Liver Transplant

Liver transplantation (liver transplantation) is the only and definitive treatment option in acute liver failure, end-stage liver failure (cirrhosis) with irreversible liver damage and some cancers of the liver. The best known treatment in the world for patients with liver failure is liver transplantation. Every day Many people around the world get the chance to live with liver transplantation and return to their healthy and active lives.

Liver Transplant

Liver transplantation is carried out in two ways as “transplant from cadaver” and “transplant with living relative donor”.

Cadaveric Liver Transplant 

It is a type of transplant that can be performed after the families of brain-dead people donate theirorgans. In order to be able to perform cadaver liver transplant, it is necessary to be presented with some examinations that the person whose organ is removed does not have any infectious disease, cancer or liver disease.
The liver, which is removed under appropriate conditions and protected in special protection fluids,must be transferred to the patient within 24 hours at the latest. Due to organ donation rates are low in our country, unfortunately, there are long waiting lists for cadaver liver transplants. Therefore, it is highly important that patients and their relatives who are on the cadaver organ waiting list should keep their phone (preferably mobile phone) with them that can be reached 24 hours a day.

Living Donor Liver Transplant

It is a form of transplantation from living donors who do not have any health and legal problems in the removal of part of the liver. In order to perform this process, there must be a blood relation up to the 4th degree between the recipient and the donor. In cases where there is no kinship but voluntary basis, the approval of the ethics boards structured within the Health Directorates must be obtained.

All tests done on the voluntary person should show that there is no harm in giving a part of the person’s liver. In the performed examinations; It should be clarified by looking at the donor’s blood assessments that there are no additional diseases necessary for donating organs. In the second stage, it is checked whether the liver has the appropriate vascular and biliary tract anatomy, whethe the liver is large enough for the recipient and donor and whether the liver is fatty. For young pediatric patients, the left side of the donor’s liver should usually be removed and for adult patients, the right half of the donor’s liver should be removed.

Evaluation Before Liver Transplantation

The patient is listed for cadaver transplant, or if there is an eager relative whose blood type matches, the person is evaluated for donation and the transplantation is scheduled. In terms of the candidate-recipient, whether the transplant is from a cadaver or a living donor does not make a difference in terms of preparation. There is a similar preparation process. After determining the blood group, biochemical analyses are performed to determine the degree of progression of cirrhosis. This degree is measured by a mathematical value, which is expressed as the MELD score, calculated by values such as impaired jaundice tests, bleeding tests, kidney tests. As cirrhosis progresses, deterioration in these values and increase in MELD score are detected. 

The calculated MELD score of 10 and above means that it is a candidate for liver transplantation. When the score is 15 and above, the patient’s registration can be placed on the national waiting list for cadaveric liver with a system permitted and monitored by the Ministry of Health (Turkish Citizens only). 

Foreign patients can find a chance with a living donor but cannot be listed in cadaveric list unless they have emergency situation due to acute liver disease, not chronic disease. Advanced stage patients with common complaints of the cirrhosis stage such as variceal hemorrhage, loss of consciousness and build up of fluid in the abdomen (ascites), and patients with advanced liver tumors are listed in the top ranks according to the severity of the disease. Before the patients are included in the list, they are subjected to other clinical examinations (heart, lung, endocrine system, psychiatry, etc.) and as a result of additional clinical tests (respiratory tests, heart ultrasound, endoscopy, etc.), it is determined whether they are suitable for liver transplantation. The main goal of these examinations is to prove that the patient’s liver is problematic enough to need a transplant and that other organ systems are resistant to problems that may occur during or after transplant surgery.

The recipient candidate, whose preparations have been completed, proceeds on several paths considering the MELD score and accompanying problems

• If the MELD score is 15 and above, it is put on the cadaveric waiting list.(Turkish citizens) 
• Since cadaveric donation is limited (because current supply does not meet the demand), individuals with advanced disease (frequent variceal hemorrhage, frequent intra abdominal infections, tumor progression, and impaired consciousness), even if with high MELD score or MELD score is low, may be offered a living liver transplant option in the presence of a volunteer candidate.
• . Patients with low MELD scores (MELD 10-15) may be transplant candidates due to their accompanying clinical problems, but cannot benefit from the cadaveric organ system. If there are candidates, liver transplantation can be done from living donor.
• Patients with a MELD score below 10 and no additional clinical problems are not yet candidates for transplant. They should be in close follow-up. 
• Those who have extrahepatic diseases (kidney failure, cardiovascular disease, pulmonary disease, psychiatric problems, etc.) are candidates for liver transplantation if their current disease can be cured by liver transplantation. If the transplant operation worsens the problems that accompany transplant surgery, medical/surgical treatments of these conditions are foreground.