Liver Transplant
Liver transplant
The liver transplantation is a treatment reserved in some centers specializing in chronic liver disease reached an advanced stage .
The main indications for this major surgery are:
In children, atresias (congenital malformation) of the bile ducts ;
In adults: primary biliary cirrhosis , primary sclerosing cholangitis , certain cases of chronic hepatitis B or C , cirrhosis with severe hepatocellular insufficiency, certain primary liver tumors and rare metabolic diseases (Wilson's disease, alpha deficiency -1-antitrypsin, overload diseases).
After transplantation , immunosuppressive therapy (corticosteroids, ciclosporin, azathioprine) is necessary.
A liver transplant is a long and complex operation that takes place in several distinct stages: removal of the diseased liver, removal of the liver from the donor to then transplant it to the recipient and finally ensure that it is functioning normally.
WHAT HAPPENS WHEN A LIVER IS AVAILABLE FOR TRANSPLANT?
A liver from a donor is offered to the transplant team by the graft distribution center of the Biomedicine Agency. The liver is offered by name to a given recipient according to priority rules defined in advance.
If you are chosen as the recipient, you are contacted by the transplant team that takes care of you to find out if you still agree to be transplanted and if there is no last minute contraindication. It is necessary that you can respond immediately, regardless of the time. You are then invited to go to the transplant center that supports you. You have to stay on an empty stomach.
Meanwhile, a surgeon from the transplant team removes the donor's liver. You will not be operated on until the surgeon has examined the donor's liver and made sure it can be transplanted.
WHERE DOES THE TRANSPLANTED LIVER COME FROM?
The liver comes in the vast majority of cases from a brain-dead donor: his brain no longer functions and is no longer able to provide vital body functions such as breathing. Only the heart continues to beat and supplies blood to the various organs including the liver.
The authorization is given by the family of the deceased or by the will of the donor, expressed during his lifetime. Comprehensive examinations are performed to ensure that no disease is transmitted to the recipient along with the transplanted liver.
The transplant of a part of a living donor liver to treat cancer is a rare procedure and not performed by all transplant centers. It is a complex operation that has many contraindications and can lead to significant complications for the donor. The part of the liver transplanted is also sometimes insufficient for the recipient. In practice, this type of transplant is discussed if the donor is in good health with a compatible liver and if the waiting period for a classic transplant is too long.
HOW IS THE INTERVENTION CARRIED OUT?
Liver transplantation is a two-step operation. The surgeon first removes the diseased liver before transplanting the healthy liver from the donor. These two steps require perfect synchronization. The transplanted liver, also called a graft, must not be deprived of blood for too long in order to be able to function normally again.
REMOVE THE DISEASED LIVER
The operation is performed under general anesthesia. The surgeon makes an incision horizontally under the ribs, and vertically towards the breastbone. This opening allows it to manipulate the entire liver.
The surgeon begins by removing the diseased liver, making sure not to spread the tumor to other areas of the body. He also takes care to limit the risk of hemorrhage, that is to say of significant loss of blood, which can occur at this stage of the operation.
TRANSPLANT HEALTHY LIVER
When all of the diseased liver is removed, the healthy liver transplant can begin. The surgeon first places the graft in the abdomen. The blood vessels are connected in priority to allow the liver to be supplied with blood again. The various vessels carrying bile are then connected. Once the transplant is performed, the surgeon tests the circulation of blood and bile.
Before closing the abdomen, small tubes called drains are installed to remove fluids and secretions such as blood, lymph or bile that may collect around the liver.
The operation is long and can last up to fifteen hours.
The transplant is a big operation which requires an important follow-up to prevent and take charge of possible complications.