as a whole does not deprive a person of the chances of a full-fledged existence, then he cannot remain without a liver - this will inevitably lead to death.
Failure of the liver from performing its functions can be triggered by a number of dangerous diseases. In a he althy 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 what cases is a gland transplanted
The main indication for surgery 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 case of:
- intrauterine anomaly of gland formation;
- inoperable malignant tumor;
- in the last stages of progressive oncology of diffuse type;
- for 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 functionalityother organs and systems.
With cirrhosis, a liver transplant is most often resorted to. This pathology is characterized by an irreversible process of replacing he althy tissue with fibrous tissue. Cirrhosis can be of several types:
- alcoholic (occurs against the background of prolonged alcohol abuse);
- viral (is the result of infection with the hepatitis C, B virus);
- congestive (develops as a result of hypoxia and venous stasis);
- primary biliary (has a genetic origin).
With the development of cirrhosis, complications incompatible with life very often occur in the form of hepatic encephalopathy, ascites, 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 to transplant the gland is made in the case of rapid progression of liver failure. Against the backdrop 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 carried out in the absence of any obstacles, including liver transplantation. Is the operation done with relative contraindications? It is difficult to answer this question unequivocally, since the doctor, when deciding on a transplant, takes into account a number of individual characteristics of the patient's body. Relative contraindications include:
- drug and alcohol addiction;
- old age;
- portal vein thrombosis;
- obesity;
- consequences of other rescheduled surgeries.
A negative decision to transplant a donor's liver will be in 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 firm "no" in the matter of transplantation. The idea of engrafting a donor organ, as a rule, is also abandoned in case of extensive metastases in a patient. If a liver transplant is necessary for cirrhosis, which has a hepatitis etiology, the patient is put on the waiting list for surgery only after the viral infection has been cured.
Who can become a donor
As you know, you can donate your organ or tissue to a recipient only on a voluntary basis. At the same time, a number of requirements are imposed on the organ donor; if at least one of them does not meet, transplantation becomes impossible. A person who is ready to give away part of his organ must:
- Pass a comprehensive medical examination, which will confirm the absence of contraindications for liver transplant surgery.
- Be biocompatible with the recipient (the person in need of a donor organ).
- Pass additional procedures to check the likely consequences after tissue removal.
- Sign the consent documents for the transplant.
Gland transplant from a relative
Forliver transplantation in Russia, it is allowed to become a donor of an adult person with good he alth who wants to donate 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 from a donor who is a relative is the best option. This type of transplantation of a part of the gland has several advantages:
- The waiting period for a donor liver is immeasurably shortened. In the general queue, most recipients wait for a suitable organ for several months, and sometimes years. But most often, in order to save the patient's life, a liver transplant for cancer or cirrhosis must be performed immediately.
- It is possible to thoroughly prepare both the recipient and the donor for the operation.
- An organ transplant from a living donor is preferable to a transplant from a deceased person.
- The likelihood of survival increases due to the simultaneous removal and transplantation of material.
- From the psychological side, the recipient perceives the implantation of an organ from a person with whom there is a blood relationship more easily.
The natural ability to regenerate ensures the gradual recovery of the liver in both participants in this complex manipulation. The gland grows to normal size, provided that at least a quarter of its initial mass is preserved.
Post-mortem transplant
Donationbody may be posthumous. In this case, the gland is taken from a person with recorded brain death (mainly after incurable traumatic brain injuries). The laws of a number of modern states prohibit organ harvesting from a deceased person.
Engraftment of a donor gland from a person with recorded brain death implies an emergency operation. The commission that determines candidates for transplantation urgently reviews the waiting list and appoints the recipient. The patient is taken to the clinic, where they do a liver transplant, prepare and proceed to the operation. From the moment of withdrawal to the beginning of the manipulation, no more than 6 hours should pass.
For baby
A separate issue is child donation. It is possible to transplant a liver to a child, but only an adult person has the right to donate part of his liver. In addition, when selecting a donor, the size of the organ should be taken into account for the best survival rate.
