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What does my liver do?
Your liver helps fight infections and cleans your
blood. It also helps digest food and stores energy
for when you need it.
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What are the signs of
liver problems?
Some signs of liver problems are
feeling tired or weak
losing your appetite
feeling sick to your stomach
losing weight
bruising or bleeding easily, such as nosebleeds
bloating due to fluid build-up in the abdomen
(ascites*)
declining mental functions
Also, liver problems often make the skin and the
whites of the eyes turn yellow, a condition called
jaundice, and may cause swelling in the legs and
the abdomen.
You cannot live without a liver that works. If
your liver fails, your doctor may put you on a
waiting list for a liver transplant.
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What is liver transplantation?
Liver transplantation is surgery to remove a diseased
liver and replace it with a healthy one. This
kind of surgery has been done for more than 38
years. Many people have had liver transplants
and now lead normal lives.
Being tired and losing your appetite can be signs
of liver problems.
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What are the reasons
for needing a liver transplant?
In adults, the most common reason for liver transplantation
is cirrhosis. Cirrhosis is caused by many different
types of liver injuries that destroy healthy liver
cells and replace them with scar tissue. Cirrhosis
can be caused by viruses such as hepatitis B and
C, alcohol, autoimmune liver diseases, build-up
of fat in the liver, and hereditary liver diseases.
In children, the most common reason for liver
transplantation is biliary atresia. Bile ducts,
which are tubes that carry bile out of the liver,
are missing or damaged in this disease, and obstructed
bile causes cirrhosis. Bile helps digest food.
Other reasons for transplantation are liver cancer,
benign liver tumors, and hereditary diseases.
Sometimes the cause of liver disease is not known.
Liver transplants can help adults and children.
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How will I know whether
I need a liver transplant?
Your doctor will decide whether you need to go
to a hospital that does liver transplants. You
will meet the liver transplant team. The team
is usually led by a liver transplant surgeon and
includes liver specialists, nurses, and other
health care professionals. The transplant team
will arrange blood tests, x rays, and other tests
to help make the decision about whether you need
a transplant and whether a transplant can be carried
out safely.
Other aspects of your health--like your heart,
lungs, kidneys, immune system, and mental health--will
also be checked to be sure you're strong enough
for surgery.
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Can anyone with liver problems
get a transplant?
You cannot have a transplant if you have:
cancer in another part of your body
serious heart, lung, or nerve disease
active alcohol or illegal drug abuse
an active, severe infection
inability to follow your doctor's instructions
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How long does it take
to get a new liver?
If you need a transplant, your name will be placed
on a national waiting list .Your blood type, body
size, and how sick you are all play a role in
when you will receive a liver. Currently, the
sickest people are at the top of the list, so
you may have to wait some time.
While you wait for a new liver, you and your
doctor should talk about what you can do to stay
strong for the surgery. You will also start learning
about taking care of a new liver.
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Where do the livers
for transplants come from?
Whole livers come from people who have just died.
This type of donor is called a cadaveric donor.
Sometimes a healthy person will donate part of
his or her liver for a particular patient. This
kind of donor is called a living donor.
All living donors and donated livers are tested
before transplant surgery. The testing makes sure
the liver is healthy, matches your blood type,
and is the right size so it has the best chance
of working in your body.
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What happens in the
hospital?
When a liver is available, you will be called
and usually taken to the Hospital by ambulance
for the surgery. If your new liver is from a person
who has recently died, your surgery starts when
the new liver arrives at the hospital.
During Surgery
The surgery can take from 4 to 14 hours. While
the surgeon removes your diseased liver, other
doctors prepare the new liver.
The surgeon will disconnect your diseased liver
from your bile ducts and blood vessels before
removing it. The blood that flows into your liver
will be blocked or sent through a machine to return
to the rest of your body. The surgeon will put
the healthy liver in place and reconnect it to
your bile ducts and blood vessels. Your blood
will then flow into your new liver.
After Surgery
You will stay in the hospital for an average of
3 to 6 weeks to be sure your new liver is working.
