Liver Transplant

About Liver Transplant

The liver, the largest internal organ, performs many critical functions, including:

• Processing nutrients, medications, and hormones.
• Producing bile, which helps the body absorb fats, cholesterol, and fat-soluble vitamins.
• Making proteins that help the blood clot.
• Removing bacteria and toxins from the blood.
• Preventing infection and regulating immune responses.

Why is a liver transplant performed? 

A liver transplant is a treatment option for those suffering significant complications due to end-stage chronic liver disease. Also in rare cases of sudden failure of a previously healthy liver, a liver transplant may be an option. A living-donor liver transplant is possible since the human liver can regenerate and return to its standard size shortly after surgical removal of part of the organ. A liver transplant is a surgical procedure of removing a liver that no longer functions and replacing it with a healthy liver from either a deceased donor or a portion of a healthy liver from a living donor. Life expectancy after a liver transplant depends on many reasons such as the reason for transplantation, age, co-morbidities, and response to the drugs the person is put on post-transplant. Most people live on for more than 10 years after liver transplantation.

Signs of Liver Failure 

Once a person has signs of liver failure, they may experience: 

• Jaundice (yellow skin and eyes)
• Vomiting
• Hand tremors
• Confusion
• Encephalopathy (comatose state)
• Fatigue 
• Muscle loss
• Itching all over the body 
• Poor blood clotting
• Swelling over the legs
• Ascites (abnormal fluid buildup in the tummy) 
• Bleeding from the esophagus (gullet), stomach, or rectum

Liver Transplant Side Effects

• Bile duct complications
• Bleeding
• Blood clots
• Failure of the donated liver
• Infection
• Rejection of the donated liver
• Mental confusion or seizures

Who is a proper Liver Transplant Candidate? 

A liver transplant is a surgical procedure that replaces a diseased or damaged liver with a healthy one from a donor. A liver transplant may be the only option for people who have end-stage liver disease, which means their liver can no longer function properly and is beyond repair. However, not everyone with liver disease is eligible for a liver transplant. Certain criteria must be met to be considered a suitable candidate for this procedure:

• The severity of the liver disease: This is measured by a score called the model for end-stage liver disease (MELD), which is based on the results of blood tests. The higher the MELD score, the more urgent the need for a liver transplant. The MELD score also determines the priority of the patient on the waiting list for a deceased donor's liver. Children are given a different score called the pediatric end-stage liver disease (PELD) score.
• The overall health status of the patient: Before being accepted for a liver transplant, the patient must undergo a comprehensive evaluation that includes tests and assessments of the heart, lungs, kidneys, digestive tract, immune system, mental health, and other organs and systems. The purpose of this evaluation is to ensure that the patient can tolerate the surgery and the post-transplant medications and that there are no other conditions that could compromise the outcome of the transplant.
• The availability of a suitable donor: There are two types of donors for liver transplant; deceased donors and living donors. Deceased donors are people who have died and donated their organs for transplantation. Living donors are healthy people who volunteer to donate a part of their liver to a recipient, usually a family member or a friend. The donor and the recipient must have compatible blood types and tissue types to prevent rejection of the new liver. Additionally, family members may also be able to act as donors if they match the patient’s blood type.
• The financial and insurance situation of the patient: A liver transplant is a very expensive procedure that involves many costs, such as the surgery, the hospital stay, the medications, the follow-up care, and the possible complications. The patient must have adequate insurance coverage or other resources to pay for these expenses. The patient must also be aware of the long-term costs of maintaining a transplanted liver, such as the lifelong use of immunosuppressive drugs and regular monitoring.

