Liver Transplantation - Living Donor
Application review
The review includes two stages. Applicants qualify for liver transplantation if all of the following statements apply to them. The recipient and the donor are related within five generations, or married to each other more than 2 years. Both of them are required to over 18 years old and to have the same or compatible blood types. But even incompatible blood type graft can still achieve comparable results after special treatment.
Basic assessment
1.The requirements and age limitation of being living donors
According to the law, the donor needs to be over 18 but no upper limit of age. The donor is better to be under 60 years old in order to prevent complications before, during and after the surgery.
2.The blood type requirements of being a living liver donor.
The blood types of the donor and the recipient can be the same, compatible or incompatible.
ABO-incompatible liver transplantation may result in an immune respond of B cell and then cause rejections. Therefore, it is necessary to have B cell antibody (rituximab) before the surgery, plasmapheresis with/without before or after the surgery. The successful rate is comparable with same or compatible blood type grafts. The cost of the medicine before and after the surgery and plasmapheresis depends on each patient’s condition.
3.The liver size of the living donor
The donating parts may be different depending on the liver sizes and liver structures of the donors. In general, the donor needs to follow the two principles below:
( 1 ) In order to offer enough liver function to the recipient, the size of the donating liver has to be as least 0.8% of the recipient’s body weight.
( 2 ) In order to stable the function of the donor’s liver, the remaining liver of the donor has to be at least 30% of its original size. The liver function of the donor will recover within 2-4 weeks. The time for liver growing to the normal size depends on each patient’s condition. Approximately, the liver will grow to 80% of the original size after 8-12 months. The donor can be discharged from the hospital within 1-2 weeks if no complications happen. The donor can be back to his/her normal life after 1 month. The doctor will give you further explanations after you pass the primary review.
Clinic/inpatient arrangement
It takes 4-8 weeks from completing the evaluation to performing the surgery. For emergent cases, the evaluation will be complete within 48 hours.
Step. 1 (clinic )
1.Blood test：blood type, the function of the kidneys and the liver,
hepatitis ABC, syphilis, AIDS, blood counting,
hemostasis.
2.Image check: liver transplant CT, 3D image synthesis
3.Female needs to take urine tests. Pregnant women are not suitable to donate their livers.
Step. 2 (staying in the hospital)
1.Blood test: tissue matching, cross-comparison test, virus check (the virus quantity of hepatitis B is , self-pay), latent tuberculosis infection tumor indexes, Human T-lymphotropic virus (HTLV-I/HTLV-II) and thyroid function.
2.Image check: bile ducts CT (self-pay), whole abdomen ultrasound, chest x ray, and breast check (female).
3.Other: Electrocardiography and liver function check.
4.Consultation: evaluation with psychologists and social workers and
consultation of Gynecology for female.
The possible outcomes of evaluations
1.Liver function disorder
There are many reasons for liver function disorder. The common is the patient who has fatty liver disease with drinking history. In order to donate a liver, the fatty infiltration of the liver must be lower than 10%. Also, the size of the liver (deducting fatty infiltration) has to be enough for donation. The patient with fatty infiltration more than 10% needs diet controlling, intensive exercising and body weight reduction for 1-2 months. Then, the patient will take CT or biopsy to evaluate the improvement. The patient with intermediate fatty liver disease is not suitable for transplant. It will endanger the life of the donor and the recipient.
2.The liver size of the living donor is too small
The safety of the donor is very important for living-donor liver transplant. If the size of the donor’s liver is too small, the remaining liver may be unable to properly function after the surgery. It will endanger the donor’s life. The solutions could be looking for another suitable donor, or increasing the size of the liver with nourishing and exercising. The amount of the increasing size is depending on each patient’s condition.
3.The anatomy variance of the donor and the recipient
It will increase the complexity and the danger of the surgery. The transplant team will make choices based on their specialties, technology and the safety of the patients.
Treatment
The duration, risks and complication
The duration of the operation depends on the donating part (left lobe, left or right liver lobe) and the variance of the blood vessel and bile duct. It normally takes 6-10 hours. The death in the surgery is approximate 3/1000. Some donors may have jaundice for a short period of time. In general, the incidence of complications is about 5%. The common complications are bile leaks, narrow bile duct, narrowing of blood vessels and wound infection. The common complications, incidences and solutions:
1.Biliary leaks or narrow bile ducts (1~3.3%): normally, it can be healed by nasobiliary drainage or percuteneous transhepatic cholangio drainage. In rare cases, it needs to place an endoscopic in a bile duct, and then have percuteneous transhepatic cholangio drainage or surgery again.
2.Fever (3.2%): it is normally caused by atelectasis, and it will be decreased by breathing training and cough with phlegm.
3.Infection (3.3%): such as respiratory infection, wound infection, urinary tract infection, vertical Transmission caused by catheters. The treatment will be giving stronger antibiotics. Severe infections are rare.
4.Hands or lower limbs dysesthesia or limb weakness (3%): due to the long period of time lying down during the surgery, the nerves of limbs may be damaged. It can be recovered after 3-month rehabilitation.
5.Bleeding after surgery(0.8-3.2%): transfusion can reduce the bleeding. Sometimes, it is needed to have another surgery to stop bleeding.
6.Peptic ulcer disease (1%): the donor may have peptic ulcer disease because of pressure. It normally can be treated by taking medicine, but in severe cases, the pressure may occur gastrointestinal bleeding.
