Liver Transplant

The liver is a large organ, weighing approximately 1.5 kilograms, located in the upper right quadrant of the body, just below the diaphragm and next to the stomach and gallbladder. It consists of two main lobes, right and left, and is one of the most complex metabolic centers in the human body.
This organ, vital for life, undertakes:

• The cleansing of toxic substances (e.g., ammonia, alcohol, drug residues) from the blood,
• The synthesis of proteins, cholesterol, and clotting factors,
• The regulation of fat, carbohydrate, and glucose balance,
• The digestion of fats through bile production,
• And supporting the immune system to fight infections.

The liver is the only organ capable of performing so many functions simultaneously, and its most remarkable feature is its ability to regenerate. Even if a significant portion of a healthy individual's liver is removed, it can regrow and reach its original volume in a short time. This feature makes it possible to safely obtain tissue from living donors in liver transplants.

However, in some cases, the liver cells are permanently damaged, and the organ becomes unable to perform its functions. This condition, called liver failure, is a serious health problem that threatens life. In advanced-stage liver failure, the only permanent treatment option is a liver transplant (transplantation).

In this procedure, healthy liver tissue taken from a living donor or a cadaver is transplanted into the patient, allowing all vital liver functions to be regained. After a successful transplant, the patient can regain a healthy life. However, a liver transplant requires an extremely delicate and multidisciplinary process; therefore, it is vital that it is performed only by experienced transplantation teams and in well-equipped centers.

What is a Liver Transplant?

A liver transplant is the procedure of replacing a diseased liver that cannot perform its functions with healthy liver tissue obtained from a living donor or a cadaver. This operation is the only permanent treatment method for patients who have developed liver failure; sustaining life is not possible without a transplant.
The transplantation process is a multidisciplinary effort that includes, in addition to the surgical operation, the evaluation of donor and recipient compatibility, pre-operative preparation, and post-operative follow-up stages. Therefore, the procedure should only be performed in healthcare institutions with fully equipped and experienced teams, such as a Liver Transplant Center or an Organ Transplant Center.

For Which Diseases is a Liver Transplant Done? Who is it Suitable For?

A liver transplant is applied in cases of acute (sudden onset) and chronic (long-term progressive) liver failure to restore the organ's function.

Acute liver failure is a condition that develops in a short time and can progress rapidly. Its most common causes include:

• Mushroom poisoning (especially mushrooms containing amatoxin)
• Toxic side effects of certain drugs (paracetamol, antibiotics, etc.)
• Viral infections (e.g., hepatitis viruses)
• Toxic substance or chemical poisonings
  
  This type of failure threatens the patient's life in a short time and may require an emergency liver transplant.
  
  Chronic liver failure, on the other hand, develops over months or years. Its most common causes are:
• Cirrhosis,
• Hepatitis B and C infections,
• Bile duct diseases,
• Excessive alcohol use,
• Genetic and metabolic diseases (e.g., Wilson's disease or hemochromatosis),
• Some nutritional disorders.
  
  In these conditions, the liver's capacity to regenerate is exhausted, and the organ completely loses its function. In this case, the only treatment option for the patient to survive is a liver transplant.
  
  The transplant is performed only on patients who undergo comprehensive medical evaluations and whose general health condition is suitable for surgery. Each patient is evaluated in detail by the expert team within the Liver Transplant Center, and the most appropriate treatment plan is created.

Acute Liver Failure

Acute liver failure is an emergency clinical condition in which an individual with no previously known liver disease loses liver functions suddenly, within days or weeks. As a result of the cessation of liver functions in a short time, toxic substances accumulate in the body, the clotting mechanism is disrupted, and serious complications progressing to loss of consciousness can develop.

This condition is a life-threatening process and can result in death if an emergency liver transplant is not performed.

The most common causes of acute liver failure are:

• Viral hepatitis (especially severe forms of Hepatitis A and B)
• Drug toxicity (paracetamol, some painkillers, antibiotics, etc.)
• Mushroom poisonings (especially mushrooms containing amatoxin)
• Autoimmune hepatitis (the immune system attacking the liver)
• Genetic and metabolic disorders (e.g., Wilson's disease, fatty acid oxidation disorders)
• Unknown viral infections
• Toxic substance and chemical poisonings
  
  Cases of acute liver failure progress rapidly, potentially requiring transplant planning within hours or a few days, and should be managed in equipped and experienced units like the Liver Transplant Center.

What are the Symptoms of Acute Liver Failure?

Symptoms of acute liver failure appear in a short time and can rapidly worsen. These symptoms are related to the liver's inability to clear toxins and its loss of clotting functions.

