Liver transplantation

• Living donor

Application review

The review includes two stages. Applicants qualify for liver transplantation if all of the following statements apply to them. The recipient and the donor are related within five generations, or married to each other more than 2 years. Both of them are required to over 18 years old and to have the same or compatible blood types. But even incompatible blood type graft can still achieve comparable results after special treatment.

Basic assessment

1.The requirements and age limitation of being living donors

According to the law, the donor needs to be over 18 but no upper limit of age. The donor is better to be under 60 years old in order to prevent complications before, during and after the surgery.

2.The blood type requirements of being a living liver donor.

The blood types of the donor and the recipient can be the same, compatible or incompatible.

ABO-incompatible liver transplantation may result in an immune respond of B cell and then cause rejections. Therefore, it is necessary to have B cell antibody (rituximab) before the surgery, plasmapheresis with/without before or after the surgery. The successful rate is comparable with same or compatible blood type grafts. The cost of the medicine before and after the surgery and plasmapheresis depends on each patient’s condition. The cost is around NT$ 100,000 to 200,000.  

 

3.The liver size of the living donor

The donating parts may be different depending on the liver sizes and liver structures of the donors. In general, the donor needs to follow the two principles below:
( 1 ) In order to offer enough liver function to the recipient, the size of the donating liver has to be as least 0.8% of the recipient’s body weight.
( 2 ) In order to stable the function of the donor’s liver, the remaining liver of the donor has to be at least 30% of its original size. The liver function of the donor will recover within 2-4 weeks. The time for liver growing to the normal size depends on each patient’s condition. Approximately, the liver will grow to 80% of the original size after 8-12 months. The donor can be discharged from the hospital within 1-2 weeks if no complications happen. The donor can be back to his/her normal life after 1 month. The doctor will give you further explanations after you pass the primary review.

 

Clinic/inpatient arrangement

It takes 4-8 weeks from completing the evaluation to performing the surgery. For emergent cases, the evaluation will be complete within 48 hours.

Step. 1 (clinic )

1.Blood test：blood type, the function of the kidneys and the liver,

hepatitis ABC, syphilis, AIDS, blood counting,

hemostasis.

2.Image check: liver transplant CT, 3D image synthesis (NTD $3,OOO, self-pay).

3.Female needs to take urine tests. Pregnant women are not suitable to donate their livers.

 

Step. 2 (staying in the hospital)

1.Blood test: tissue matching, cross-comparison test, virus check (the virus quantity of hepatitis B is NTD $3,000, self-pay), latent tuberculosis infection (NTD $2,5OO, self-pay), tumor indexes, Human T-lymphotropic virus (HTLV-I/HTLV-II) and thyroid function.

2.Image check: bile ducts CT (NTD $7,200 for the developer, self-pay), whole abdomen ultrasound, chest x ray, and breast check (female).

3.Other: Electrocardiography and liver function check.

4.Consultation: evaluation with psychologists and social workers and

consultation of Gynecology for female.

 

The possible outcomes of evaluations

1.Liver function disorder

There are many reasons for liver function disorder. The common is the patient who has fatty liver disease with drinking history. In order to donate a liver, the fatty infiltration of the liver must be lower than 10%. Also, the size of the liver (deducting fatty infiltration) has to be enough for donation. The patient with fatty infiltration more than 10% needs diet controlling, intensive exercising and body weight reduction for 1-2 months. Then, the patient will take CT or biopsy to evaluate the improvement. The patient with intermediate fatty liver disease is not suitable for transplant. It will endanger the life of the donor and the recipient.

2.The liver size of the living donor is too small

The safety of the donor is very important for living-donor liver transplant. If the size of the donor’s liver is too small, the remaining liver may be unable to properly function after the surgery. It will endanger the donor’s life. The solutions could be looking for another suitable donor, or increasing the size of the liver with nourishing and exercising. The amount of the increasing size is depending on each patient’s condition. 

3.The anatomy variance of the donor and the recipient

It will increase the complexity and the danger of the surgery. The transplant team will make choices based on their specialties, technology and the safety of the patients. 

 

Treatment

The duration, risks and complication

The duration of the operation depends on the donating part (left lobe, left or right liver lobe) and the variance of the blood vessel and bile duct. It normally takes 6-10 hours. The death in the surgery is approximate 3/1000. Some donors may have jaundice for a short period of time. In general, the incidence of complications is about 5%. The common complications are bile leaks, narrow bile duct, narrowing of blood vessels and wound infection. The common complications, incidences and solutions:

1.Biliary leaks or narrow bile ducts (1~3.3%): normally, it can be healed by nasobiliary drainage or percuteneous transhepatic cholangio drainage. In rare cases, it needs to place an endoscopic in a bile duct, and then have percuteneous transhepatic cholangio drainage or surgery again.

2.Fever (3.2%): it is normally caused by atelectasis, and it will be decreased by breathing training and cough with phlegm.

3.Infection (3.3%): such as respiratory infection, wound infection, urinary tract infection, vertical Transmission caused by catheters. The treatment will be giving stronger antibiotics. Severe infections are rare. 

4.Hands or lower limbs dysesthesia or limb weakness (3%): due to the long period of time lying down during the surgery, the nerves of limbs may be damaged. It can be recovered after 3-month rehabilitation.

5.Bleeding after surgery(0.8-3.2%): transfusion can reduce the bleeding. Sometimes, it is needed to have another surgery to stop bleeding.

6.Peptic ulcer disease (1%): the donor may have peptic ulcer disease because of pressure. It normally can be treated by taking medicine, but in severe cases, the pressure may occur gastrointestinal bleeding.

7.Ileus (3.6%): after the surgery, the adhesion and enteroparalysis may cause ileus. It normally can be treated by resting gastrointestinal tracts, hydrating and replenishing electrolytes. In rare cases, surgical treatment is needed.

8.Pneumothorax or pleural effusion (3%): normally conservative treatment and percuteneous transhepatic cholangio drainage will reduce the conditions.

9.Portal vein thrombosis (0.5%-0.7%): it normally needs another surgery to remove thrombosis, and sometimes it will need to place stents.

 

Nursing care plan

The liver function of the donor will recover within 2-4 weeks. The duration for liver growing to the normal size depends on each patient’s condition. Approximately, the liver will grow to 80% of the original size after 8-12 months. The donor can be discharged within 1-2 weeks if no complications happen. The donor can be back to his/her normal life after 1 month. The doctor will give you further explanations after you pass the primary review

 

Revisits/follow-ups

After discharged, please turn for your check-up every once or twice a week depending on your condition. After 3~6 months, you may return every 2 month (please follow the instructions given by the doctor). If you have any discomforts or confusions outside of the hospital, please contact the transplantation team at 02-2875-7625, or make an appointment online.