What are the most characteristic signs of liver diseases?
- Jaundice
- Dark colour of urine
- Water retention in the abdominal area
- Vomiting of blood
- Tendency of the body to bruise easily
- Gray or clay-colored stools
- Confusion or coma
- Extreme weakness (exhaustion)
- Excessive drowsiness
- Bleeding
Who needs a liver transplant?
According to international guidelines, any patient who suffers from cirrhosis and has a life expectancy of no more than one year should be considered suitable for a liver transplant. How severe the liver disease is is graded from "A" to "C". In general, all patients with grade "C" and most patients with grade "B" and some patients with grade "A" are suitable candidates for liver transplantation. Hepatologists decide which alternative is appropriate for patients – liver transplant or drug therapy. Surgical success is directly proportional to the health status of patients when they undergo the transplant.
Which patients need a liver transplant?
- Severe liver cirrhosis: hepatitis B, hepatitis C, alcoholic liver cirrhosis, Wilson's disease, primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune liver cirrhosis, cryptogenic liver cirrhosis, non-alcoholic steatohepatitis (cirrhosis associated with hepatic steatosis)
- Genetic and metabolic diseases: glycogen storage disease, tyrosinemia, alpha-1 antitrypsin deficiency, biliary atresia.
- Cancers of the liver: hepatocellular carcinoma, neuroendocrine tumour, hemangioendothelioma
- Acute liver failure: mushroom poisoning, high-dose paracetamol poisoning, acute hepatitis.
From whom can a liver transplant be obtained?
a. Liver transplantation from a deceased donor
This transplant can be done from deceased people who have agreed to donate their organs or from those who have suffered brain death and then their relatives give permission for the deceased's organs to be donated. Such organs can be donated to people depending on the compatible blood group and the urgency of the patients, according to the relevant legislation of the Ministry of Health of Turkey.
b. Living donor liver transplantation
This is a surgical method in which part of the healthy liver of a donor relative is transplanted to the patient who needs a new liver. The donor can be the recipient's wife with whom they have lived together for at least two years or any relative up to the fourth degree of blood relationship or legal relationship. However, in case there is no relative who is a suitable donor and he/she is a long time acquaintance or friend, approval from the Ethics Committee of the Health Department is required.
Operation:
The operation takes 8-10 hours. Liver transplant surgery is performed by a team of surgeons, anaesthesiologists, radiologists, intensivists, gastroenterologists, technicians and nurses.
The first requirement for liver transplantation is blood group compatibility.
What blood type can be the recipient and what the donor?
0 0 0-А-B-AB
A 0-A A-AB
B 0-B B-AB
AB 0-A-B-AB AB
Rhesus /Rh/ factors do not matter in liver transplantation.
In some exceptional circumstances and in infants, it may be possible to perform a transplant without blood group compatibility.
What tests are performed on the recipient and the donor?
Biochemical tests, radiological imaging, some specific tests regarding the risk of infection are performed on the liver transplant recipient, as well as consultation with a cardiologist and a specialist in lung diseases. The living donor undergoes some biochemical investigations along with computed tomography (CT) to look at the vascular structures of the liver, magnetic resonance imaging (MRI) to assess the bile ducts, and, if necessary, a liver biopsy is performed to look for hepatic steatosis and some chronic liver diseases.
What part of the living donor's liver is removed?
Usually, 40 to 70% of the liver is removed in adults for transplantation. The liver is divided into two – left lobe and right lobe. The anatomical division of the liver allows us to get two separate and independently functioning liver parts. On average, the right lobe represents 60% of the liver and the left lobe is 40%. The donor gallbladder is also removed during the transplant operation.
What are the risks to the living donor? Is there any danger in the future?
It is accepted that there is a risk of death for living donors of 2-5 per thousand (0.2-0.5). In other words, the success rate is 99.5 - 99.8%. In addition, some "simple" complications may occur that prolong the hospital stay of the living donor and require medical treatment in 10-15% of cases, as well as other complications such as bleeding, bile leakage, water retention in the lungs or abdominal cavity that require surgical intervention in 5-10% of cases. Nevertheless, long-term follow-up studies have shown that donors usually do not have problems related to liver transplant surgery in later periods of their lives. Almost all liver donors answer "Yes" to the question "If you had the chance to go back in time, would you donate your liver again?".
What are the risks of liver transplant surgery?
In most cases, the post-operative complications are surgical complications and infections such as bile leakage and blocked vessels. In the long term, complications such as cancer formation, organ rejection or bile duct stricture can occur. Nevertheless, the survival rate in the first year is 90 percent. Most patients return to a normal and healthy lifestyle.
How much does liver transplant surgery cost?
According to Turkish laws, people who are insured by the Social Security Agency can receive a liver transplant for free at liver transplant centres.
However, people who are not Turkish citizens, have to pay for the transplant themselves.
Prevention of liver disease
Prevention of liver cancer
Liver cancer can be prevented in two ways. One is to avoid alcohol and take preventive measures against infection with hepatitis B or C. Viral hepatitis (hepatitis B or C) is transmitted through the use of contaminated needles between drug addicts, through blood transfusions, and rarely through secretions or sexually from infected people. Another precaution is close monitoring of patients who suffer from liver disease. Some of these patients may develop cancerous growths. This situation can be prevented by performing a liver transplant at the right time or by operating on the diseased liver tissue.
Prevention of the development of viral hepatitis
Vaccination - Hepatitis B vaccination is routinely given to toddlers as part of a program to develop immunity. The hepatitis A vaccine is given to people who are at risk of infection when they travel. (There is currently no vaccine for hepatitis C, D, or E).
Blood Transfusion - During a blood transfusion, blood products are routinely tested for hepatitis B, C, or HIV to reduce the risk of infection.
Antibody preparation - in the event of exposure to the hepatitis B virus, an antibody preparation may be administered to prevent hepatitis B infection. Protection against hepatitis B and C is very important in high-risk groups.
These high-risk situations are:
- Unsafe blood transfusion
- Family history of hepatitis B or C.
- Surgical procedures or dental manipulations
- Intravenous drug use
- Sexual relations without precautions
- Dialysis
- Medical employees or others in the field.