Liver transplantation is the process of replacing a damaged liver with a healthy donor liver in patients with advanced liver failure or irreversible liver damage. This method, performed by transplanting healthy liver tissue from a living donor or a brain-dead cadaver donor to the patient, is one of the most effective and permanent treatment options in end-stage liver disease.
What is Liver Transplantation?
Liver transplantation is the process of surgically removing a patient's own liver, which is no longer able to perform its function, and replacing it with a healthy donor liver in advanced-stage liver disease. This procedure is usually performed in cases of severe liver damage, cirrhosis, or irreversible deterioration of liver function.
Liver transplantation, performed by transplanting a healthy liver or liver tissue from a living donor or a cadaver donor to the recipient, is a vital treatment method that can significantly improve the lifespan and quality of life of patients.
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Why is a Liver Transplant Performed?
Liver transplantation is performed when the liver is irreversibly damaged, unable to perform its functions, and the patient's life is threatened. These situations include:
End-stage liver failure (cirrhosis)
Cirrhosis develops as a result of permanent damage to liver tissue and its replacement by fibrotic (scar) tissue. In the advanced stage, fluid accumulation in the abdomen (ascites), jaundice, changes in consciousness (hepatic encephalopathy), variceal bleeding, and serious clotting disorders develop. At this point, medical treatment is insufficient, and the permanent solution is liver transplantation.
Acute (sudden onset) liver failure
Liver transplantation is also performed in cases of liver failure that develops rapidly and progresses quickly in a previously healthy person. In this case, liver functions can deteriorate severely within hours or days. In this life-threatening situation, a transplant decision can be made without delay.
Liver cancer
Liver transplantation can also be performed in liver cancer patients who meet certain criteria. In cases of hepatocellular carcinoma (HCC), particularly in the context of cirrhosis, if the tumor falls within certain size and number criteria, transplantation treats both the cancer and the underlying cirrhosis.
Metabolic and genetic liver diseases
Some congenital metabolic diseases can severely impair liver function. These diseases include:
- Wilson's disease
- Hemochromatosis
- Alpha-1 antitrypsin deficiency
- Some childhood metabolic diseases
Who is a Suitable Candidate for a Liver Transplant?
Suitability for a liver transplant is determined by evaluating the severity of the disease, developing complications, additional diseases, and the patient's overall condition to tolerate the transplant. The groups that may be suitable for transplantation are:
Patients with acute or chronic liver failure
The primary reason for candidacy for a liver transplant is liver failure.
- Acute liver failure (sudden, severe damage developing in a previously healthy person due to factors such as viruses, drug/mushroom poisoning, or autoimmune causes),
- Chronic liver failure (mostly on the basis of cirrhosis).
Patients with cirrhosis who are ready for transplantation (evaluation with MELD/Child)
In cirrhotic patients, the need for a transplant is evaluated through blood tests, clinical condition, and scoring systems. Two main systems are used in this evaluation:
- MELD score (calculated using values such as sodium, bilirubin, INR, and creatinine),
- Child score (considering bilirubin, albumin, INR, as well as findings such as fluid accumulation/ascites in the abdomen and altered consciousness)
A MELD score of 15 or higher, and a Child score of B or C, are important thresholds suggesting that the time for a transplant has arrived.
Patients with serious complications due to cirrhosis
In some cirrhosis patients, not only the scoring but also the presence of complications strengthens the candidacy for transplantation. The following conditions, particularly those referred to as "portal hypertension complications," are important in the transplant evaluation:
- Fluid accumulation in the abdomen (ascites)
- Bleeding from esophageal varices
- Alcoholized consciousness (hepatic encephalopathy)
Who Cannot Receive a Liver Transplant?
Liver transplantation is not performed on every liver patient; the decision is made by evaluating the extent of the disease, vascular structure, cancer status, and the patient's general health condition together.
- Liver transplantation is not performed on patients with cancer that has spread outside the liver (metastatic).
- Transplantation is not performed on patients with advanced-stage liver tumors that have affected the major vessels or who do not meet the transplantation criteria.
- In cases where the portal vein is severely thrombosed (completely blocked), surgical transplantation may not be possible.
- Transplantation is not performed on individuals with advanced and uncontrolled heart disease due to the high risk of major surgery.
- Patients with severe and irreversible lung disease are not considered suitable for transplantation.
- Transplantation is not safe in patients who have developed multiple organ failure.
- Transplantation is not performed on individuals whose general condition is so poor that they cannot tolerate surgery.
- Transplantation is not performed on patients with a low MELD score who can be controlled with medical treatment, as it is unnecessary.
