The liver is the largest organ in the body. It is found in the right upper abdomen, to the right of the stomach and behind the ribs. It is a very complex organ and has over 400 functions. Some major functions include storage of energy (glucose), vitamins, iron, and other minerals; making proteins, removal of chemically changing drugs, alcohol, processing of worn out red blood cells, bile production and killing of germs that enter the body through the intestine.
The liver is also able to regenerate itself. But when illness causes permanent and irreversible damage to the liver, transplantation might be an option to help maintain life. The first actual transplant was performed in the 1960s, and has become a standard form of therapy in the 1990s. The successes of transplantation have been due largely to major advances in surgical techniques, and new drugs preventing rejection of the new liver.
Reasons for Liver Transplantation
Medical treatment is always the first choice of therapy for liver diseases and liver damage. Only when all other forms of treatment have been unsuccessful and when the patient's liver can no longer support life will liver transplants be considered. This is also known as end stage liver disease.
Several conditions that cause chronic or continuing liver inflammation are more commonly treated with transplantation. Severe, irreversible and advanced scarring of the liver (i.e. cirrhosis) also leads to end stage liver disease. The following conditions are the most common causes of end stage liver disease:
- Chronic viral hepatitis B and C
- Primary sclerosing cholangitis
- Primary biliary cirrhosis
- Alcohol related liver disease
- Autoimmune hepatitis
- Liver disorders inherited or present at birth
- Drug induced liver damage
Survival rates depend a lot on the underlying disease of the recipient. Primary cancer of the liver has the lowest long-term survival at about 50%-60%1. Primary biliary cirrhosis and primary sclerosing cholangitis have survival rates of over 90%1.
Liver Transplants in NUH
The National Liver Transplant Center started at the National University Hospital since 1990. It is run by a multidisciplinary team comprising of transplant hepatologists, gastroenterologists, intensivists, transplant liver surgeons, and other staff.
To date, more than 100 liver transplants were performed at our unit. We are also the national tertiary referral centre for patients with complicated or severe liver diseases.
Commonest indications of liver transplants at our centre were liver cancer, and decompensated liver cirrhosis from chronic hepatitis B. Our 5-year and 10-year survival rate is 72% and 64%, respectively, which is comparable to international standards. (Unadjusted Patient Survival by Year of Transplant at 5 Years and 10 Years Deceased Donor Liver transplants from OPTN database – 72.5% and 59.4%2)
- Liver Transplant, Jackson Gastroenterology, Chek Med Systems®, Inc; 2002
This material does not cover all information and is not intended as a substitute for professional care. Please consult with your physician on any matters regarding your health.
Transplant centres are dedicated that have teams of surgeons and other professionals to evaluate and select patients, and perform surgery and follow-up care. In addition, they also maintain close communications with transplant candidates and the network that rations the livers as they become available.
Members of the transplant team include:
- Hepatobiliary Surgeons: trained in the field of transplantation
- Hepatologists: Liver specialist overseeing medical needs during the transplant period.
- Transplant Coordinators: registered nurses who perform evaluations, education and post-operative follow-ups.
- Transplant Social Workers: provides support for the patient and his/her family in dealing with stress and issues associated with chronic illness and transplantation
- Intensivists: Specialists in Intensive Care Unit who take care of transplant patients immediately after transplant while they are still at the Intensive Care Unit
- Anaesthetists: Specialist anaesthetists who take special care before, during, and after transplant surgery
- Psychiatrists: assess suitability of potential transplant donors and recipients psychologically
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