Type of Liver Transplant 

Different types of liver transplants may be offered to a person who has end-stage liver disease and needs a new liver to survive. The type of liver transplant depends on the source and size of the donor's liver, as well as the recipient’s condition and preference. The main types of liver transplants are:

• Orthotopic transplant: This is the most common type of liver transplant, where the entire liver of a deceased donor is transplanted into the recipient. The donor's liver must match the recipient’s blood type and tissue type to reduce the risk of rejection. The recipient’s diseased liver is removed and replaced by the donor's liver in the same location. The surgery usually takes 4 to 12 hours and requires a long recovery period.
• Split liver transplant: This is a type of liver transplant where a liver from a deceased donor is divided into two parts: a smaller left lobe and a larger right lobe. The left lobe is transplanted into a child, while the right lobe is transplanted into an adult. This way, one donor liver can save two lives. However, not all donor livers are suitable for splitting, and the recipients may have a higher risk of complications, such as bleeding or bile duct problems.
• Living donor liver transplant: This is a type of liver transplant where a part of the liver of a living donor, usually a relative or a friend, is transplanted into the recipient. The donor and the recipient must have compatible blood types and tissue types, and the donor must be healthy and willing to undergo surgery. The donor’s liver will regenerate after the surgery, while the transplanted part will grow to fit the recipient’s body. 

These are some of the main types of liver transplants, but there may be other variations or combinations depending on the availability of donors and the specific needs of the recipients. 

Age Restrictions for Liver Transplant 

Age restrictions for liver transplants are not fixed but rather depend on various factors, such as the source and condition of the donor's liver, the health and prognosis of the recipient, and the policies and practices of the transplant center. Generally speaking, older people have a lower chance of receiving a liver transplant than younger people, because they may have more medical complications, a shorter life expectancy, and a lower quality of life after the transplant. However, age alone is not a decisive criterion, and each case is evaluated individually based on the potential benefits and risks of the transplant.

The age of the donor also affects the outcome of the liver transplant. Generally, younger donors have better quality livers than older donors, and their livers are more likely to function well and last longer in the recipients. However, due to the shortage of available organs, older donor livers are also used for transplantation, especially for older or sicker recipients who have a lower chance of getting a younger donor liver. Older donor livers may have more damage, such as fibrosis, steatosis, or reduced blood flow, which can increase the risk of complications, such as primary graft non-function, ischemia-reperfusion injury, or chronic rejection.

The decision to accept or reject a candidate or a donor for a liver transplant is made by a multidisciplinary team of experts, who weigh the pros and cons of the procedure and consider the ethical and practical implications.

The Assessment Process Before Liver Transplant 

The assessment process before a liver transplant is a comprehensive evaluation that determines whether a person is eligible and suitable for a liver transplant. The process involves a series of tests, consultations, and education sessions that aim to assess the physical, mental, social, and financial aspects of the transplant. The process may vary depending on the transplant center, but it usually takes about a week and requires the presence of a caregiver or a support person.

The tests that are performed during the assessment process include blood tests, chest X-rays, lung function tests, electrocardiogram (ECG), fitness tests, echocardiogram, kidney function tests, coronary angiography, scans, and endoscopy. These tests check the condition and function of the liver and other organs and identify any potential complications or contraindications for the transplant. The tests also help to determine the severity and urgency of the liver disease, which is measured by a score called the model for end-stage liver disease (MELD) or the pediatric end-stage liver disease (PELD) for children.

The assessment process before a liver transplant is a crucial step that helps the transplant team decide on the candidacy and priority of the person for a liver transplant. The decision is based on the results of the tests and consultations, as well as the availability and suitability of a donor's liver. The decision is communicated to the person and the family, and if approved, the person is placed on the waiting list for a liver transplant. The assessment process also prepares the person and the family for the transplant journey and provides them with support and guidance throughout the process.

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

Liver Transplant Surgery

What happens during a liver transplant surgery? 

A liver transplant surgery is a complex and life-saving procedure that involves replacing a diseased or damaged liver with a healthy one from another person. The surgery can be performed using a whole liver from a deceased donor or a part of a liver from a living donor. The surgery usually takes several hours and requires general anesthesia and a large incision in the upper abdomen. The steps of the surgery may vary depending on the type of transplant, but they generally include the following:

• The surgeon disconnects the blood supply and the bile ducts from the recipient's liver and removes it from the body. The surgeon may also remove the gallbladder and the spleen if they are affected by the liver disease.
• The surgeon places the donor liver or the liver segment in the recipient's abdomen and connects the blood vessels and the bile ducts. The surgeon may use surgical clips, stitches, or staples to secure the connections. The surgeon may also place a tube in the bile duct to drain excess bile and prevent blockage.
• The surgeon closes the incision with stitches or staples and covers it with a sterile dressing. The surgeon may also place a drain in the abdomen to remove any fluid or blood that may accumulate after the surgery.
• The recipient is transferred to the intensive care unit (ICU) for close monitoring and recovery. The recipient may need a ventilator to help with breathing, a catheter to drain urine, and an intravenous (IV) line to deliver fluids and medications. The recipient may also receive blood transfusions, antibiotics, painkillers, and immunosuppressive drugs to prevent rejection of the new liver.

