When liver transplantation should be carried out and when can it be avoided
Liver transplantation is a complex and dangerous surgical procedure. It is allowed only in patients with decompressed cirrhosis, the causes of which can be viral hepatitis C, B or D (in this case, hepatitis therapy is mandatory before the surgical procedure), or alcohol. Also, liver transplantation is prescribed for acute liver failure and liver cancer (in the absence of metastases to other organs).
On the one hand, the surgical procedure is performed only in patients with the most severe cases of cirrhosis. On the other hand, deteriorating conditions in patients complicate the successful outcome of the surgical procedure (increased risk of heavy bleeding during surgery, cardiovascular complications, liver rejection in the postoperative period, etc.).
A search for donor starts when liver transplantation is indicated for a patient, after more than 20 tests are completed. Livers can be transplanted only from donors related to patients (a part of the liver is taken from the donor), according to the legislation of Ukraine. Patients’ siblings, parents or children can come to their aid. Not in every instance both the patient and the potential relative are willing to take life risks associated with the surgical procedure for the donor. In addition, there are risks at each stage: both during the surgical procedure and in the postoperative period (rehabilitation of the donor can last more than a month).
There are general requirements to the donors, in addition to kinship:
Abroad, liver transplantation from unrelated deceased donors is possible. Yet, getting such liver is not so easy. Firstly, transplantation is carried out only in those cases when the risk of dying within a year is too high for the patient without the surgical procedure. This means that, in the first place, the liver is always provided to those patients who are in desperate need of it, while the rest continue to wait for their turn. Secondly, after being entered on the waiting list, the patient cannot leave the city limits, where the transplantation procedure is planned, which is fraught with additional costs. Thirdly, even when liver is found and the surgical procedure takes place, the risk of rejection is too high – more than 70 % of people with liver transplant live only up to 5 years after the surgery.
To extend patient’s life for as long as possible after liver transplantation, the patient should be continuously administering the so-called immunosuppressive agents, medicinal products suppressing the patient’s own immune system. The other side of the coin in administering such medicinal products is the risk of development of permanent illness due to the immune system suppression. That is why it is extremely important for the patients to be constantly careful, to minimize visits to public places in order to minimize the risk of contacting viral diseases that can cause more serious complications. Also, physical activities are contraindicated for them. Nutrition – exclusively based on a special diet. And, of course, 100 % giving up bad habits.
For more than 50 years, since the first liver transplantation procedure, the world has known the only possible cure for liver cirrhosis – a special surgical procedure, which often prolonged patients’ life just for a couple of years, while offsetting its quality. Over the past decade, as an alternative, scientists tried treating liver cirrhosis with stem cells – injections of patients’ own or foreign stem cells, which can turn into hepatocytes – liver cells – once they get in the body. Yet, such treatment is unsafe. It has been proven that stem cells getting into the body from the outside can both turn into organ cells and malignant cells, contributing to the development of cancer. Because of its unpredictability, stem cell treatment in liver cirrhosis was not granted any legal permission on the global level.
Traditionally, cirrhosis is treated with hepatoprotectors – medicinal products absolutely ineffective for the treatment of this disease. At best, they allow merely a slight slowdown in the development of liver fibrosis and cirrhosis. They are unable to regenerate the damaged liver cells.
The effective non-surgical technique, which allows for complete restoration of the liver, as well as for maintenance of a long and high-quality life for the patients without exposure of patients’ relatives to the risks, has been the latest development in the treatment of liver cirrhosis. These developments are the achievements of Ukrainian biotechnologists in combination with the latest advanced European techniques. The treatment process is totally safe and comfortable for the patient. The patients can feel significant improvements in their condition in the process of treatment. They can move on with their usual activities – going to work, spending time with their families.
This treatment technique has successfully passed clinical trials in different institutions both in Ukraine, and abroad. In REGENERATION clinic, its efficacy and safety have been proven by grateful, healthy patients and their relatives worldwide.
Leading infectious disease specialist, hepatologist, therapist, Candidate of Medical Sciences, member of the European Association of Hepatologists, awarded by the Ministry of Health of Ukraine
Leading gastroenterologist, hepatologist, member of the Ukrainian Association of Gastroenterologists
Сhief Medical Officer of Institute for Elastography, Phd, chief specialist in ultrasound diagnostics of the Ministry of Health of Ukraine