How is a Liver Transplant Surgery Performed and What Happens During and After the Operation?

Liver transplant usually takes between 6 to 12 hours. During the transplant, surgeons remove the patient’s liver and replace it with a donor liver. Since the liver transplantation is large and invasive procedure, surgeons must insert multiple tubes into the body. These tubes are essential to help the body perform specific functions during and several days after surgery. 

Tube replacement 

• A tube is sent through the mouth to the trachea to help the patient breathe through the liver transplant surgery  and one or two days after surgery. The tube is connected to a breathing apparatus that automatically enlarges the patient’s lungs.  

• A NG tube enters the patient’s stomach through the nose. This tube remains in place for several days until bowel function returns to normal.  
• A tube is inserted into the bladder to collect urine. A few days after surgery  this tube will be removed. 
•  Three tubes are inserted into the patient’s abdomen to remove blood and secretions from the liver. These tubes will remain in place for about a week.  
• In some cases, the surgeon places a special tube called the T-tube in the bile duct. The T tube removes the bile and transfers it into a small sac outside the patient’s body to measure it several times a day. 

Only certain patients receive the T-tube t, which remains in place for about 6 months. The tube does not cause any discomfort and does not interfere with daily activities. 

Liver transplant complications  

Liver transplant surgery has important complications. The risks associated with this procedure are: 

• Biliary complications, including biliary leakage or reduced biliary tract 
• Bleeding 
• blood clotting 

• Donated liver failure 
• Infection 
• Donated liver traces 
• Rejection 
• Mental confusion or convulsions 

• Long-term complications may include recurrence of liver transplanted liver disease. 

Two major problems that occur after liver transplantation are rejection and infection. 

1. Rejection 

The patient’s immune system tries to repel foreign bodies that invade the body. but the immune system cannot differentiate between transplanted liver and foreign invaders, such as viruses and bacteria. Therefore, the patient’s immune system may attempt to invade and destroy the new liver. About 64% of all patients receiving liver transplant have partial rejection, mostly during the first six weeks of transplantation. Anti-rejection  drugs are given to the patient to ward off an immune attack. 

Types of liver transplant rejection 

After transplantation, three types of rejection may occur, including: 

• Hyperacute rejection: Antibodies secreted from donor B lymphocytes that bind to vascular endothelial cell surface antigens and cause a reaction. In this reaction, the complement system is activated and usually has a profound effect. This rejection occurs at the moment of transplantation or several hours after surgery when the antigens are completely unmatched. 
• Acute rejection: The cause of this rejection is T lymphocyte cells. This type of rejection is more common and suppressive drugs are usually prescribed to prevent this type of rejection. This rejection may occur a day or weeks after surgery. 
• Chronic rejection: This type of rejection occurs without any signs or symptoms about a year after the transplant or over may years. The cause of this type of rejection is unknown, but acute rejection is a strong predictor of chronic rejection. 

Symptoms of transplant rejection include encephalopathy, jaundice, bruising, and bleeding ,weakness, anorexia, muscle aches, low fever, a slight increase in white blood cell counts and tenderness in the area of ​​operation were noted with pain. 

1. Infection 

Due to usage of antirejection (immunosuppressant) medications that block the immune system so that the liver is not rejected, the patient is at high risk for infections. This problem decreases with time. Not all patients have an infection problem and most infections can be treated successfully . 

What are antirejection (immunosuppressant) medications? 

After a liver transplant, you receive drugs called immunosuppressants. These drugs slow down or stop the immune system to prevent it from rejecting the new liver. The patients should use these drugs exactly as prescribed for the rest of their lives. 

These immunosuppressants can include a variety of side effects: 

• Osteoporosis 
• Diabetes 
• Diarrhea 
• Headache 
• Hypertension 
• High Cholesterol 

Since antirejection medications work by suppressing the immune system, they also increase the risk of infection. 

How long after a liver transplant, is the patient discharged? 

The average hospital stay after a liver transplant is two to three weeks. Some patients may be discharged in less time, while others may stay in hospital longer, depending on the problems that may arise. The patient should be prepared for both possibilities. 

The patients will be taught how to take new medicines and to check their blood pressure and pulse. By doing these things, the patients are involved in controlling their health. Before being discharged, the patients will learn the symptoms of rejection and infection, and will know when to contact their physician. 

Readmission is common after discharge from hospital, especially during the first year after liver transplant; hospitalization is usually due to transplant rejection or infection. 

Liver transplant cost 

The cost of liver transplantation in the United States is estimated at about $ 580,000, In countries such as Turkey the cost of this operation is reported to be around $100,000, and in India about $ 50,000. 

In Iran, however this procedure is done at a much lower cost about 17000-27000 $ Contact us for more information .

Author : Maryam Shiani