Living Donor Liver Transplantation 認識活體肝臟移植(英文)
Living Donor Liver Transplantation 認識活體肝臟移植(英文)
The liver performs a lot of important work in the human body. Once irreversible diseases occur and cannot be treated traditionally, liver transplantation becomes the only treatment to prolong life when there are no other medical methods or machines to replace the failing liver. A living-donor liver transplant (LDLT) involves transplanting a portion of the liver from a healthy adult into a recipient.
LDLT donors screening
According to Article 8 of the Human Organ Transplant Act, the hospital removing an organ from a living body for a transplant operation shall abide by the following provisions:
- The donor should be aged 20 or above and has a sound mental capacity.
- The donor shall issue written consent with the free will and the written proof of his or her nearest relatives.
- The donor is confirmed to meet the criteria of donation subject to professional psychological, social, and medical assessments and the review and approval of the Medical Ethics Committee.
- The recipient should be restricted to no more than a fifth-degree of kinship, or the spouse of the donor.
- Adults or married minors aged over 18 years may donate part of their liver organ to relatives no more than a fifth-degree of kinship. Unmarried minors aged over 18 years may donate part of their liver organ to blood relatives of no more than a fifth-degree of kinship with the written consent of their legal representative.
- For removing an organ from a living body for a transplant operation, the hospital should give a detailed and complete psychological, social, and medical evaluation of the donors. The evaluation results should show that the donors are eligible for donation, and voluntarily donate organs without pressure and without entering into any transactions involving money or consideration, which should be examined and approved by their Medical Ethics Committee.
What examinations do donors undergo before surgery?
- Blood type, blood sugar, liver and kidney function, hepatitis, syphilis, AIDS, blood count, a tumor marker.
- Liver ultrasonography, electrocardiogram, chest, and abdomen X-ray.
- Examination: tissue matching differential diagnosis, cross-matching test, autoimmunity antibody.
- Computed tomography and functional magnetic resonance imaging.
- Social, psychological, and psychiatric assessments by social workers and psychiatrists.
What are the indications for liver transplant recipients?
- Congenital biliary atresia
- Congenital liver metabolic diseases
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
- Acute liver failure caused by fulminant hepatitis or drugs
- Primary hepatic malignant tumors and resection of tumors is not suitable for the liver function
- Decompensated cirrhosis: cirrhosis caused by viral hepatitis, alcoholic cirrhosis, unexplained cirrhosis
- Budd-Chiari syndrome
- Other terminal liver diseases that cannot be treated with traditional methods
What is the current procedure for LDLT?
Whether to donate the left or right lobe of the liver will be determined on the recipient's body size. Liver resection requires general anesthesia. The wound is usually large (more than 15cm). An intraabdominal organ structure is examined during the operation. The liver will be examined, and an ultrasound examination will be performed during the operation to confirm the structure of related blood vessels. The gallbladder is separated, and a catheter is inserted into the cystic duct, with the end of the common hepatic duct separated for cholangiography as a reference for cutting off the right hepatic duct. In the absence of bile duct malformation, the right hepatic artery and right portal vein are separated, while the structures between the posterior liver and inferior vena cava are dissected, leaving the right inferior hepatic vein (if any) larger than 0.5cm. The right hepatic vein is separated, and the liver parenchyma is cut along the mark. The liver is completely cut into two halves. The right liver to be donated is removed, and the liver graft is transferred to the recipient's room for implantation.
What is the effect of donating a portion of liver on the health of the donor?
Under normal circumstances, the human body will have temporary liver function deficiency after donating part of the liver. The liver function index usually returns to normal within 2 weeks after the operation. The regeneration of liver cells after the surgery will reach 80-100% of the original liver volume several weeks to six months following the procedure. After discharge, regular follow-up examination, a balanced diet, normal daily work and rest, adequate sleep and moderate exercise are required.
What are the risks and complications of LDLT?
- Possible complications in living liver donors: According to foreign reports, the death rate of donors is 0.2%-0.5%. Others such as bile leakage or postoperative biliary stricture (1%-3.3%), fever (3.2%), infection (3.3%). Paresthesia of hands or lower limbs or weakness of the limbs (3%), postoperative bleeding (0.8%-3.2%), peptic ulcer (1%). Intestinal obstruction (3.6%), pneumothorax or pleural effusion, hepatic insufficiency, jaundice, ascites (0.3%-0.8%), and liver failure (0.2%).
- Possible complications in LDLT recipients: intraperitoneal hemorrhage, vascular embolism, bile leakage, bile duct stenosis, rejection, infection, and pulmonary complications.
Benefits of LDLT surgery
Overall, recipients have a one-year survival rate of about 90% and a three-year survival rate of about 85% after liver transplantation. For a living donor, it would be a very positive experience to know that you have helped the recipient to improve their health and even be able to continue to live.
Notes for recipients after surgery
- Long-term follow-up and getting prescriptions are required in the transplant clinic after surgery. Patients may need hospitalization if they have the following conditions, such as fever and rejection
- For long-term use of immunosuppressive drugs, public places and various possible sources of infection (e.g. pigeons or sources of opportunistic infections in nature) should be avoided as far as possible. In the use of medicines (including Chinese and Western medicines), care should be taken to avert drug interactions and grapefruit and various foods and medicines that interfere with immunity.
I would like to donate my liver to my relatives. Where should I go?
- Organ Transplantation Center: (04) 22052121 ext. 2981
- Liver transplant clinic:
- clinic 011 on Monday evening (Critical Care Center Building B1)
- clinic 288 on Wednesday morning (Cancer Center 2F)
Liver transplant process
- Evaluate liver transplant patients
- Submit patient data to the liver transplantation independent review team
- Convene an independent review meeting on liver transplantation
- Screen living liver donors for eligibility
- Donors undergo evaluation at the transplant clinic
- Phase 1 outpatient evaluation
- Prepare relevant relationship documents
- Phase 2 outpatient evaluation
- Submit donor information to the Medical Ethics Committee for review
- Arrange LDLT surgery
- Postoperative follow-up after LDLT