Liver Transplantation: Treatment, Effects & Risks

Liver transplantation is necessary for severe liver disease when conservative measures are no longer successful. In this procedure, a healthy liver is implanted in the abdomen of the diseased person and his or her immune system is then suppressed so that the transplant is not rejected.

What is a liver transplant?

Infographic on the anatomy and structure of the liver. Click to enlarge. A liver transplant involves replacing a diseased liver with another person’s healthy liver. Orthotopic liver transplantation is most commonly used. In this procedure, the attending surgeons completely remove the patient’s liver and replace it with a donor organ in the same location. Liver transplantation is a serious surgical procedure, which is mainly used for end-stage liver disease and acute liver failure. If a complete liver is transplanted, it comes from a deceased person. However, it is also possible to transplant part of a liver from a healthy person.

Function, effect, and goals

A liver transplant is usually the last attempt to treat a liver disease that is otherwise untreatable. Only in exceptional cases is liver transplantation necessary in children or adolescents. This is usually the case if there is a malformation of the bile ducts. Various metabolic diseases can also impair the function of the liver so severely that it must be removed and a healthy one inserted. These include Wilson’s disease, primary bleeding disorders, and familial amyloidosis. Indications for liver transplantation include cirrhosis caused by hepatitis B/C or obesity (fatty liver). If liver trauma occurs as a result of an accident, transplantation may also be necessary. Acute liver failure can occur as a result of severe intoxication. In addition, toxins such as those of the tuberous mushroom or drugs such as paracetamol can damage the liver. Another application of liver transplantation is malignant diseases such as hepatocellular carcinoma or hepatoblastoma. If liver transplantation is necessary, orthotopic liver transplantation is most commonly performed. This is a standardized procedure in which the patient’s entire liver is removed and the liver of a deceased patient is used. In order for the liver to function after the transplant, surgeons must connect the patient’s blood vessels to those of the transplant. If the doctors are able to restore blood flow, the transplanted liver is oxygenated and can begin functioning. In the final step, the patient’s bile duct is still connected to the bile duct of the recipient organ and the abdomen is closed. Drains are inserted to ensure that wound secretions can drain away. An orthotopic liver transplant takes several hours. If the surgery goes well, the patient must stay in the hospital for several weeks. In addition to orthotopic liver transplantation, living donation is also possible. In this case, part of the liver is removed from a family member or acquaintance of the patient. Then, the patient’s liver is removed and the donor’s part is implanted. The removed part of the donor’s liver grows back after a few weeks.

Risks, side effects, and hazards

Liver transplantation has many dangers and risks, and as with any surgery, the patient may even die in the process. The risk of surgery is higher the more advanced the liver disease. Since the benefits and risks of liver transplantation are very individual, it is of utmost importance to inform the patient in detail before the operation. Even general anesthesia carries risks. It is not uncommon to experience postoperative nausea and vomiting after waking up. Allergic reactions to the medication given cannot be ruled out either. In principle, however, general anesthesia is not excessively dangerous. A considerably greater risk is posed by the possible rejection of the donor organ. To prevent rejection, immunosuppressants must be administered, which suppress the patient’s immune system. This drug therapy must be administered over a long period of time or for life. Possible side effects of immunosuppression include diarrhea, nausea, headaches, and stomach problems up to and including stomach ulcers.In addition, there is an increased risk of osteoporosis and kidney function may be impaired. Due to the strong immunosuppression, patients have a significantly increased risk of infection after transplantation. However, this risk exists to this extent only in the initial period after transplantation, because thereafter the drug dose can be significantly lowered.