Liver transplant in Iran: All you need to know

Liver transplant stands for the replacement of a diseased liver with a healthy liver from another person. Liver transplant is considered the only effective treatment for end-stage liver disease and acute liver failure. However, the availability of donor organs is a major limitation for the process.

What is liver transplant survival rate?

Survival rate depends on many factors, and there is no simple answer. However, about 75% of people who undergo liver transplant live for at least five years generally. In many cases, people who had a liver transplant lived for more than 30 years afterwards.

Who is a proper liver transplant candidate?

In general, every individual who is suffering from a chronic irreversible liver disease, who can no longer see results with medical therapy, and who is able to tolerate a major surgery is a candidate for liver transplant surgery. Some of liver transplant conditions and criteria are:

• Hepatitis C
• Hepatitis B
• Alcohol-caused liver disease
• Primary liver cancers
• Primary biliary cirrhosis
• Non-alcoholic steato-hepatitis or fatty liver disease
• Primary sclerosing cholangitis
• Alpha 1 Antityrpsin deficiency
• Autoimmune hepatitis
• Polycystic disease
• Hemochromatosis
• Veno-occlusive disease
• Wilson’s disease

For how long do you have to wait before you can get a liver transplant?

One of the main issues that worry the patients is the waiting list, as it is typical for the patients to wait for at least 149 days before undergoing a liver transplant, while children have to wait only for 86 days.

Is there an age restriction for liver transplant procedure?

In order to be a liver a donor, you must be between the ages of 18 and 60. At the same time, in case of requiring a liver transplant, it is really preferred for the patient to be under 70 years old.

Are children allowed to have a liver transplant?

Transplants are done when a child’s liver does not work well and he/she will not survive without a new one. This condition is called liver failure. However, a liver transplant is only recommended when all other medical treatments have failed. In some cases, a child does not need an entire new liver. In these cases, a living person, like a parent, can donate part of a liver by undergoing a procedure called a “living-donor liver transplant.”

This type of transplant is mainly preferred, since a person who donates a part of his or her liver can have a normal-sized liver again within just a few months of donating the tissue because livers grow new cells on their own.

How many types of liver transplant are there?

There are four different types of liver transplant that may be offered to the patient:

An orthotopic transplant

The most common transplant is called orthotopic liver transplant. In this procedure, the whole liver is taken from a recently deceased donor who has pledged his or her organs for donation prior to death and had not has transmissible illness or cancers that may be transmitted to the recipient.

Living donor transplant

Living donor liver transplant means the donor is a willing living person who wants to remove either the left lobe of their liver, which is used mostly for children, or the right lobe, which is mostly recommended for adults. Following transplantation, the transplanted lobe will quickly regenerate itself, and the remaining lobe for the donor will also grow back.

Split type liver transplant

Split donation involves transplantation of a liver from a recently deceased individual to two recipients. This type is perfect for a case of an adult and child patient, where the donated liver will be split into the left and right lobes.

Auxiliary liver transplantation

Auxiliary liver transplantation is a variety of liver transplantation where the recipient’s own liver is not completely removed. Its purpose is to retain the native liver in case of spontaneous recovery or if there is a potential for future gene therapy in cases of hereditary or metabolic liver diseases.

What is the assessment process prior to liver transplant surgery?

In most cases, your doctor will ask you to have a proper assessment or evaluation before you can be put on the waiting list. This thorough assessment is needed to check whether you are a suitable candidate or not and to determine the urgency of your condition. The assessment will be carried out at a liver transplant center, and the process normally takes about 5 days. Furthermore, a hospital stay may be required, or you may be able to go home at the end of each day, depending on your condition and on the doctor’s advice.

What happens during the assessment?

A proper assessment involves taking multiple tests to check your liver and general health. Before starting the tests, the doctor will check your condition verbally by asking about the symptoms and their effect your daily life. Your medical history will also be checked, in addition to your history with substances, such as drinking or drug problems. In general, tests might include:

• Blood tests
• X-rays and scans
• Heart tests – such as an electrocardiogram (ECG)
• Breathing tests – such as spirometry
• An endoscopy
• Abdominal ultrasound
• Complete physical examination
• Heart test for adults
• Lung function test for adults

Once your evaluation is complete, the transplant team will carefully review all your information and give their recommendation of the best treatment option for you. A transplant coordinator will contact you to schedule a time to discuss your care plan.

Is it essential for the blood type of the donor and the patient to be compatible?

