1- Phase 1 -
There are a number of reasons that
the assessment period is vitally important.
Firstly, and foremost, it
is to ascertain the extend of your liver disease.
Secondly it is vital
to make sure that all avenues have been explored and that all medical
treatments have been considered prior to transplantation, and thirdly it
is important to ensure that you are fit to undergo transplant surgery and
that there are no contra-indications.
Both you and your family will be
fully informed about all the aspects of liver transplantation.
information will help you to make an informed decision about the treatment
that is being offered to you.
2- Phase 2 - Waiting for a suitable
How long do I have to
Donor livers are matched with recipient by
blood group and size. Waiting is probably the hardest phase for you
because it is the time of least activity. The wait can range from weeks to
months , on average you may be waiting 6-9 months depending of the
Where will I wait?
Hopefully you will be well enough to wait at home.
How will I be contacted?
transplant coordinator will take telephone numbers from you and your
What should I do if I'm unwell?
If you are unwell, put on antibiotics or other medication, or
admitted to another hospital while you are on the waiting list please
inform the transplant coordinators.
Can I go on
holiday whilst on the list?
Going abroad is not
advisable while on the waiting list because it would not be possible to
get you to the hospital on time for your transplant surgery.
is a special occasion that you feel that you cannot miss, please discuss
that with your transplant coordinator.
What time of
the day will the call come at?
question. You could be called at any time of the day or night, although it
is more likely you will receive a call in the evening time.
Will the transplant always go ahead?
In certain situations your operation may be canceled after you
have been called to the hospital. If the donor liver is found to be
unsuitable the transplant surgery would be canceled. If this should happen
you will be allowed to return home and you will remain on the waiting
3- Phase 3 -
The staff will be expecting you
and will arrange some tests when you arrive.
These tests include a
chest x-ray , an E.C.G. , some blood tests and taking of swabs to detect
any infection that may be developing.
The medical registrar will carry
out a physical examination and will ask you to sign a consent form for
your transplant surgery.
Some tablets may be ordered to help you to
relax before you go to the theatre.
Before going to the theatre you
will be asked to have a shower and put on a theatre gown.
You will be
transferred from your bed to the operating table.
You will be attached
to a monitor to observe your heart rate, a blood pressure cuff will be
placed on your arm and a probe will be placed on your finger.
incision (cut) is made in the shape of the Mercedes Benz symbol or an
upside down "Y".
To remove your diseased liver the surgeons must
identify the blood vessels bringing blood to and away from the liver and
the bile duct, which takes bile from the liver to the bowel.
vessels are the inferior Vena cava, the Portal Vein and the Hepatic
Clamps are placed on the vessels to stop blood flowing while
your diseased liver is being removed.
Dressings will be placed on your
wounds and bags will be attached to the drains to collect any fluid that
On average, patients loose between two and six liters of blood
during the surgery.
This is replaced as required as the surgery
After you will be transferred into an intensive care bed.
The transplant Coordinator arranges to meet your family at regular
intervals to update them on how your transplant is progressing.
hour after you return to the intensive care unit your family can visit
This is to allow time for you to be connected to the ventilator
and monitors and for blood tests and x-rays to be taken.
4- Phase 4 - The
post operative period
You will be asleep for
approximately 24 - 48 hours.
A ventilator will be helping you to
breathe and allow your body to rest.
One nurse will look after you'll
the time. There will be various drips in your arms and neck to enable us
to give you the fluids and drugs you may require.
These will be
gradually removed, as you get better. You will have a catheter in you
bladder to drain your urine until you are able to use the toilet
You will have two tubes in your nose, one of which will be
used for feeding.
The sedation will be gradually turned down and as
soon as you are fully awake the ventilator will be taken away. You will be
given painkillers continuously until you are fully awake.
early mobilization. This is important because it helps to reduce some
complications after the surgery.
The potential complications can be
divided into three sections:
The technical complications include
bleeding during of after the surgery, a blockage/clot in the hepatic
artery, primary graft non function, this is when the new liver fails to
work, or starts to work but fails to work properly.
Later strictures or
narrowing can appear in the bile ducts and/or the hepatic artery.
more common and likely problems that you may encounter will be due to
infection and rejection. Rejection is a normal body process. Your body's
immune system is designed to fend off any foreign bodies and infections.
Your immune system will recognize the new liver as a foreign and will try
to get rid of it. Rejection is managed by giving you anti-rejection
This medication suppresses your immune system, and helps
prevent your body fight against infections.
5- Phase 5 - Getting back to
The average stay in hospital is
approximately 3-4 weeks.
It is important to remember everybody is an
individual so your stay could be longer or shorter.
To prepare you for
going home after your transplant you will be encouraged to increase your
mobility. Walking within the hospital or in the grounds, if the weather is
suitable is encouraged.
The increased exercise will possibly make you
more tired than you expect but it will help you to build up your strength.
Remember to set realistic goals to yourself.
Once at home it will take
some months for life to return to normal, but the liver transplant team
will be on hand to support you and answer any questions you may
We will expect you to attend the liver transplant clinic at
Initially this will be every fortnight, but become
less as time goes on. From time to time we may need to ring you if we are
not happy with your blood tests and ask you to be admitted to be
Your medication is for life and it is absolutely imperative
that you always take it unless told not you by a member of the transplant
After you liver
transplant, you will need to take medications called Immunosupressants.
These medications are used to help prevent your body rejecting your new
They do this by reducing the body's immune response. You need to
take three of the following medications:
It may be necessary for you to take immunosuppressant drugs
* Immunosupressants must not be discontinued
suddenly except on the advice of the doctor in the liver unit .
7- A final
The aim of Liver Transplantation is to
return the individual to a normal lifestyle or as near normal as
This means that you should be able to do anything you wished
to do prior to your illness and transplant, whether that be returning to
education, your career, having family or traveling the world.
liver team are there to support you and your family, and monitor your
condition through out the transplantation process.
Patients of many
ages undergo transplant - from small babies to older patients.
case of Amyloid because it's not a liver disease is more a liver mutation.
Depending how affected you are by Amyloid deposits by the time of the
operation you'll get regression in the symptoms or not.
Then your body
starts to get ride of the deposits naturally because there's no more
mutated ttr met 30 in your blood. This process is very slow, so you
shouldn't expect dramatic changes if you already have many affected areas
in your body.
Timing is everything and the sooner
the better for you, that could decide how you live the rest of your