A liver transplant surgery is a major operation that carries significant risks and complications, such as bleeding, infection, blood clots, bile leaks, organ rejection, and graft failure. The recipient will need regular follow-up visits and tests to check the function and health of the new liver. The recipient will also need to take immunosuppressive drugs for the rest of their life to prevent the immune system from attacking the new liver. A liver transplant surgery can improve the survival and quality of life of people with end-stage liver disease, but it also requires lifelong care and commitment.

The Recovery Stages After Liver Transplant 

A liver transplant is a major surgery that requires a long and gradual recovery process. The recovery stages after liver transplant can be divided into four phases: hospital stay, early recovery, late recovery, and long-term follow-up. Each stage includes:

• Hospital stay: This phase lasts for about a week, during which the recipient stays in the hospital for close monitoring and care. The recipient may need a ventilator, a catheter, an IV line, and a drain in the abdomen. The recipient will also receive blood transfusions, antibiotics, painkillers, and immunosuppressants. The recipient will have regular blood tests, scans, and biopsies to check the function and health of the new liver.
• Early recovery: This phase lasts for about 3 months, during which the recipient returns home and continues to recover under the supervision of a caregiver and the transplant team. The recipient will have frequent follow-up appointments and tests to adjust the immunosuppressants and prevent rejection or infection. The recipient will also need to follow a healthy diet, avoid alcohol, and take care of the surgical wound. The recipient will gradually resume normal activities, such as walking, driving, and working.
• Late recovery: This phase lasts for about 9 months, during which the recipient regains strength and stamina and returns to most of their normal activities and hobbies. The recipient will still need to take immunosuppressants and have regular check-ups, but less often than before. The recipient will also need to protect their skin from the sun, as immunosuppressants increase the risk of skin cancer. The recipient will also need to maintain a healthy lifestyle, such as exercising, eating well, and managing stress.
• Long-term follow-up: This phase lasts for the rest of the recipient's life, during which the recipient enjoys a good quality of life and a normal life expectancy. The recipient will still need to take immunosuppressants and have annual check-ups and tests to monitor the health of the new liver and the side effects of the medications. The recipient will also need to be alert for any signs of rejection, infection, or recurrence of the original liver disease. The recipient will also need to have regular screenings for cancer and other complications.

These are the main recovery stages after liver transplant, but they may vary depending on the individual situation of the recipient and the donor. A liver transplant is a complex and challenging procedure, but it can offer a chance for a better quality of life for people with end-stage liver disease.

The Main Complications of Liver Transplant 

Some of the main complications of liver transplant include:

• Vascular complications: These are problems that affect the blood vessels that supply the liver, such as the hepatic artery, the portal vein, and the hepatic veins. Vascular complications include thrombosis (clotting), stenosis (narrowing), aneurysm (bulging), and bleeding. Vascular complications can cause ischemia (lack of blood flow), infarction (tissue death), or hemorrhage (excessive bleeding) of the liver. Vascular complications can be diagnosed and treated with imaging techniques, such as ultrasound, CT angiography, or MR angiography, and with endovascular interventions, such as angioplasty, stenting, or embolization.
• Biliary complications: These are problems that affect the bile ducts that drain bile from the liver, such as the common bile duct and the hepatic ducts. Biliary complications include strictures (scarring), leaks, stones, and infections. Biliary complications can cause cholestasis (blockage of bile flow), cholangitis (inflammation of the bile ducts), or biloma (collection of bile outside the ducts). Biliary complications can be diagnosed and treated with imaging techniques, such as ultrasound, MR cholangiopancreatography, or ERCP, and with endoscopic or surgical interventions, such as sphincterotomy, stenting, or drainage.
• Infectious complications: These are problems that involve the invasion of microorganisms, such as bacteria, viruses, fungi, or parasites, into the liver or the surrounding tissues. Infectious complications include abscesses (pus-filled pockets), sepsis (bloodstream infection), or hepatitis (inflammation of the liver). Infectious complications can be caused by the immunosuppressive drugs that are used to prevent rejection of the new liver, or by the exposure to contaminated blood or organs during the transplant. Infectious complications can be diagnosed and treated with blood tests, cultures, biopsies, and antibiotics or antiviral drugs.
• Rejection complications: These are problems that occur when the immune system of the recipient attacks the new liver as a foreign body. Rejection complications include acute rejection, which happens within the first few weeks or months after the transplant, and chronic rejection, which happens over a longer period. Rejection complications can cause inflammation, fibrosis, or cirrhosis of the liver. Rejection complications can be diagnosed and treated with blood tests, biopsies, and immunosuppressive drugs.

