Surgery and recovery
Liver transplants are performed only at major medical centers around the country, by expert teams of transplantation surgeons. In the past, donated organs came only from people who had died and agreed to donate their organs. Recently some centers have also begun performing “live donor” organ transplants, in which part of the liver from a matched donor is removed and transplanted. The surgery is possible because healthy livers can regenerate themselves. Within a year, the part of the liver removed from a donor has fully grown back.
Transplant patients typically spend a few days in an intensive care unit after surgery, where their condition can be carefully monitored. Then they are moved to a regular hospital room for a stay of two to three weeks, on average. Patients who are critically ill at the time of the transplant may need to remain in intensive care and in the hospital longer, up to three months. Once patients leave intensive care, they begin to resume normal diets and are encouraged to get out of bed and walk.
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The paradox of rejection
The most dangerous risk for transplantation patients is rejection. This occurs when the body’s immune system attacks and destroys the transplanted organ.
Why does the immune system, which is there to protect us, try to reject the life-saving transplant? Rejection occurs because the immune system’s job is to target and destroy foreign cells that pose a risk. Immune cells identify foreign cells by looking at unique molecular fingerprints on their surfaces and comparing them to the body’s own unique molecular fingerprints. In this way, the immune system distinguishes between “self” and “non-self.” A donor organ comes from someone whose cells have a different molecular fingerprint. Unfortunately, the immune system reacts as if the body has been invaded. It unleashes its destructive power to get rid of the foreign cells that it has mistakenly perceived as a threat. If not suppressed, the immune system can destroy a transplanted liver within days.
Several drugs have been developed that stop or slow the rejection process. Anti-rejection drugs may be given by injection during the first several weeks and later in pill form.
All anti-rejection drugs work by suppressing the immune system. As a result, they make patients more susceptible to infections. Other side effects include elevated blood pressure, fluid retention, puffiness, and bone loss. Over time, as the body begins to tolerate the new organ, patients require less anti-rejection medicine. Still, it’s likely that all transplant patients will have to take the drugs for the rest of their lives. Because of the potentially serious side effects, doctors typically try to lower the dosage to the smallest amount required to prevent rejection. To prevent serious infections, transplant patients are often given antibiotics in pill form.
Liver transplantation doesn’t always succeed. In some cases, the transplanted organ may fail to function. Clots forming in the blood vessels that supply the transplanted organ may cut off blood supply, starving the new liver. Sometimes doctors are unable to stop the rejection process. If the liver begins to fail, a second transplant may be necessary.
In rare cases, the hepatitis C infection comes back. However, new direct-acting agents can cure it, according to research reported by the American Gastroenterological Association. Some have had success with a combination of ledipasvir, sofosbuvir, and ribavirin, while other researchers used a combination of sofosbuvir and simeprevir to get rid of the infection.