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THE PHARMA REVIEW (JULY - AUGUST 2011)

Liver Transplantation

Dr. Ravishankar Bhat

Abstract
Liver transplantation is surgical procedure, which has come as boon to patients whose liver is irreversibly destroyed. Liver is one organ, if irreversibly damaged, can be fatal, as there is long-term liver dialysis available. In Liver transplantation, the native liver is taken out and a new liver is replaced in that place. The new liver may be from a person who is brain dead (Brain dead: Person who's brain is irreversibly damaged and heart is functioning) or from a living related donor. The living related donor's part of liver is taken out and transplanted to the patient who requires the liver.

 
Liver is transplanted to a patient whose liver is destroyed irreversibly due to various diseases. Cirrhosis is the most common reason for liver transplantation. Cirrhosis is a condition where healthy liver is destroyed and replaced by scar tissue. The common causes for the same are infections by viruses like hepatitis B or Hepatitis C, alcohol abuse, autoimmune diseases, deposition of fat in the liver and hereditary liver diseases. Liver tumours restricted to liver and can't be surgically removed also may be benefited by transplantation. When liver is destroyed without cirrhosis due to acute diseases of liver like infection or drug toxicity, Liver transplantation can be the only way to save the patient in emergency. Children with developmental problems in liver not compatible with life will survive after liver transplantation. During the surgery patient’s native liver is removed. Then a new liver is transplanted. In living donor liver transplantation, up to 70% of donor’s liver is removed and transplanted to recipient. Here good surgical skill and good decision making of the surgeon helps for safe and successful surgery. This is a long surgery which done in teamwork. It requires lots of planning after extensive preoperative investigations. During surgery many gadgets and instruments are required to improve the quality and safety of procedure. Postoperatively the recipient requires Intensive care management for few days, with many blood product transfusions and antibiotic injections with intensive monitoring. After the surgery patient will require immunosuppressants to safe guard the new liver from immunity of the patient. Therefore patient will have to take few medications regularly and require visiting the doctor frequently to assess the dosage and monitor for infections and tumours as side effects of these medications
A donor has to be of blood group matching the recipient, should be healthy, should not be overweight with liver anatomy being suitable for donation as it should be safe to the donor and liver should be sufficient to recipient. Donation is safe with a very low mortality of less than 1% and minimal morbidity. Donor requires approximately 10 days of hospital stay. After the surgery they are requested not to lift weight for 3 months to prevent hernia. Other than this there is no restriction in their life style. The liver grows to normal size within few weeks, so there is no long term harmful effects or reduction in liver function for the donors.

 

 

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