LIVER TRANSPLANTATION

General Information

DEFINITION--Replacement of a diseased liver with a healthy liver obtained immediately after death from a donor with compatible immunological characteristics. In some cases, a segment of the liver of a living, related donor may be used.

BODY PARTS INVOLVED--Diseased or abnormal liver; healthy donor liver; blood vessels and bile ducts connected to liver.

REASONS FOR SURGERY--End-stage liver failure from liver cancer or other liver disease, such as chronic hepatitis.

SURGICAL RISK INCREASES WITH

• Infants.
• Obesity; smoking; stress.
• Excess alcohol consumption.
• Poor nutrition.
• Recent or chronic illness.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
• Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.

What To Expect

WHO OPERATES--General surgeon with transplant experience and training.

WHERE PERFORMED--Hospital.

DIAGNOSTIC TESTS

• Before surgery: Immune-system and liver-matching procedures; studies of body systems.
• After surgery: Blood studies.

ANESTHESIA--General anesthesia by injection and inhalation with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

• Liver is removed from donor, then chilled and preserved until surgery.
• An incision is made under the recipient's ribs. The abdominal muscles are separated or split, and the peritoneal cavity is opened.
• The liver and its bile ducts are isolated.
• The liver is cut free and removed. The donor liver is positioned and sewn in place. Blood vessels and bile ducts are connected.
• The peritoneum and abdominal muscles are closed. The skin is closed with sutures or clips, which usually can be removed about 1 week after surgery.

POSSIBLE COMPLICATIONS

• Excessive bleeding.
• Surgical-wound infection.
• Rejection of transplant.
• Bile-duct obstruction.

AVERAGE HOSPITAL STAY--3 weeks.

PROBABLE OUTCOME--A successful transplant prolongs life and improves the quality of life for a few months to a few years in patients who might otherwise have died. Allow about 6 months for recovery from surgery.

Postoperative Care

† Move and elevate legs often while resting in bed to decrease the likelihood of deep--vein blood clots.

MEDICATION---

Your doctor may prescribe:

• Pain relievers. Don't take prescription pain medication longer than 4 to 7 days. Use only as much as you need. > Stool softeners to prevent constipation. > Antibiotics to fight infection. > Immunosuppressants to decrease the likelihood of rejection.

ACTIVITY

• Resuming daily activities, including work, as soon as you are able can help the healing process.
• Avoid vigorous exercise for 6 weeks after surgery.
• Resume driving when your doctor determines that healing is complete.

DIET---Your doctor will prescribe a diet.

Call Your Doctor If

† Pain, swelling, redness, drainage or bleeding increases in the surgical area.

• You develop signs of infection: headache, muscle aches, dizziness or a general ill feeling and fever.
• You experience new symptoms such as nausea; vomiting; constipation; abdominal swelling; back pain; jaundice; or fluid retention in abdomen, eyes or ankles.