A liver transplant is a surgical procedure in which a patient with irreversible liver damage receives a liver from a non-identical donor (allograft). Diseases such as Primary Sclerosing Cholangitis (PSC), hepatocellular carcinoma (liver cancer), and cirrhosis (scarring of the liver) may cause irreversible liver damage and subsequent end stage liver disease (ESLD). One of the most common reasons a liver transplant is performed is for liver cirrhosis caused by hepatitis C or alcohol abuse.
A patient being considered for liver transplantation must undergo an extensive assessment that includes diagnostic testing such as blood work, and imaging of the liver, as well as psychological and social counseling. It is inherent that the patient is tobacco and drug free, and will be required to prove cessation by passing drug screens as well as attending any required rehabilitation program or counseling. Only after the required criteria is met may the patient being placed on the UNOS (United Network of Organ Sharing) waiting list, although this unfortunately does not mean they will be transplanted immediately and must await a donor liver.
Prior to transplant, a patient will begin antirejection medications such as Tacrolimus or cyclosporine, mycophenolate, or a compilation of medications to ready the body for accepting its new liver. Compliance must be emphasized as the transplanted liver may be rejected without adherence to the prescribed medication regimen. These medications are especially important during the first year post transplant and will likely be lifelong medications even though the likelihood of rejection decreases after this time period.
When a donor liver is secured, the transplant patient will arrive to the transplant center and prepped for surgery with an IV placed, as well as an arterial line to monitor the patient’s internal pressures in conjunction with sedation. A large chevron (V-shaped) incision extending from the right ribcage to the lower abdomen will be made as the surgeon separates healthy tissue and blood vessels while readying the patient for the new liver. The liver will be transplanted and each blood vessel connected before the incision is closed. The procedure can take between four and 12 hours.
The patient will be in ICU for several days for monitoring, with an expected stay of 7-14 days. Potential risks following the procedure may include blockage of blood vessels within the transplanted organ, bleeding, clots, rejection or infection. Lengthy recovery of transplant patients may lead to activity intolerance with the majority recovering fully within 2-3 months.
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