Liver
If you place your right hand over the area under the ribs on the right side of your body it will just about cover the area of your liver. The liver is the largest gland, and the largest solid organ in the body, weighing some 1.8 kg in men and 1.3 kg in women. It holds approximately 13% (about one pint or 0.57 litres) of your total blood supply at any given time and has over 500 functions.
If you place your right hand over the area under the ribs on the right side of your body it will just about cover the area of your liver. The liver is the largest gland, and the largest solid organ in the body, weighing some 1.8 kg in men and 1.3 kg in women. It holds approximately 13% (about one pint or 0.57 litres) of your total blood supply at any given time and has over 500 functions.
The liver is dark reddish brown in colour and is divided into two main lobes (the larger right and the smaller left) which are further subdivided into approximately 100,000 small lobes, or lobules. About 60% of the liver is made up of liver cells called hepatocytes which absorb nutrients and detoxify and remove harmful substances from the blood. A hepatocyte has an average lifespan of 150 days. There are approximately 202,000 in every milligram of your liver tissue. The liver receives its blood supply via the hepatic artery and portal vein.
What is liver transplantation?
Liver transplantation is surgery to remove a diseased or injured liver and replace it with a healthy whole liver or a segment of a liver from another person, called a donor. A successful liver transplant is a life-saving treatment for people with liver failure, a condition in which the liver no longer works as it should.
Liver functions
Liver functions include:
* processing digested food from the intestine
* controlling levels of fats, amino acids and glucose in the blood
* combating infections
* clearing the blood of particles and infections, including bacteria
* neutralising and destroying all drugs and toxins
* manufacturing bile
* storing iron, vitamins and other essential chemicals
* breaking down food and turning it into energy
* manufacturing, breaking down and regulating numerous hormones including sex hormones
* making enzymes and proteins which are responsible for most chemical reactions in the body, for example those involved in blood clotting and repair of damaged tissues.
Some of the most important functions are:
Producing quick energy
One of the liver’s most important functions is to break down food and convert it into energy. Carbohydrates, such as bread and potatoes, are broken down to glucose and stored mainly in the liver and muscles as glycogen. When energy is required in an emergency the liver rapidly converts its store of glycogen back into glucose ready for use.
Your liver also helps the body to get rid of waste. Waste products which are not excreted by your kidneys are removed from the blood by the liver. Some of them pass into the duodenum and then into the bowel via the bile ducts.
People with liver damage may sometimes lose the ability to control glucose concentration in the blood and need a regular supply of sugar.
Fighting infections
Your liver plays a vital role in fighting infections, particularly infections arising in the bowel. It does this by mobilising part of your body’s defence mechanism called the macrophage system. The liver contains over half of the body’s supply of macrophages, known as Kuppfer cells, which literally destroy any bacteria that they come into contact with. If the liver is damaged in any way its ability to fight infections is impaired.
Symptoms of liver damage can be difficult to spot as they are not always obvious – they can include tiredness, nausea and itching.
Why do you need a liver transplant?
You may need a liver transplant if your liver is damaged to the point where it is unable to repair itself and is likely to fail completely. Your doctor may advise you to have a transplant when it is thought this will either dramatically improve your quality of life or that, without a transplant, you will die.
The main causes of severe liver damage that lead to people needing a transplant are:
* cirrhosis
* viral hepatitis
* metabolic conditions (problems with the physical and chemical processes that take place inside your liver to keep you alive)
* paracetamol poisoning
What are the signs and symptoms of liver failure?
By the time you discover you need a transplant your liver might begin to fail and your quality of life may be very poor. You may have experienced the following symptoms:
* loss of appetite
* generally feeling unwell and being tired all the time
* feeling sick and being sick
* very itchy skin
* loss of weight and muscle wasting
* enlarged and tender liver (you may feel very tender below your right ribs)
* increased sensitivity to alcohol and drugs (medical and recreational)
* yellowing of the skin and whites of the eyes (jaundice)
* swelling of the lower abdomen, or tummy (ascites), or the legs (peripheral oedema)
* fever with high temperatures and shivers, often caused by an infection
* vomiting blood
* dark black tarry stools (faeces) or pale stools, associated with cholestatic disease
* periods of mental confusion.
Having a liver transplant is a major undertaking but can lead to a resolution for these symptoms and, if successful, you should have an average life expectancy.
What is the process for getting a liver transplant?
The process for getting a liver transplant begins with a referral by a doctor to a transplant center. People seeking a liver transplant are carefully evaluated by a team at the transplant center to determine whether they are suitable candidates for transplantation. The evaluation includes a complete medical history, physical examination, blood and urine tests, x rays and other imaging tests, and tests to check the function of the heart, lungs, and kidneys. The transplant team usually includes liver transplant surgeons; liver specialists, called hepatologists; nurses; transplant coordinators; social workers; a psychiatrist; and other specialists. A financial counselor may help with making arrangements to pay for the transplant.