The most common symptoms:

• Jaundice (yellowing of the skin and eyes)
• Nausea, vomiting, and loss of appetite
• Abdominal pain, fluid accumulation in the abdomen (ascites), and edema (swelling) in the legs
• Fatigue, weakness, feeling of feebleness
• Easy bruising on the skin, excessive bleeding from small wounds, nose and gum bleeds
• Dark-colored urine, gray or light-colored stool
• Dizziness, slowed perception, drowsiness, hand tremors, confusion, or coma (hepatic encephalopathy)
• Insomnia or feeling of restlessness
• Kidney dysfunction and low blood count (in advanced cases)
  
  When these symptoms are observed, it is vital to consult an Organ Transplant Center without delay.

Chronic Liver Failure

Chronic liver failure is a condition where the liver irreversibly loses its function as a result of long-term damage. It usually develops on the basis of cirrhosis and progresses over years, making a liver transplant necessary.
In such failures, liver cells are gradually destroyed, the liver shrinks, and irregular nodules (cirrhotic structure) form on it. When it reaches the final stage, toxic substances accumulate in the body, blood clotting is impaired, and multiple organ functions are affected.

The most common causes of chronic liver failure are:

• Chronic Hepatitis B and C infections
• Alcohol-related liver damage
• Autoimmune liver diseases (e.g., autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis)
• Bile duct diseases
• Genetic and metabolic diseases (Wilson's disease, alpha-1 antitrypsin deficiency, hemochromatosis, non-alcoholic steatohepatitis - NASH)
• Vascular disorders (e.g., Budd-Chiari syndrome)
• Cirrhosis of unknown cause (cryptogenic cirrhosis)

In these diseases, the liver's capacity to repair itself is lost. The disease can lead to serious consequences such as fluid accumulation in the abdomen, variceal bleeding, jaundice, and coma. At this point, a liver transplant is the only treatment option that saves the patient's life.

What are the Symptoms of Chronic Liver Failure?

Since chronic liver failure is slow-progressing, symptoms are usually noticed in advanced stages. However, there are some findings that need attention even in the early stages of the disease.

The most common symptoms:

• Jaundice (yellowing of the skin and eyes)
• Dark-colored urine, gray or clay-colored stool
• Fluid accumulation in the abdomen (ascites)
• Swelling in the legs and/or body (edema)
• Nausea, loss of appetite, weight loss, and feeling of weakness
• Extreme fatigue, weakness, and muscle wasting
• Easy bruising on the body, excessive bleeding from small wounds, nose and gum bleeds
• Black stool (melena) and vomiting blood (hematemesis)
• Drowsiness, hand tremors, confusion, or coma (encephalopathy)
• Insomnia, slowing of perception and expression, euphoria or depression in mood
• Itchy skin, redness in palms, spider-web shaped red spots (spider nevi)
• Breast enlargement in men, loss of body hair, decreased sexual function
• Menstrual irregularities in women, sexual dysfunction, or menopause
• Wasting of facial and body muscles (sign of chronic malnutrition)

In advanced cases, life-threatening complications such as hepatic coma (encephalopathy) and vomiting blood can be seen. At this stage, a liver transplant is the only way to extend the patient's life expectancy and improve their quality of life.

Who Cannot Have a Liver Transplant?

A liver transplant is a life-saving treatment for life-threatening conditions such as cirrhosis and acute or chronic liver failure. However, not every patient is a suitable candidate for this procedure.

The transplant candidate must be in a physical condition to withstand the surgery, be able to use immunosuppressive drugs regularly, not miss check-ups, and avoid habits that could harm the liver.

Some medical and behavioral conditions are considered contraindications for liver transplant (situations where transplant cannot be performed) as they seriously reduce transplant success.

Liver transplant is not performed in the following situations:

• Active alcohol or substance use: The risk of the liver being damaged again after transplant is very high in patients with ongoing alcohol addiction or substance use.
• HIV (AIDS) infection: Advanced HIV infection weakens the immune system, increasing the risk of post-operative infection.
• Advanced heart or lung disease: Conditions such as heart failure, advanced COPD, or pulmonary hypertension prevent the safe performance of the surgery.
• Massive liver failure and brain edema: In cases of massive liver failure with very severe brain edema, the surgical risk is fatal, so transplant is not performed.
• Cancer that has spread outside the liver (metastatic): Transplant is not performed because the risk of cancer recurrence after transplant is very high.
• Active, uncontrolled infections: Untreated systemic infections can cause post-transplant complications, so the transplant is postponed or cannot be performed.
• Severe psychiatric illnesses: Transplant is not considered appropriate in diseases such as schizophrenia, severe depression, bipolar disorder, because medication compliance cannot be ensured.
• Severe, irreversible systemic diseases: Diseases such as advanced kidney failure, uncontrolled diabetes, terminal cancer are outside the indication for transplant as they shorten life expectancy.
• Severe pulmonary hypertension: If the mean pulmonary artery pressure is above 50 mmHg, the surgical risk becomes fatal.
• Diseases that limit life expectancy in the short term: Transplant is not suitable in cases of multiple organ failure, such as cardiovascular system, nervous system, or blood diseases.
• Untreatable infectious diseases: Infections that cannot be controlled, such as hepatitis, sepsis, or tuberculosis, constitute a contraindication for transplant.
  The presence of such conditions, the patient's general health status, and psychosocial suitability are evaluated multidisciplinary by the Liver Transplant Center team. The aim is to ensure the highest success rate and long-term healthy life in patients undergoing transplant.

