A liver transplant (liver graft) is performed in the following three steps

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Definition

What is a liver transplant?

A liver transplant (liver transplant) is an operation to replace the liver of a patient with liver disease with a healthy liver. This liver replacement can be done either in whole or in part from someone else.

This procedure is also divided into two types, namely donors who come from living people and donors of hearts from patients who have died. Living donor liver grafts are an alternative when a deceased donor is not available.

Liver donation from living patients can be done because the human liver can grow back after the surgical removal of part of the organ.

Generally, liver grafts are a last resort when medications and treatments from doctors are not showing satisfactory results. In addition, this procedure is also needed when you have liver failure and there is no tool that can completely replace liver function.

Who needs a liver donor?

Liver transplantation is usually recommended for people who have complications from end-stage chronic liver disease or cirrhosis of the liver.

Keep in mind that before getting a liver donor, you may need to wait, given the demand for liver grafts.

This makes the level of liver damage one of the benchmarks, whether a patient really needs a donor liver in the near future.

That is why, not all patients with liver disease need a liver transplant. In fact, there are several health conditions that are considered not allowed to perform liver transplant surgery, such as people with severe pulmonary hypertension.

If you have any questions, consult your doctor for more information. It is important that you discuss all possible treatment options for treating chronic liver disease.

Preparation

Transplantation is a fairly lengthy preparatory procedure. Here are some things to consider before getting in line for liver transplant surgery.

Talk to your doctor

Long before entering the operating room, you will need to consult a doctor to find out if your liver is in accordance with the conditions for a liver transplant. The reason is, liver transplantation is the last treatment option if other treatments have not worked.

In addition, not everyone can undergo this operation, as the condition of the body is not very healthy, which makes the risk of surgery quite large. If you and your doctor feel that this treatment is appropriate, the doctor will refer you to a transplant center.

Go to the transplant center

After getting a referral from a doctor, you can consider choosing a transplant center based on several things, such as:

• the number and type of transplants performed each year,
• transplant survival rates at the site,
• consider the services provided by the transplant center, as well
• understand the costs that will be incurred, both before and after surgery.

You will also undergo an examination from the transplant center to determine whether you meet the requirements or not. These examinations range from liver function tests to general medical examinations.

After the examination is complete and you are in good health for the transplant, you will be placed on a liver surgery waiting list.

Waiting for a suitable liver donor

Normally, the waiting period for a deceased donor transplant can last from less than 30 days to more than 5 years. How long you wait also depends on the severity of the liver damage.

In addition, there are other factors to consider, such as blood type, age, body size, and overall health.

If a donor liver from a deceased person is found, the transplant center will contact you. They will tell you what to do before going to the hospital and ask you to come to the hospital immediately.

Ensuring a suitable donor liver

Not only from transplant centers, liver donors can also come from family members, friends, or partners who want to become living donors.

The transplant center will determine whether you and the person have the appropriate blood type and body size. Then, they will also ask potential donors to undergo a comprehensive medical examination.

This is so that doctors can find out how the donor's liver functions and the history of the disease he has. When you get the green light, you and the donor can perform a liver transplant.

Maintain health

Keeping your liver healthy is the most important part of liver transplant preparation, whether you are waiting for it or the surgery is scheduled. The things below can also help speed up recovery after surgery.

• Take medication as prescribed.
• Follow diet guidelines and exercise schedule.
• Routinely consult a doctor.
• Maintain mental health.

Procedure

There are three procedures involved when a liver transplant takes place. The following are the three procedures that occur during liver transplant surgery.

Removal of the donor liver

The liver transplant process usually begins with surgery to remove healthy liver tissue from the donor. This procedure can be performed by grafting a portion of liver tissue from a living or deceased donor into the recipient's body.

Some of the transplanted liver tissue can grow back into a normal, intact organ. This also applies to some of the remaining liver tissue in living donors.

Operation back table

After the donor's liver is removed, the team of surgeons may make the necessary changes to the liver tissue to suit the recipient's needs.

This also includes reducing the size of the liver which is performed right before transferring it to the recipient's body.

Liver transplant surgery to the recipient

A transplant is the last step of a liver transplant. This procedure will implant healthy liver tissue from the donor to replace the damaged or malfunctioning liver.