The evaluation of a transplant candidate typically includes assessment of
* the status of the person’s liver disease
* other diseases and conditions the person has
* the likelihood the person will survive the transplant operation
* the person’s ability to follow instructions and the complex medical regimen required after a transplant
* the person’s mental and emotional health
* the person’s support system
Status 1 Patients
Critically ill patients with acute liver failure who are likely to die within a week are categorized as status 1 patients and are given highest priority for liver transplantation.
What might prevent a person from having a liver transplant?
Each transplant center has its own guidelines regarding eligibility for liver transplantation. A center might determine that a person with acute or chronic liver failure is not a candidate for a liver transplant if the person has
* cancer outside the liver
* infection throughout the body
* advanced heart or lung disease
* an alcohol or drug abuse problem
* AIDS
* the inability to follow a treatment regimen
* a lack of psychosocial support
In addition, the transplant candidate may decide not to go forward with a transplant.
Where do donated livers come from?
Most donated livers come from deceased donors—donors who have recently died. Adults usually receive the entire liver from a deceased donor, although a segment of the liver can be transplanted when the donor liver is too large. Because few donor livers come from children, pediatric recipients more often receive a portion of a liver from an adult donor. Occasionally, an adult liver is split into two portions and given to two different recipients. For example, the smaller left lobe may be given to a child and the larger right lobe given to an adult.
A small number of liver transplants are performed using living donors. Most living donors are relatives of the recipient. In living donor transplantation, a segment of the donor’s healthy liver is surgically removed and transplanted into the recipient. Because a healthy liver can regenerate, the donor’s liver soon grows back to normal size after the surgery, while the segment of the liver that was transplanted into the recipient also grows to normal size.
The entire left lobe or a portion of the left lobe of the liver from a living adult donor is usually sufficient for transplantation in a child. For adult recipients, the larger right lobe of the liver may be needed. However, the removal of the right lobe of the liver from a living donor is a challenging and complex surgery with significant risks to the donor, including death.
What happens during liver transplant surgery?
When a suitable liver from a deceased donor is matched to a person who is ready to receive it, the surgery is scheduled as quickly as possible. The recipient completes presurgical testing and is prepared for surgery while the donor liver is obtained, transported to the hospital, and carefully checked to ensure it is suitable for transplantation.
Liver transplant surgery is complex and can take up to 12 hours. The patient receiving the liver requires general anesthesia given through a breathing tube inserted into the windpipe, intravenous lines to provide medicine and fluids, and a catheter to drain urine.
An incision is made in the upper abdomen, and the surgical team detaches the diseased or injured liver from blood vessels and the common bile duct, clamps the vessels and duct, and removes the liver. The team then attaches the recipient’s blood vessels and common bile duct to those in the donor liver. The donor liver is typically placed in the same location where the diseased or injured liver was. Tubes are sometimes placed around the transplanted liver to allow blood and fluids to drain out of the abdomen. A tube may be used to temporarily drain bile from the new liver into an external pouch so the bile can be measured to determine whether the liver is producing bile as it should. In cases where the recipient’s common bile duct cannot be connected to the donor’s bile duct, the donor bile duct is drained into a loop of small intestine.
After surgery, the patient goes to an anesthesia recovery area and then to an intensive care unit. After the patient is stabilized, the breathing tube used for anesthesia is removed and the patient moves out of intensive care and into a regular hospital room. Patients usually stay in the hospital from 1 to 2 weeks after a liver transplant.
Living donor transplants involve two surgeries performed in the same hospital. In one operating room, a surgical team removes the transplant recipient’s diseased or injured liver. In another operating room, another surgical team removes a segment of the donor’s healthy liver. Then the segment of donor liver is transplanted into the recipient. Otherwise, the surgery and recovery for the recipient is similar to that for a recipient of a liver from a deceased donor. The living donor typically remains hospitalized for about 1 week after surgery.
What are the complications of liver transplantation?
Possible complications of liver transplant surgery include
* bleeding
* damage to the bile ducts
* blood clots in the liver’s blood vessels
* infection
* rejection of the new liver by the body’s immune system
* side effects from the immunosuppressive medications liver transplant recipients must take to prevent rejection
In addition, liver diseases can recur in transplanted livers. The transplanted liver can be damaged if, for example, a person who had cirrhosis caused by long-term alcohol abuse resumes drinking after the transplant. Recurrence of certain liver diseases such as hepatitis C can also damage the transplanted liver. Recurrence of hepatitis B in the transplanted liver can now be prevented. Finally, autoimmune diseases, such as autoimmune hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis, may also recur.
If a person’s transplanted liver fails as a result of rejection or recurrent disease, the doctors on the transplant team must decide whether another transplant is possible.
Conclusions
A liver transplant is a surgical procedure by which a surgeon replaces a dysfunctional or damaged liver with a healthy one. Either a part of liver or whole liver is transplanted, according to the indication of the transplant.
In most cases, liver is taken from a deceased donor. It is also possible to take a part of liver from living donor. Since liver is the only organ in the body which can regenerate to increase its size, a part of liver when transplanted in the body rebuilds to the normal size liver within few weeks.
India is a home for one of the best surgeons and hospitals for Liver Transplant at much affordable cost. This makes India at the top destination option for the Liver Transplant.
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