Thus, a recipient under the age of 15 is transplanted with only half of one of the liver lobes, while adult patients always receive whole lobes.
Types of transplants
There are only three main methods of liver transplantation:
- orthotopic;
- heterotopic;
- resumption of bile drainage.
The first one is the most widespread. It involves the complete removal of a diseased human organ, and a donor gland or its share is placed in its place. Aftertransplantation, the liver should take its natural physiological place in the space under the diaphragm. Such an operation is carried out in eight cases out of ten. The procedure lasts from 8 to 12 hours, is carried out in stages.
Heterotopic transplantation is an operation in 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 a part of the inferior vena cava only if the whole liver is transplanted with the corresponding fragment of the blood vessel. The arteries and bile duct leading to the organ are crossed. Circulation is maintained by shunting with special pumps.
Third transplantation option: Donor liver is transplanted without a gallbladder. To restore the 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. As soon as 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, so sufficient time is allocated for preparation before the liver transplantation. By the way, rehabilitation will take much longer.
A patient on the waiting list must be ready at any time for an emergency transplant. The patient needs:
- Completely give up bad habits.
- Follow a diet anddoctor's advice.
- Don't put on weight.
- Exercise regularly, get basic physical activity.
- Take medication from prep course.
A potential recipient must always be in the access zone, be in touch and have collected things, documents in case of an urgent operation. The slightest change in he alth 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 test;
- electrocardiography;
- oncotests;
- Ultrasound of internal organs.
In addition, the patient is given a trial injection of donor tissue into the body for prophylactic purposes to prevent rejection of the gland after transplantation. To increase the chances of survival, a he althy organ is removed simultaneously with the patient's hepatectomy. If this condition cannot be met, the donor gland is stored chilled 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 long they live with a donor organ, is possible only after the rehabilitation period has passed. Any type of transplantation is one of the most complex surgical interventions requiring a lot of time for recovery.
The patient spends the first week after surgery in the intensive care unit, soas this period is the most dangerous for the patient. A number of complications can occur after a liver transplant:
- Primary liver failure. The “foreign” organ does not immediately begin to perform its functions, therefore intoxication of the body is possible. The tissues of the gland undergo necrosis. In severe cases, an urgent second liver transplant is needed. If this is not done, the patient will die.
- Bleeding.
- Peritonitis.
- Portal vein thrombosis.
- Tissue infection accompanied by inflammation.
- Organ rejection.
The last of these is a normal reaction of the recipient's immune system to a foreign body. Typically, rejection is stopped by suppressing the immune response with immunosuppressants. The patient will have to take these drugs for quite a long time, until the new organ takes root completely. As soon as the risk of rejection decreases, the dosage is reduced.
According to reviews, a liver transplant forces the patient to radically change his lifestyle. Mandatory conditions for the patient are:
- Regular follow-up with a hepatologist during the first year after transplantation.
- Periodic ultrasound, clinical blood and urine tests.
- Follow your diet (Diet 5 is recommended).
- Inadmissibility of high physical activity.
A patient with depressed immunity needs to be protected from viruses that can become fatal for him due to temporary inability tobody to resist infectious diseases. It is important to understand that the risk of organ rejection accompanies the patient until the last days, and without taking 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 live.
How long do people live after a liver transplant
In Russia, transplantation of internal organs is carried out according to federal programs. The Ministry of He alth sends the patient to one of the transplantation centers, where he undergoes a detailed examination. After that, his data is entered on the waiting list. When the turn comes and a suitable donor is found, the patient will be operated on. By the way, there is also a queue for those who want to receive iron from a relative.
As already mentioned, life prognosis for liver transplant patients can only be given after rehabilitation. Up to 90% of recipients live over one year. The five-year survival threshold is overcome by about 85%, and the fifteen-year - no more than 60%. The best results in terms of survival are observed in patients who received a liver from a living donor. The complete recovery of the donor organ occurs in just a few months, since in most cases a portion of the gland is removed using a minimally invasive laparoscopic method.
