Liver transplantation is a surgical procedure that involves taking a diseased or damaged liver and replacing it with a healthy one. Generally, it is recommended when the liver is no longer able to perform its normal activities (liver failure or end-stage impairment of its functioning).
The causes of liver disease can be various: viral infections and / or alcohol abuse, diseases present at birth (congenital). The resulting damage is gradual and determines the change of the liver structure with the formation of nodules and the replacement of the parts (liver tissue) damaged with scars (fibrosis) formed by another type of cells that give rise to the so-called "connective tissue ". This tissue, however, does not perform the same functions as the liver cells and, consequently, the organ no longer functions well either from the metabolic point of view, nor from the synthetic point of view, causing the development of a disease that takes the name of cirrhosis of the liver.
Some of the main causes of liver disease are:
- viral hepatitis, such as related hepatitis C and B
- prolonged alcohol abuse
- diseases of the biliary tract (primary biliary cholangitis and primary sclerosing cholangitis)
- pigment storage diseases in hepatocytes: Wilson's disease (copper accumulation), hemochromatosis (iron accumulation), etc.
Cirrhosis of the liver is the natural basis (substrate) for the onset of liver cancer (hepatocellular carcinoma-HCC).
Liver failure can also occur very quickly as a result of inflammation and death (necrosis) of a large number of cells that make up the liver, the hepatocytes.
Liver transplantation may be recommended for the treatment of liver cirrhosis and, in selected cases, of liver cancer (hepatocellular carcinoma) and acute liver failure occurring on a healthy liver.
Requirements (parameters) necessary to undergo a liver transplant.
A rigorous and in-depth process of assessing the health (clinical conditions) and psychological status of a patient is envisaged before he or she obtains the green light for inclusion on the waiting list for liver transplantation from a transplant center. This procedure is necessary to ascertain that the patient's state of health allows him to undergo such a delicate surgery without running further risks, to be sure that he is aware of what he is about to face and that he is reliable with regard to the therapy and checks to be followed after the transplant For example, those suffering from cirrhosis of the liver due to alcohol abuse must undergo a course of assistance that will help them to get away from addiction for good.
In fact, liver donations are fewer than requests and this requires ascertaining, on the one hand, that the patient's state of health is not so compromised (as in the case of advanced liver cancer) as to put the patient at risk. result of the transplant itself; on the other hand, that the patient is responsible and motivated to observe behaviors that do not affect their own health and that of the organ received.
Types of liver transplant
There are three main ways to perform a liver transplant:
- liver transplant from a living donor: a part of the liver, usually the left lobe, is taken from the living donor and transplanted into the patient.Both parts of the liver (the one that remains in the donor and the one received by the patient) are, in fact, able to regenerate themselves until adequate liver function is obtained.
- liver transplant from deceased donor: in the event that the donor, while alive, has expressed to his family, in writing or verbally, the will to donate the organs at the time of his death or has not expressed himself, but the family members do not object, the liver it can be picked up and transplanted to a patient on a waiting list
- liver transplant using the Split-Liver technique: in the event that the donor has expressed a willingness to donate in life, the liver can be surgically divided into two parts, a right and a left (split). pediatric patient (age less than or equal to 17 years and 365 days at the time of registration on the waiting list) and the right hemifegate in an adult, but it is also possible that transplants are carried out in two adult patients
Most liver transplants are performed using organs from donors who are no longer alive and almost all are performed in a so-called "orthotopic", Or by transplanting the new liver in the same anatomical position in which the removed organ was located.
The operation is divided into three phases, hepatectomy (removal of the liver from the patient), anhepatic phase (without liver) e transplant.
The number of patients who need a liver transplant is much greater than the actual availability of organs; therefore, there is a waiting list in which the severity of the disease and the time elapsed since they were inserted is considered. (read the Bufala).
In Italy, the average waiting time on the list for a liver transplant is 1 year and 6 months for the standard list and 1 year for the pediatric list.In 2019, 2536 patients were on the waiting list. The total list satisfaction index is 46.6% and the mortality rate on the list has remained almost stable (4% compared to 4.2% in 2019).
The mortality rate is due precisely to the fact that, in the face of a scarce availability of organs, liver transplantation is the only definitive treatment for a person with liver disease; in fact, as for the heart, lungs and kidney, there are no aids that can replace and / or improve a damaged liver function.
For his part, the person enrolled on the waiting list must take the utmost care to keep his state of health in good condition and must communicate any changes to his transplant center, in order to be always ready and suitable to answer the call that can take place at any time, day and night.
Life after the transplant
Immediately after the transplant, symptoms gradually improve but most people need to stay in the hospital for at least a couple of weeks.
Resuming active life after surgery can take a long time but, in most cases, normal daily activities can be resumed within a few months (Video).
The transplant person will have to undergo periodic checks to check (monitor) the improvements over time and receive the so-called "immunosuppressive" medicines that he will have to take for the rest of his life to reduce the risk of rejection of the transplant.
The life expectancy after a liver transplant is generally good. More than 9 out of 10 people are still alive after a year, about 8 out of 10 people live a minimum of 5 years, and many people live for 20 years or more.However, a liver transplant is a complex surgery, not without risks and with serious complications that can occur during the transplant, immediately after the operation (post-operative) or even after some time.
Some of the main issues associated with liver transplantation are:
- bleeding complications during surgery
- rejection of the new organ transplanted by your body
- absence of functional recovery by the new liver which may be such that a new liver transplant is required in a very short time
- increased risk of infections
- impairment of kidney function
The National Transplant Center collects and publishes every year updates on the quality of transplant results, in terms of organ and patient survival at one and five years, for each individual center. The data relating to the results of the individual Centers are published on the website http://www.trapianti.salute.gov.it