The Diet After Liver Transplant Surgery

A healthy diet after liver transplant surgery should include the following elements:

• Low-fat and low-sodium foods: Foods that are high in fat and salt can increase the risk of high blood pressure, high cholesterol, heart disease, and weight gain, which can affect the health of the new liver and the kidneys. Foods that are low in fat and salt include lean meats, poultry, fish, eggs, low-fat dairy products, fruits, vegetables, whole grains, beans, nuts, and seeds. Processed and fried foods, red meat, cheese, butter, margarine, sauces, dressings, snacks, and desserts should be limited or avoided.
• High-fiber foods: Foods that are high in fiber can help with digestion, bowel movements, blood sugar control, and cholesterol levels, which can benefit the new liver and overall health. Foods that are high in fiber include fruits, vegetables, whole grains, beans, nuts, and seeds. Fiber supplements can also be used if advised by the doctor or dietitian.
• Adequate protein and calories: Protein and calories are essential for the healing and growth of the new liver and the body. Protein can be found in animal and plant sources, such as meat, poultry, fish, eggs, dairy products, soy, tofu, beans, nuts, and seeds. Calories can be obtained from carbohydrates, fats, and proteins, but they should be balanced and not excessive. The amount of protein and calories needed depends on the weight, height, age, activity level, and medical condition of the person. The doctor or dietitian can provide specific recommendations and guidelines.
• Vitamins and minerals: Vitamins and minerals are important for the immune system, the metabolism, and the function of the new liver and other organs. Some vitamins and minerals may be deficient or excessive after the liver transplant surgery, due to the medication, the diet, or the liver disease. Therefore, it is advisable to take a multivitamin and mineral supplement that is prescribed by the doctor or dietitian. Some vitamins and minerals that may need special attention are calcium, vitamin D, iron, zinc, magnesium, and selenium.
• Fluids and hydration: Fluids and hydration are vital for the circulation, elimination, and balance of the body. Water is the best fluid to drink, as it helps to flush out toxins and waste products from the new liver and the kidneys. Other fluids, such as juice, milk, tea, coffee, and soup, can also be consumed, but they should be low in sugar, caffeine, and sodium. Alcohol should be avoided, as it can damage the new liver and interfere with the medication. The amount of fluid needed depends on the weight, the climate, the activity level, and the medical condition of the person. The doctor or dietitian can provide specific recommendations and guidelines.

These are some of the main elements of a healthy diet after liver transplant surgery, but there may be other factors that influence the dietary needs and preferences of the person. A doctor or a dietitian can provide individualized advice and support to help the person follow a healthy diet that suits their lifestyle and goals.

Liver Transplant Rejection signs

Liver transplant rejection is a condition that occurs when the immune system of the recipient attacks the new liver as a foreign object. Rejection can happen at any time after the transplant, but it is more common in the first few months. Rejection can be acute, which means it happens suddenly and severely, or chronic, which means it happens gradually and mildly. Rejection can damage the new liver and affect its function, and it may require treatment with medication or another transplant.

