One of the longest and most complex surgeries. Despite this, it is performed quite frequently.
Indications
Liver transplantation is used in cases of cirrhosis in the terminal stage, which can result from alcohol abuse and hepatitis diseases. Liver failure can be a reason for transplantation. In rare cases, transplantation is performed for benign and malignant liver tumors.
Donor Selection
The liver must immediately perform its function after transplantation; otherwise, the patient may die within the first 72 hours after the surgery. Unfortunately, there are no artificial devices capable of replacing this vital organ. Therefore, the guarantee of a successful operation is only a healthy donor liver. A donor may have brain death but have a normally functioning heart. The size of the transplanted liver should correspond to the size of the recipient's liver or be slightly larger. If the liver is too large, the left lobe of the liver is taken as a transplant. A liver with 40% or more of the parenchyma replaced by fat is considered unsuitable for transplantation. A series of tests for compatibility between the transplant organs and the donor are conducted.
Recipient Preparation
The patient must undergo thorough examination. The goal of the diagnosis is to determine the overall health status and the ability to undergo transplantation. Other serious diseases must be excluded. The recipient must not consume alcohol or nicotine for six months prior to the surgery. If necessary, treatment for identified diseases that may hinder effective transplantation is conducted.
Rejection
Acute rejection during liver transplantation occurs due to the destruction of the liver involving T-lymphocytes. This reaction is suppressed through immunosuppression. It usually occurs about six months after transplantation but can develop within four weeks after the surgery. The main symptoms of rejection include fever and weakness. A biopsy is performed to confirm rejection. Chronic rejection can occur within several months or several years after transplantation. For prevention, immunosuppression is conducted with a selection of drugs with different mechanisms of action. Complications after transplantation are classified into four degrees, and each requires its own treatment course.