7.Ileus (3.6%): after the surgery, the adhesion and enteroparalysis may cause ileus. It normally can be treated by resting gastrointestinal tracts, hydrating and replenishing electrolytes. In rare cases, surgical treatment is needed.
8.Pneumothorax or pleural effusion (3%): normally conservative treatment and percuteneous transhepatic cholangio drainage will reduce the conditions.
9.Portal vein thrombosis (0.5%-0.7%): it normally needs another surgery to remove thrombosis, and sometimes it will need to place stents.
Nursing care plan
The liver function of the donor will recover within 2-4 weeks. The duration for liver growing to the normal size depends on each patient’s condition. Approximately, the liver will grow to 80% of the original size after 8-12 months. The donor can be discharged within 1-2 weeks if no complications happen. The donor can be back to his/her normal life after 1 month. The doctor will give you further explanations after you pass the primary review
Revisits/follow-ups
After discharged, please turn for your check-up every once or twice a week depending on your condition. After 3~6 months, you may return every 2 month (please follow the instructions given by the doctor). If you have any discomforts or confusions outside of the hospital, please contact the transplantation team at 02-2875-7625, or make an appointment online.
Liver Transplantation - Living Recipients
Qualification review
Living liver transplantation is another option for patients who have the end stage liver diseases (except end stage liver cancer) to save or extend their lives. Most end stage liver failure patients are suitable for liver transplant unless the patient has other contraindication, such as septicemia, aids, malignant tumor of outer liver, severe cardiovascular disease, drug addiction or alcohol addiction.
The assessment is to measure the suitability of patient and to provide important information for the patient.
Examinations and assessments
1.medical records review
2.blood type and tissue matching
3.Regular blood, biochemical, urine and stool tests
4.Virology examination
5.infection assessment
6.breast x ray and abdominal ultrasound (or abdominal CT)
7.Optional gastroscopy
8.electrocardiogram
9.psychiatrist consultant
10.social worker consultant
11.nutritionist consultant
If patients are also elders or having diabetes, they need to take further cardiac examinations, such as cardiac ultrasound or systolic function. Elder women need to take breast and cervix examinations. Elder men need to take prostate examinations and bladder function examinations if having difficulties of urination. Oral health is also important. If you have cavities, you need to take treatments immediately. Otherwise, they may become the cause of transplant infections.
Clinic/inpatient arrangements
We will arrange the following living transplant examinations:
1.Blood tests:
Blood type, functions of liver and kidney, hepatitis ABC, the virus quantity of hepatitis BC , syphilis, AIDS, blood counting, hemostasis, tissue matching, autoimmune system, virus check, tumor indexes, PIVKA II , Human T-lymphotropic virus (HTLV-I/HTLV-II), thyroid function, arterial blood oxygen, latent tuberculosis infection
2.Image check:
All patients: liver transplant CT, 3D image synthesis , abdominal blood vessel ultrasound and chest x ray
Liver cancer patient: chest CT, whole body bone scan and positron emission tomography
Female: Breast ultrasound and mammography
3.Consultations
Psychology division: evaluating if the patients are in good medical, social and psychological conditions.
Cardiology: cardiac ultrasound for evaluating if the cardiac function is suitable for the transplant surgery
Colon and rectal surgery division: colonoscopy and proctoscopy for evaluating if the rectum, colon or ileum having malignant tumors
Gynecology and obstetrics: pap smear test and ultrasound for evaluating if having malignant tumor
4.Other: electrocardiography, urinalysis and urine cytology
Treatments
A living liver donation is performed under general anesthesia, therefore, during the surgery, you will not feel anything. In order to detecting the central venous and blood pressure, a central venous catheter will be inserted in the right part of your neck, and an artery catheter will be inserted in your upper limbs. The use of a bladder Foley catheter for monitoring urine output is also necessary. The surgery is performed in abdomen. The liver with cirrhosis will be removed from the incision that looks like a Mercedes-Benz logo. Besides the ill liver, part of the arteries and vein connecting with the ill liver, common hepatic duct and the whole gallbladder will also be removed. Then, place the new liver in the abdomen. The resource of new liver may be a deceased donor or a closed-relative living donor. The new liver will be connected with your liver veins, inferior vena cava, hepatic portal vein, liver arteries. When they are all matched, the new liver will receive blood flowing through. Then, the doctor will connect the new liver with your bile ducts and small intestine, and then create a new bile drainage duct. However, the new liver does not come with the gallbladder. Sometimes, it is necessary to remove the gallbladder or ligate the left kidney vein during the surgery. After the surgery, the doctor will place some drainage tubes in the abdomen for the bleeding drainage and observing biliary leaks or biliary bleeding.
Nursing care plans
1.To preventing the rejections damage the new liver, you need to take anti-rejection medicines for the rest of your life. The anti-rejection medicines are also known as immunosuppressive drugs. Taking the medicines may lead to some complications, including higher chance of having cancers and infections, damage of kidney and nerves and metabolic disease (hyperglycemia, hyperuricemia and hyperlipidemia). You need to regularly test the concentration of medication and certain indexes of blood.
2.You may have psychological or metal issues due to the surgery and the anti-rejection medications. With these conditions, you may take counseling or medical treatments.
Revisits/follow-ups
After discharged from hospital, you need to visit your doctor to follow up your condition once a week in the beginning. After stabilizing, you may visit the doctor once every 2 weeks or a month. During the visits, you will need to take blood tests to measure the liver function and the drug level of the anti-rejection medication. You may also need image study (ultrasound) every 3~6 months.
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Estimated Cost
For estimated medical costs, please contact International Medical Services Center.