The signs and symptoms of liver transplant rejection may vary depending on the type and severity of the rejection, and they may not always be noticeable. However, some of the common signs and symptoms that might indicate a liver transplant rejection include:

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

The treatment for liver transplant rejection depends on the cause, type, and extent of the rejection, and it may involve adjusting the dose or type of immunosuppressive drugs, which are medications that suppress the immune system and prevent it from attacking the new liver. Sometimes, additional drugs, such as steroids or antibodies, may be given to treat the rejection. In some cases, a second transplant may be needed if the rejection is severe or irreversible. 

Liver transplant in Iran

Equipped hospitals and advanced specialized centers with experienced doctors and specialists are available in all medical treatment areas in Iran. Also, good hotels and entertainment centers have made Iran an appropriate choice for patients who suffer from end-stage chronic liver disease. Shiraz is Iran’s leading city in liver transplant surgery, but keep in mind because this is an organ donation surgery, you’ll need to travel to Iran with your donor for liver transplant surgery to be done.

How much does a liver transplant in Iran cost?

A liver transplant can be a life-saving treatment for people with end-stage liver disease, but it is also a very expensive procedure that involves many costs, such as the surgery, the hospital stay, the medications, the follow-up care, and the possible complications.

The cost of a liver transplant can vary depending on the source and condition of the donor's liver, the health and prognosis of the recipient, and the policies and practices of the transplant center. The cost of a liver transplant can also vary depending on the country where the transplant is performed, as different countries may have different healthcare systems, insurance coverage, and currency exchange rates. However, it can generally cost anywhere between 20,000 to 45,000 USD for the entire process including pre-operative exams and post-operative care. This is significantly lower than the cost of a liver transplant in many other countries.

One of the reasons why the cost of a liver transplant in Iran is lower than in other countries is that Iran has a legal and regulated system of organ donation and transplantation, which allows the use of living donors and deceased donors for liver transplants. Iran also has a high number of skilled and experienced surgeons and transplant centers, which perform more than 2,000 liver transplants per year, with a high success rate and a low complication rate.

Legal Approval for Liver Transplant in Iran

Liver transplant operations in Iran must be approved by the Supreme Council of Health and Medical Education. This council approves the surgery only after verifying that all safety standards are met and that the patient’s rights are protected throughout the process. Furthermore, any hospital or medical professional involved in the transplant must have a valid license from the Ministry of Health and Medical Education.

After receiving the approval, the patient must fill out all the required paperwork and provide any necessary information to ensure that the surgery is done safely and responsibly. With these steps completed, a liver transplant in Iran can be carried out without any problems. In Iran, the donor and recipient must share the same nationality to be eligible for a liver transplant operation. This is done to ensure that all legal requirements are fulfilled and that both parties are well-prepared for the surgery.

Therefore, any potential donor-recipient pairs must comply with all of the legal requirements before they can proceed with a liver transplant in Iran. By following these steps and ensuring that all necessary regulations are adhered to, patients can be confident that their surgery will be done safely and responsibly.

Finding a Matching Donor

As your donor must be the same nationality as yours, there are a few criteria to determine if a person is the right match for you. These are necessary factors for being someone’s match for a liver transplant:

Blood Type Test

you can receive a kidney from compatible donors only:

The Rh factor (+ or -) of the blood does not matter. If the donor’s blood type is compatible with you, the donor can take the next test: tissue typing.

Tissue Typing (HLA)

If your blood types match, the next step is a tissue typing match called human leukocyte antigens (HLA). This test compares genetic markers which prolongs the likely lifetime of the transplanted liver. A good match means your body is less likely to reject the liver.

Crossmatch

This includes mixing a small sample of your blood with the donor’s blood in the lab. This test will determine whether your blood’s antibodies will react against certain antibodies in the donor’s blood. If your blood serum destroys the donor’s cells, this is called a positive crossmatch, which means the transplant can’t be done. If you do so, the transplanted liver will be rejected immediately. A negative match will mean that they are compatible and that your body is less likely to reject the donor’s liver.

Anti-Rejection Medication (Immunosuppressants)

Following transplant surgery, the liver recipient’s body will detect the new organ as an external object, and command the immune system to destroy it, which is why they are prescribed immunosuppressants.

Immunosuppressants will reduce the immune system’s function, thus preventing the liver from being rejected and destroyed by the immune system. The recipient will be on a lifetime regimen of immunosuppressants. For liver transplant patients, post-surgery care is vital.