Understanding Liver Transplantation: Short Facts About it

Where is the human liver located? The liver is located in the upper right abdomen and weighs 1.5–2 kg in adults. The gallbladder is located below the liver, to the right.

What is the structure of the liver? The liver is wedge-shaped with a smooth surface. It consists of four lobes, which are divided into a total of eight segments. The largest lobe connects it to the diaphragm, allowing it to respond to breathing movements.

What are the functions of the liver? The liver is the central metabolic organ in humans. Therefore, the liver has a very rich blood supply, giving it a dark red-brown colour. The blood flows from the portal vein via the hepatic artery into the liver and leaves it again via the hepatic veins, which lead to the vena cava . Blood that reaches the liver contains sugar, fat, amino acids and vitamins that have been absorbed from the intestine into the bloodstream. Within the liver cells the nutrients are utilized as needed, stored, converted, broken down or released into the blood. One of the liver’s main tasks is to detoxify the body and to eliminate waste products and foreign substances. Toxic substances (e.g. ammonia) are transferred into non-toxic chemicals. The liver breaks down alcohol; it also filters hormones, defective cells, bacteria, and drug remains from the blood. It releases water-insoluble toxins directly into the intestine via bile. Water-soluble harmful substances are released into the blood and excreted via the kidneys and urine. The liver also releases bile through the bile duct into the digestive tract, where it aids in the digestion of fats.

When is a liver transplant carried out ? A liver transplant becomes necessary when the liver fails. Liver failure can be caused by chronic and acute liver diseases, but also by malignant tumours, congenital metabolic disorders and malformations.

Examples of chronic liver diseases:

Cirrhosis of the liver after hepatitis B, hepatitis C or a combination of hepatitis B and D

Cirrhosis of the liver due to alcohol abuse (a frequent, major cause!)

Cirrhosis of the liver in inflammatory diseases of the bile duct

Cirrhosis of the liver due to autoimmune liver diseases

Fatty liver

Examples of acute liver diseases:

Liver failure in hepatitis

Poisoning from drugs, fungi, medicines or chemicals

Malignant tumours in the liver itself (hepatocellular carcinoma = primary liver cell carcinoma, angiosarcoma or hepatoblastoma)

Metastases in the liver originating from malignant tumours in other areas of the body

Examples of congenital malformations:

Hereditary diseases and malformations of the bile ducts.

Cystic liver (hereditary cyst growth, formation of cavities)

Bile duct atresia (incomplete formation, or complete absence of the bile ducts).

How is a liver transplant performed? There are basically three surgical procedures:

Post-mortem transplantation of a whole organ: The complete organ of a deceased donor is transplanted.

Split liver transplantation: By dividing the donor liver during post-mortem removal, two patients can receive a new organ.

Living donation: The recipient receives a liver segment that has been removed from a living donor. The advantages are obvious : the surgery date can be planned, and the time between removal and implantation of the donor organ is short.

All procedures follow a similar sequence: First, the donor liver is prepared. During this procedure, part of the medical team removes the gallbladder as well as any attached tissue, and prepares the areas that are to be connected to the recipient’s vessels. Meanwhile, the other surgeons expose the recipient’s liver-supplying vessels in the upper abdomen. The diseased liver is removed by severing the blood-supplying vessels as well as the hepatic vein and bile duct (hepatectomy). When the donated organ is implanted, it is connected to the recipient’s blood vessels and bile duct. One special form of transplantation is “domino donation”. As this can damage organs in the recipient’s body after about 20 to 30 years, it is only recommended for older patients.

What happens after a liver transplant? A liver transplant takes around five to eight hours. Afterwards, the patient remains in intensive care for two to seven days for monitoring, followed by a further two weeks in a regular ward . This time is used to optimally adjust their medication, such as immunosuppressants, and to guide and support them in their physical rehabilitation. If there are no complications, the patients can be transferred to a rehabilitation clinic, where they will spend a few more weeks before being discharged home.

What complications can occur after a transplant? Acute rejection (in the first 90 days after surgery): This is a result of the immune system’s reaction, which activates antibodies against the foreign organ. It is not uncommon and can usually be effectively treated with medication.

Chronic rejection: This occurs during the earliest three months after the transplant, sometimes only after years. It is also due to the immune system’s reaction and the activation of antibodies.

Warning signs of a rejection reaction include weakness, fatigue , fever, loss of appetite, abdominal pain, clay-coloured stools, dark urine and yellowing of the whites of the eyes and skin.

EXERCISE:

1. A liver transplant becomes necessary when the liver fails by chronic and acute liver diseases, but also by malignant tumours, congenital metabolic disorders and malformations. A) True B) False

2. Warning signs of a rejection reaction after liver transplantation include: A) Weakness B) Fatigue C) Fever D) Loss of appetite E) Abdominal pain F) Dark urine

3. A liver transplant takes about one to two hours. Afterwards, the patient remains in a regular ward. A) True B) False

You’ll find the answer below.

BIBLIOGRAPHY 1. www.heidelberg-university-hospital.com 2. www.dict.cc 3. www.mayoclinic.org 4. www.mhh.de 5. www.unimedizin-mainz.de 6. www.webster-dictionary.org

CARMEN LOBITZ Carmen Lobitz ist freie Trainerin, Lehrerin und MTL. 1998 gründete sie lobitz seminare in Berlin, die Englischseminare für Health Professionals anbieten. Kontakt: mail@lobitz-seminare.de www.lobitz-seminare.de

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Lösung für Exercise:

1. A

2. A bis F

3. B

Understanding Liver Transplantation: Short Facts About it

Where is the human liver located?

What is the structure of the liver?

What are the functions of the liver?

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Understanding Liver Transplantation: Short Facts About it

Where is the human liver located?

What is the structure of the liver?

What are the functions of the liver?

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