Who Cannot Be a Liver Donor?

A liver transplant can only be performed with healthy liver tissues obtained from voluntary individuals who meet specific health and compatibility criteria.
It is essential that the donor has the physiological structure to tolerate the surgery, has normal liver functions, and gives the donation decision of their own free will.
Individuals who do not meet these criteria cannot be liver donors.

Individuals who cannot be liver donors are:

• Persons not making the donation of their own free will (those donating under pressure or unwillingly)
• Individuals under 18 years of age
• Persons over 60 years of age (due to reduced regeneration capacity)
• Persons with a kinship degree beyond the 4th degree (ethical committee approval must be obtained for kinship degrees after the 4th degree).
• Persons with blood group incompatibility with the recipient
• Overweight (obese) individuals
• Persons with abnormal liver structure or function
• Individuals whose liver anatomy is not suitable for surgery
• Persons with advanced disease in vital organs such as heart, lung, kidney
• Hepatitis B, Hepatitis C, or HIV positive individuals
• Those carrying an active infection or systemic disease
• Individuals with psychiatric disorders or conditions affecting mental decision-making
• Individuals with alcohol or substance addiction
• Women during pregnancy
• Individuals with diseases that increase surgical risk, such as uncontrolled diabetes, hypertension, or metabolic syndrome
  
  Donor suitability is usually determined by a detailed medical evaluation lasting 2-3 days by the expert team at the Liver Transplant Center.
  During this process, laboratory, imaging, and psychological tests are applied to ensure the safety of both the donor and the recipient at the highest level.

Is Liver Transplant Risky?

A liver transplant can carry risks depending on the stage of the disease and the patient's general condition. A liver transplant is a very comprehensive operation where the largest blood vessels in the body are cut and reconnected. Therefore, complications such as bleeding, clotting disorders, or the transplanted liver not functioning sufficiently can develop.

Additionally, immunosuppressive drugs used after the transplant can increase the risk of infection. Despite all these factors, transplants performed by experienced teams have high success rates, and patients can return to a healthy life.

How Should Blood Group Compatibility Be in Liver Transplant?

Blood group compatibility between the recipient and the donor is one of the basic conditions for a successful liver transplant. Usually, exact matching of blood groups is preferred; however, in some cases, individuals with blood group 0 (zero) can donate a liver to other groups. This blood compatibility assessment done before the transplant reduces the risk of organ rejection and increases the safety of the operation.
 

Liver Transplant Blood Group Matching Table

The donor being Rh (+) or Rh (-) has no clinical significance for liver transplantation.

How is a Liver Transplant Performed? Stages and Application Process

A liver transplant is performed by transplanting healthy liver tissue taken from a living donor or a cadaver (donor with brain death) in place of the patient's damaged liver.
Cadaveric liver transplant is the method where the liver taken from individuals who have donated organs and have been diagnosed with brain death is used. Due to the limited number of donations, many patients are placed on a waiting list. If the patient's turn has not come, a life-saving intervention can be performed with a living donor liver transplant from close relatives with a suitable blood group.
In living donor transplants, a portion of the donor's liver is taken (usually the right or left lobe) and transplanted according to the recipient's body measurements. The donor's liver regenerates and reaches its normal size in the weeks following the surgery.

Application Process

On the day of the surgery, both the donor and the recipient are operated on simultaneously in different operating rooms. The liver piece taken from the donor is placed in the position of the patient's removed liver, and the blood vessels and bile ducts are carefully connected. Living donor transplant takes an average of 8-12 hours, while cadaveric transplant takes 4-6 hours.
After the transplant, the patient is monitored in the intensive care unit for a while, then receives treatment in the hospital for 7-10 days. During this period, they are carefully monitored for infection, clotting disorders, and organ rejection risk.
Yeditepe University Hospitals have high success rates in both living donor liver transplant and cadaveric liver transplant applications. With its experienced surgical team and multidisciplinary medical infrastructure, it restores a healthy life to many patients with results above world standards.