Donors must have a liver anatomy that is suitable for donation and a compatible blood type with the recipient. For instance, if you have type O blood, you are a “universal donor” and can donate to anyone. However, if you are type A, you can donate to those who are also type A as well as type AB. Type B blood types can donate to other type B and to Type AB. This is while type AB people can donate to those with that same blood type, regardless of the Rh factor.

How is the liver transplant procedure done?

Liver transplant is a lengthy operation, as it takes normally 4 to 12 hours to complete. The surgeon begins by making an incision shaped like an upside-down and lopsided “Y” that stretches from one side of the rib cage to the other. The short, straight portion of the incision that extends up to the breastbone is 3 to 4 inches long. Then the surgeon makes a 12-16 inches long incision from one side of the rib cage to the other. After the incision is done, the surgeon removes the diseased liver, and Implants the new donor liver using a “piggyback” technique. Finally, the surgeon connects the portal vein, hepatic artery and bile duct, and closes the incision.

What are the recovery stages after liver transplant, and how long does the post-operation nursing stage take?

In the first healing stages, it is possible to stay in the intensive care unit for a few days, since it is necessary for doctors and nurses to keep a close eye on your condition. They will test your liver for any signs that might indicate a complication. Next, patients will have to spend 5 to 10 days in the hospital. Once they are stable, they will be taken to a liver transplant recovery area to continue the recovery process. Finally, patients will have to take medications for the rest of their life, as some of the prescribed drugs, called immunosuppressants, help prevent your immune system from attacking your new liver, and the other drugs help reduce the risk of other complications after your liver transplant.

What are some of the prescribed liver transplant drugs?

Liver transplant recipients take medication for the rest of their lives to help prevent the body from rejecting the liver. This type of medicine is known as anti-rejection (immunosuppressive) drugs. There are many known brands such as Neoral (cyclosporine), Prograf (tacrolimus; FK 506), Solu-Medrol (methylprednisolone) Prednisone, and many others. However, patients must not take any medication unless approved by the transplant team, as most of these medications have common side effects, such as bone thinning, diabetes, diarrhea, headaches, high blood pressure, and high cholesterol.

What is liver transplant bypass?

The process of a liver transplant bypass or a veno-venous bypass is a controversial medical process as it is associated with many life-threatening complications. However, in many cases, veno-venous bypass is the safest way to undergo the surgery, as during liver transplantation, major veins are clamped by the surgeon in order to decrease the blood returning to the heart, which has the potential to decrease the blood pressure and the blood flow to the vital organs. The only way to avoid this is diverting the blood flow through an external circuit bypassing the clamps and returning this blood to the heart, which is done by the technique called liver transplant bypass.

What is meant by anastomoses?

Anastomoses serve as a backup routes for blood flow if one link is blocked or otherwise compromised.

How can anastomoses help during liver transplant?

Liver implantation involves anastomoses of the inferior vena cava, portal vein, and hepatic artery. After blood flow is restored to the new liver, the biliary (bile duct) anastomosis is constructed, either to the recipient’s own bile duct or to the small intestine.

What are the main complications of liver transplant surgery?

Liver transplant surgery carries a risk of significant complications, such as:

• Blood clots
• Bile duct complications, including bile duct leaks or shrinking of the bile ducts
• Bleeding
• Failure of donated liver
• Rejection of donated liver
• Mental confusion or seizures
• Infection

In addition, there are Long-term complications such as the recurrence of liver disease in the transplanted liver.

Is there a preferred diet after liver transplant?

After getting your surgery done, it is necessary to adjust your diet to keep your liver healthy and functioning well in order to prevent excessive weight gain, as well as infections, high blood pressure and other complications. In general, if you were unable to stick to a certain diet, there are several tips that are advised by many detritions in order to maintain your liver’s health after the surgery:

• Eat lean meats, poultry and fish.
• Have enough fiber in your daily diet, by eating at least five servings of fruits and vegetables every day.
• Eat whole-grain breads and cereals and other grains.
• Drink low-fat milk and eat other low-fat dairy products to help maintain enough calcium.
• Maintain a low-salt and low-fat diet.
• Avoid alcohol.
• Stay hydrated by drinking adequate water and other fluids every day.
• Avoid grapefruit and grapefruit juice due to their effect on a group of immunosuppression medications (calcineurin inhibitors).

What Is Liver transplant failure (rejection)?

Rejection is a normal reaction of the body’s immune system to a foreign object. When a new liver is placed in a person’s body, the body sees the transplanted organ as a threat and tries to attack it. The immune system makes antibodies to try to kill the new organ, not realizing that the transplanted liver is beneficial. To allow the organ to successfully live in a new body, medications must be given to trick the immune system into accepting the transplant and not thinking it is a foreign object.