As a recipient of a donor, you will be under anesthesia (anesthetic) to reduce pain. You will also be given medication to prevent too much blood loss.

During the procedure, the doctor will make an open incision in the stomach to transplant a new liver. After that, the doctor will also install several medical tubes so that body functions can continue to work after the liver transplant.

When is it necessary to return home after surgery?

You will likely be able to go home about 2 weeks after the surgery. Living donors can also go home about 1 week after surgery.

The doctor will also tell you when you can return to normal activities. You may not be able to return to your normal activities a few months after the liver transplant.

Most people can return to work, be physically active, and have a normal sex life if they regularly see a doctor to make sure your liver is functioning properly and you don't have any other health problems.

Side effects and risks

The procedure for liver transplantation, which is long and looks convoluted, actually aims to reduce the risk of complications, both after and during surgery.

Here are some things to watch out for from liver transplant surgery.

Liver graft complications

Both during and after the liver transplantation process is carried out, there are a number of risks that need to be watched out for, namely:

• bile duct complications, such as bile duct leakage,
• bleeding,
• blood clots,
• infection,
• the body's rejection of a new heart,
• confusion, as well
• recurrence of liver disease after transplant.

Drug side effects

After a liver transplant, you will take medication for the rest of your life to help prevent the body from rejecting the donated liver. This anti-rejection drug can actually trigger various side effects, such as:

• thinning bones,
• diabetes,
• diarrhea,
• headache,
• high blood pressure,
• high cholesterol, and
• risk of infection.

Result

The survival rate for liver transplants of course depends on the condition of each person.

Reporting from the Mayo Clinic, about 75% of people who undergo liver transplants can generally live for at least five years.

This means that every 100 people who get a donor liver there will be 75 people who live for five years. While 30 other patients will die within five years.

In addition, recipients of liver donors who were living donors were said to have better short-term survival. This compares with patients who received donor liver who had died.

Even so, it is still difficult to compare long-term results. The reason is, recipients of donors who are still alive usually have a shorter waiting time to undergo surgery.

Not only that, the level of their liver damage was also not as severe as the recipients of donated liver from donors who had died.

Lifestyle

There are many challenges that need to be overcome after an organ transplant including liver, especially facing possible complications and returning to everyday life.

If you do not take proper care, it will be very dangerous for the transplanted organs and overall health. So, what needs to be done after the liver transplant is done?

Always follow the doctor's instructions

After a liver transplant, the body's immune system perceives the donor liver as a foreign object and tries to protect the body by rejecting it.

That is why, you need to follow the doctor's prescription and visit the hospital for regular check-ups. If you experience signs of infection such as fever and diarrhea, consult a doctor immediately.

Avoid strenuous activity

After coming home from surgery, you also need to protect the operation area to prevent infection and other complications.

That way, you can return to your normal, active life. For that, there are several limitations to keep in mind as follows.

• Do not lift more than 2 kg for the first 6 weeks.
• Avoid carrying items weighing 9 kg for the first 3 months.
• Avoid activities that pull the abdominal muscles for 3 months, such as sweeping.
• Shower with shower better than bathing.
• Do not run on hard surfaces such as asphalt for 6 months.
• Not undergoing strenuous physical activity for 1 year, such as riding a motorbike.
• Avoid driving a car, especially when taking pain relievers.

Even so, you can still exercise lightly, such as walking, cycling, or swimming. However, make sure beforehand whether the type of exercise you want to do is in accordance with the body's condition after undergoing liver surgery.

Healthy diet

In order for the recovery process to be faster, it is also recommended that you eat a healthy and balanced diet. Your doctor and nutritionist will work together to create a healthy diet plan to meet your nutritional needs.

You also need to avoid certain foods for the drugs prescribed by your doctor to work properly. For example, avoid consuming grapefruit to prevent its adverse effects on immunosuppressant drugs.

In addition, you also need to limit some of these things so that the new liver function works properly, such as:

• salt,
• cholesterol,
• raw food,
• sugar, and
• fat.

It is also important to reduce to stop drinking alcohol and not smoking to maintain a healthy liver.

If you have further questions, please contact your doctor to get the right solution.