Liver Transplantation

Liver Transplantation

T I-IE liver is one of the largest organs in the body. It is a dark chocolate brown coloured organ and is situated mainly on the right side of the abdomen, lying under and protected by the lower ribs. The liver is in contact with the surface of the dome of diaphragm. There is only one liver in our body and it is an absolutely indispensable organ. Complete removal or destruction will be followed by death in a very short time.

The liver is the great chemical laboratory of the body. It is the seat of the fundamental processes concerned in the metabolism of carbohydrates proteins and fats. Among it's many functions it is involved in the process of digestion, nutrition and the development of the red blood cells. It also produces bile, which flows out through a channel into the small intestine and helps detoxify harmful substances in the blood.

As told earlier, complete removal of liver causes death. Fortunately, nature has given us a tremendous amount of reserve liver tissue. It has been estimated that more than 80 per cent of the liver cells can be damaged or destroyed before symptoms of liver insufficiency will appear. Another positive feature is the liver's great capacity for regeneration and rebuilding itself after disease has injured the cells, or even destroyed large numbers of them. There are ways to prevent damage to one's liver. Protect it from the harm which can result from excessive drinking of alcoholic beverages, and from poisons such as carbon tetrachloride to which one may be exposed at work or while engaged in hobbies that require solvents. Obesity also damages the liver. A good, balanced diet and normal weight prevents this. The liver in a healthy body does not need to be "stimulated" by any medicines or tonic such as those which claim to increase the flow of bile. Liver transplant means replacing a damaged liver by a workable liver or part of the same from cadaver/donor. The man who receives a healthy liver or a portion of a healthy liver is known as recipient. Liver is usually damaged irreversibly due to some diseases such as cirrhosis, some metabolic disease, biliary disease, liver cancer etc. Under such circumstances liver transplant could be life saving.

There is only one liver in human body. It is however divided into two parts right and left parts. If someone donates one part of his liver he will not face any problem and will live normal life. Donors from whom liver or a part thereof is taken out for transplantation belong to two categories (i) Cadaveric and (2) Living related. The whole liver is removed from the cadaveric donor whereas part of the liver is taken out from the living related donor.

Professor Thomas Starzol of Pittsburg USA transplanted the first liver in human body on March 1, 1963. After that liver transplant is done in many places of the world. Today liver transplant is an approved and recognised treatment for end stage liver disease. In Singapore liver transplants are going on since 1990.

Liver Transplantation :
While dialysis is an option for people with kidney disease, no similar treatment is available for people with severe liver disease. Liver transplantation is the only option when the liver can no longer function. Some people who might have benefited from liver transplantation die before a suitable liver becomes available. Although the success rate of liver transplantation is somewhat lower than that of kidney transplantation, 70 to 80 per cent of the recipients survive for at least 1 (one) year. Most of these survivors are recipients whose liver was destroyed by primary biliary cirrhosis, hepatitis, or the use of a mediaction toxic to the liver transplantation as treatment of liver cancer is rarely successful. The cancer usually returns in the transplanted liver or elsewhere, fewer than 20 per cent of recipients survive for even a year. Surprisingly liver transplants are rejected less vigorously than transplants of other organs, such as the kidney and heart. Nonetheless, immune suppressant drugs must be taken after surgery. If the recipient has an enlarged liver, nausea, pain, fever, jaundice on abnormal liver function as shown by blood test results, the doctor may perform a needle biopsy. The biopsy results help determine whether the liver is being rejected and whether the dosage of immune suppressant drugs should be increased. The entire liver transplant operation is divided into two parts, e.g., donor and recipient operation. Two team of surgeons perform these two operations. Generally each team is composed of three surgeons. The team taking out the liver or part of the liver from the donor is known as harvesting team and the team transplanting the new liver to the recipient is known as recipient team.

Clinical Manifestations of Liver Disease:
Liver disease can manifest itself in many different ways. Manifestations of liver disease that are particularly important include jaundice, cholestasis, liver enlargement, portal hypertension, ascitis, liver encephalopathy, and liver failure. When making the diagnosis of liver disease, a doctor considers a patient's description of the symptoms and conducts a physical examination.

Major clinical features of liver disease include jaundice, enlarged liver, fluid in the abdomen (ascities), confusion from encephalopathy, gastrointestinal bleeding form varicose, portal hypertension.

Skin:
Spikerlike blood vessels, red palm, florid compulsion, itching.

Blood:
Decreased number of white blood cells (leukopenia), Decreased number of red blood cells (Anaemia), Decreased number of platelets (thrombo cytopenia), a tendency to blood colt (coagulopathy).

Hormones :
High levels of insulin but presupposes to it, causation of menstrual periods and decreased fertility (in women), impotence and femlnisation (in men).

Heart and blood vessels increased heart rate and amount of pumped, low blood pressure (hypertension).

General:
Fatigue, weakness weightless, poor appetite, nausea and fever.

Submitted By
Dr. Maswoodur Rahman Prince

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