What are the signs of liver rejection?

There are common symptoms of rejection. However, each individual may experience symptoms differently. Common liver transplant rejection symptoms may include:

• Fever greater than 100°F (38°C)
• Fatigue
• Irritability
• Jaundice – yellowing of the skin and eyes
• Dark urine
• Itching
• Abdominal swelling or tenderness
• Headache

What can be done to prevent liver rejection?

Medications must be given for the rest of the individual’s life to prevent rejection. Each case requires different set of medications and different dosages. However, there are common brands among most cases such as Tacrolimus and Prednisone.

Who is a good candidate to become a liver donor?

To become a living liver donor, you must:

• Be a willing adult between the age of 18 and 60 years
• Be prepared to commit to the pre-donation evaluation process, surgery and recovery
• Be in good health and a proper psychological condition
• Have a compatible blood type
• Have healthy liver and kidney function
• Have a healthy weight
• Be willing to abstain from alcohol until fully recovered

Do donors have to get an evaluation first?

First of all, doctors meet with all members of our live donor team as a part of the evaluation process. Afterwards, several tests will be required to determine their liver transplant eligibility. The tests normally include:

• Blood tests
• Chest X-ray
• CT scan
• Electrocardiogram (EKG)
• Physical exam
• Tissue matching

What conditions are considered as liver transplant exclusion criteria?

Some conditions are to be excluded immediately, preventing the person from being an eligible donor. For instance, any donor with the following conditions is to be excluded:

• Advanced cardiopulmonary disease
• Severe pulmonary hypertension
• HIV infection
• Evidence of extensive intracranial neurological deficit
• Active extra-hepatic malignancies
• Chronic alcohol and/or substance abuse
• Persistent extrahepatic infection
• Unstable major psychiatric disorders
• Protein S deficiency, due to the increased risk incurred by the thrombophilic donor as well as the risk of transmitting the thrombophilia to the liver recipient.

Liver transplant and liver Cirrhosis

Liver transplant is the last and most effective treatment option for people with liver failure whose condition cannot be treated with any other medical treatments. In medical terms, there are two types of liver failure. The first one that happens in a matter of weeks is called acute liver failure, which is an uncommon condition. The second type that is more common occurs slowly over months and years and called (cirrhosis).

What are the main causes of liver Cirrhosis?

• Hepatitis B and C.
• Alcoholic liver disease, which causes damage to the liver due to excessive alcohol consumption.
• Nonalcoholic fatty liver disease, a condition in which fat builds up in the liver, causing inflammation or liver cell damage.
• Genetic diseases affecting the liver, including hemochromatosis that causes excessive iron buildup in the liver, and Wilson’s disease that causes excessive copper buildup in the liver.
• Diseases that affect the bile ducts (the tubes that carry bile away from the liver), such as primary biliary cirrhosis, primary sclerosing cholangitis and biliary atresia. In fact, biliary atresia is the most common reason for liver transplant among children.

How to choose liver transplant centers?

If your doctor recommends a liver transplant, you may be referred to a transplant center. However, before considering a specific center, there are many things to take into consideration, such as:

• The number and type of transplants the center performs every year.
• The cost of the entire procedure.
• The transplant center’s liver transplant survival rates.
• The additional post operation care services provided by the center.

What does a liver transplant team normally consist of?

Since this procedure is a delicate one that requires a lot of attention before, during, and after the surgery, the liver transplant team must consist of many individuals who belong to different medical fields, such as:

Transplant coordinator

A transplant coordinator will teach you about your liver disease, treatments, and how to take care of yourself after your liver transplant.

Transplant hepatologist

A transplant hepatologist will evaluate your current liver disease and will discuss the option of liver transplantation with you.

Transplant surgeon

This is the one who performs the operation. He or she will explain the liver transplantation surgery to you.

Social worker

Helps determine your ability to cope with the impact of liver transplantation on you and your family by asking you about your family life and social habits and giving you some recommendation about that.

Medical psychologist

The medical psychologist will prepare you mentally and psychologically to undergo the surgery.

Nutritionist

This specialist will help you understand your dietary needs and determine the foods and nutrition that are best for you during liver transplant process.

How can I arrange my medical trip to have liver transplant in Iran?

You can simply choose the most direct way by contacting AriaMedTour using one of the numbers provided on the website. You can also hit “Get a Free Consultation” on the website and fill a form in order to get a thorough evaluation for your condition and upcoming trip.