You will take medicines to prevent rejection of
your new liver and to prevent infections. Your
doctor will check for bleeding, infections, and
rejection. During this time you will start to
learn how to take care of yourself and use your
medicines to protect your new liver after you
go home.
In the hospital, you will slowly start eating
again. You will start with clear liquids, then
switch to solid food as your new liver starts
to work.
After surgery you will learn how to take care
of your new liver.
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What is rejection?
Rejection occurs when your body's natural defences,
called the immune system, damage the new liver.
Your immune system keeps you healthy by fighting
against things that don't belong in your body,
such as bacteria and viruses. After a transplant,
it is common for your immune system to fight against
the liver and try to destroy it.
How is rejection prevented?
To keep your body from rejecting the new liver,
you will take medicines. These drugs, such as
steroids, cyclosporine, tacrolimus, sirolimus,
and mycophenolate mofetil, are called immunosuppressants.
Immunosuppressants weaken your immune system's
ability to reject your new liver.
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Do immunosuppressants
have any side effects?
Yes. You can get infections more easily because
these drugs weaken your immune system. You will
need to stay away from people who are sick. These
drugs may also increase your blood pressure, cause
your cholesterol to rise, cause diabetes, weaken
your bones, and damage your kidneys. Steroid drugs
may also cause changes in how you look by causing
weight gain. Your doctor and the transplant team
will monitor these effects and may treat you for
complications.
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What are the signs of
rejection?
Doctors will check your blood for liver enzymes,
the first sign of rejection. Often rejection does
not make you feel ill. Sometimes rejection can
cause: nausea, pain, fever or jaundice. Often,
a liver biopsy is needed to be sure that the transplanted
liver is being rejected. For a biopsy, the doctor
takes a small piece of the liver to view under
a microscope. Blood tests will show if the new
liver is being rejected.
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What are the other problems
that can damage the liver transplant?
Return of the problem that made the transplant
necessary in the first place is the most common
problem for patients with liver transplants. Also,
hepatitis C virus may damage a transplant if the
patient was infected before the operation took
place.
Other problems include
Blockage of the blood vessels going into or
out of the liver
Damage to the tubes that carry bile into the
intestine
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What if the transplant
doesn't work?
Liver transplants usually work. About 80 to 90
percent of transplanted livers are still working
after 1 year. If the new liver does not work or
if your body rejects it, your doctor and the transplant
team will decide whether another transplant is
possible.
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How do I take care of
my liver after I leave the hospital?
After you leave the transplant centre at the hospital,
you will see your doctor often to be sure your
new liver is working well. You will have regular
blood tests to check that your new liver is not
being damaged by rejection, infections, or problems
with blood vessels or bile ducts. You will need
to avoid sick people and report any illnesses
to your doctor. You will need to eat a healthy
diet, exercise, and not drink alcohol, especially
if alcohol was the cause of damage to your own
liver. You should use medicines, including ones
you can buy without a prescription, only if your
doctor says they are safe for you. It is important
to do what your doctor says to take care of your
new liver.
Eating a healthy diet and taking the medications
are part of taking care of your new liver.
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Can I go back to my
daily activities?
Yes. After a successful liver transplant, most
people can go back to their normal daily activities.
Getting your strength back will take some time,
though, depending on how sick you were before
the transplant. You will need to check with your
doctor on how long your recovery period should
be. Social workers and support groups may be able
to help you adjust to life with a new liver.
Work. After recovery, usually three months, most
people are able to go back to work.
Diet. Most people can go back to eating as they
did before. Some medicines may cause you to gain
weight, and others may cause diabetes or a rise
in your cholesterol. Meal planning and a balanced
low-fat diet can help you remain healthy.
Exercise. Most people can engage in physical
activity after a successful liver transplant.
Sex. Most people return to a normal sex life
after liver transplantation. It is important for
women to avoid becoming pregnant in the first
year after transplantation. You should talk to
your transplant team about sex and reproduction
after transplantation.
If you have any questions, you may want to check
with your doctor before starting any activity.
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