Liver transplant

A Liver transplant is necessary for severe liver disease when conservative measures are no longer successful. A healthy liver is placed in the patient's abdomen and his immune system is then suppressed so that the transplant is not rejected.

What is a liver transplant?

At a Liver transplant a sick liver is replaced by another person's healthy liver. The orthotopic liver transplant is the most common.

The surgeon in charge completely removes the patient's liver and replaces it with a donor organ in the same place. A liver transplant is a serious surgical procedure which is mainly used for end-stage liver diseases and acute liver failure.

If a complete liver is transplanted, it comes from a deceased person. However, it is also possible to transplant part of the liver of a healthy person.

Function, effect & goals

A Liver transplant is usually the last attempt to treat an otherwise no longer treatable liver disease. Liver transplantation in children or adolescents is only necessary in exceptional cases. This is usually the case when there is a malformation of the biliary tract.

Various metabolic diseases can also impair the functioning of the liver so severely that it has to be removed and a healthy one inserted. These include Wilson's disease, primary bleeding disorders and familial amyloidosis. Indications for a liver transplant are, for example, cirrhosis caused by hepatitis B / C or by obesity (fatty liver).

If liver trauma occurs as part of an accident, a transplant may also be necessary here. Acute liver failure can result from severe intoxication. In addition, poisons such as the death cap mushroom or drugs such as paracetamol can damage the liver. Another area of ​​application for liver transplantation is malignant diseases such as hepatocellular carcinoma or hepatoblastoma.

If a liver transplant is necessary, the most common type of liver transplant is orthotopic. This is a standardized procedure in which the patient's entire liver is removed and the liver of a deceased person is inserted.

In order for the liver to function after the transplant, the surgeons must connect the patient's blood vessels to those of the transplant. If the doctors are able to restore the blood flow, the transplanted liver is supplied with oxygen and can begin to function.

In the last step, the patient's bile duct is connected to the recipient organ's bile duct and the abdomen is closed. Inserted drains ensure that wound secretions can drain away. An orthotopic liver transplant takes several hours. If the operation went well, the patient has to stay in the hospital for a few weeks.

In addition to an orthotopic liver transplant, a living donation is also possible. A part of the liver is removed from a family member or friend of the patient. After that, the patient's liver is removed and the donor part is inserted. The removed part of the donor's liver grows back after a few weeks.

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Risks, side effects & dangers

A Liver transplant carries many dangers and risks and, as with any operation, the patient can even die. The more advanced the liver disease, the higher the risk of surgery.

Since the advantages and risks of liver transplantation are very individual, it is of the utmost importance that the patient is informed precisely before the procedure. General anesthesia already carries risks. It is not uncommon for postoperative nausea and vomiting to occur after waking up. Allergic reactions to the medication given cannot be ruled out either. Generally, however, general anesthetics are not overly dangerous.

The possible rejection of the donor organ represents a considerably greater risk. To prevent rejection, immunosuppressants must be administered which suppress the patient's immune system. This drug therapy must be carried out over a long period of time or for life. Possible side effects of immunosuppression include diarrhea, nausea, headache, and stomach problems up to stomach ulcers.

There is also an increased risk of osteoporosis and kidney function may be impaired. Due to the strong immunosuppression, the patients have a significantly increased risk of infection after the transplant. However, this risk only exists to this extent in the first time after the transplant, as the drug dose can be significantly reduced afterwards.