How is a Liver Transplant Performed?
The surgery is performed under general anesthesia and can take hours. First, the patient's damaged liver is carefully removed. Then, the healthy liver is placed in the abdomen, and its vessels and bile duct are individually connected. Once blood flow is established, the new liver begins to function.
If the transplant is from a living donor, the donor and recipient surgeries are started simultaneously and coordinated by two separate teams. While the appropriate portion of the liver is removed from the donor, the diseased liver is removed from the recipient, and preparations are completed; thus, the organ is transplanted quickly without delay.
Following the surgery, the patient is closely monitored in the intensive care unit. Bleeding is controlled, organ functions are monitored, and medications are started to regulate the immune system to prevent the body from rejecting the new liver. With proper follow-up and treatment, patients can eventually return to their daily lives.
What are the Donor Requirements for Liver Transplantation?
In living liver transplantation, both the donor's suitability for the recipient and their own health are extremely important. The requirements for a donor are as follows:
- Individuals under 18 years of age cannot be donors. Generally, those between 18 and 60 years of age are suitable.
- Blood group compatibility with the recipient is necessary. In some special cases, different blood groups may be considered, but perfect compatibility is ideal.
- They must not have a serious chronic disease.
- They must not have an active infection.
- They must not have fatty liver, cirrhosis, or structural disease in their liver.
- Heart, lung, and kidney functions must be normal.
- The donor's liver volume must be large enough for the recipient, and the remaining portion in the donor must be at a safe level.
- The donor must be a volunteer. A psychiatric evaluation is performed. Ethical committee approval is required for non-related donations.
- Extreme obesity is not preferred.
The following groups may not be suitable for donation:
- Those with active hepatitis or infectious diseases
- Those with advanced fatty liver disease
- Those with serious heart and lung diseases
- Those with uncontrolled diabetes or hypertension
- Those who are deemed psychiatrically unsuitable
What Should Liver Transplant Donors Pay Attention To?
Being a living donor in a liver transplant is a serious responsibility both from a humanitarian and medical perspective. Therefore, the person who will donate their liver needs to pay attention to some important points before and after the surgery.
Things to Consider Before the Surgery
The living donor must be completely healthy. Therefore, detailed blood tests, imaging, and organ evaluations are performed. The donor candidate must:
- Not have liver disease
- Not have serious heart, lung, or kidney disease
- Not have an active infection
- Be psychologically ready for the process. In addition, it is important to quit smoking and alcohol consumption before the surgery, eat a regular diet, and follow the preparation process recommended by the doctor.
Things to Consider After the Surgery
In the post-operative period:
- Doctor check-ups should not be missed.
- Medications should be taken regularly.
- Heavy lifting should be avoided in the first few weeks.
- Attention should be paid to hygiene to prevent the risk of infection.
- A balanced diet with sufficient protein should be followed.
Since the liver is a regenerative organ, the remaining liver tissue will gradually grow back to normal capacity. However, activities that strain the body should be avoided during this healing process.
What Happens If Organ Rejection Occurs After a Liver Transplant?
After a liver transplant, the body's immune system may perceive the newly transplanted liver as foreign and develop a defense against it. This is called organ rejection. However, thanks to the immunosuppressive drugs used today, organ rejection can often be controlled.
When organ rejection is detected, usually:
- Immunosuppressive drug doses are increased.
- Additional treatments are started.
- Short-term hospitalization is necessary if required.
Most acute (early stage) cases of organ rejection can be controlled with appropriate treatment. Early detection increases treatment success.
Frequently Asked Questions About Liver Transplantation
How Long Does a Liver Donor Live?
Living donors, under appropriate health conditions, can continue their lives with a normal lifespan and quality of life after surgery.
Is Liver Transplantation a Definitive Solution?
Liver transplantation is the most effective treatment for end-stage liver disease, but it requires lifelong follow-up and medication.
How Many Years Does It Take for the Liver to Regenerate?
The liver largely regenerates in volume within a few months after a living donor transplant.
Is There an Age Limit for Liver Transplantation?
There is no strict age limit; what matters is the patient's biological age and overall health condition that allows them to withstand the surgery.
What are the Risks for the Liver Donor?
While living donation is considered safe, as with any major surgery, there is a risk of bleeding, infection, and rarely, serious complications.
Is Liver Transplantation a Difficult Surgery?
Liver transplantation is a long and technically complex surgery requiring advanced surgical expertise.
How Long Does It Take for a Person to Recover After a Liver Transplant?
Patients can usually return to daily life within a few weeks after a transplant, but full recovery can take several months.
