If a patient is deemed suitable for transplant, the liver transplant team will discuss the following two options with the patients:
Deceased donor liver transplant
A deceased donor liver transplant involves replacing the recipient's diseased liver with a partial or whole liver from a deceased donor. If a patient is medically suitable, he/she will be added to the national liver waiting list and will undergo transplant surgery as soon as a suitable donor is identified.
Living donor liver transplant
A living donor liver transplant is when a healthy living person donates a part of his/her healthy liver to replace the recipient's diseased liver. After the transplantation, the liver in both the donor and recipient will regenerate itself. The living donor does not need to be genetically related to the recipient.
The diseased liver is removed and a healthy liver is transplanted in its place. This requires an operative wound/scar called a "Mercedes Benz" in the middle of the abdomen. The operation is complex and takes six to twelve hours. Removing the old liver can be slow, especially if patient has had previous surgery done. The liver is attached to five vital structures, all of which have to be divided and bleeding from all connected structures has to be controlled.
A portion of the donor's liver is removed for transplant into the recipient. Donor's liver will regenerate to full size a couple of weeks after surgery. There is no long-term risk of impaired liver function for the donor. Donors usually spend a week in the hospital to recover. Full recovery takes up to three months.
Most people return to normal physical activity within twelve months after liver transplantation. Most patients are also capable of returning to the work force. Sports activity can be resumed but it's best to avoid contact sports. Lifting heavy objects should be avoided for the first six months. Sexual activity can be resumed when desired.
In order for the liver transplant to be successful, the patient needs to take life-long medications (immunosuppressive agents) to prevent the rejection of the transplant liver. Immunosuppressive agents must be taken as long as the transplanted liver is functioning. There will be close follow-ups with the patient's liver specialists. The patient may also need to take other medications to prevent or treat transplant related conditions as and when necessary.
Usually, you will not need to follow the same dietary restrictions that were necessary before your operation. In some cases, however, the side effects of your medications may cause other temporary restrictions to be necessary. As your immune system will be suppressed to prevent rejection of the new liver, you will be at risk of infections, which includes food-borne illnesses. Your dietician will provide you information concerning food safety in the home, so that you can protect yourself from unnecessary infections.
1. Are there risks to the living donor?
As with any surgery, a liver donation carries risks. These include temporary arm numbness, temporary jaundice, bleeding, infection, bile leakage and even death. However, most donors do well and those with no complications can make a full recovery in three months. Donors are well looked after by their transplant surgeons through follow-ups at the clinic.
2. What is the Success Rate for Liver Transplantation?
Liver transplantation is a major operation. The majority of complications tend to occur in the first three months, especially in patients who have been seriously ill prior to the operation. Complications may be due to primary failure of the liver, rejection, technical complications (e.g. blockage of the hepatic artery), infection and haemorrhage (bleeding). However, more than 75% – 85% of patients who undergo liver transplantation do well.
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