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1- Phase 1 - Assessment

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.
This 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 Liver


How long do I have to wait?

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 countries.

Where will I wait?

Hopefully you will be well enough to wait at home.

How will I be contacted?

The transplant coordinator will take telephone numbers from you and your family.

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.
If there 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?

Another difficult 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 list.


3- Phase 3 - The Operation

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.
An 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.
These vessels are the inferior Vena cava, the Portal Vein and the Hepatic Artery.
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 drains.
On average, patients loose between two and six liters of blood during the surgery.
This is replaced as required as the surgery progresses.
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.
One hour after you return to the intensive care unit your family can visit you.
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 yourself.
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.
We encourage 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.
The 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 medication.
This medication suppresses your immune system, and helps prevent your body fight against infections.


5- Phase 5 - Getting back to normal

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 have.
We will expect you to attend the liver transplant clinic at regular intervals.
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 reviewed.
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 team.


6- Immunosupressants
 

After you liver transplant, you will need to take medications called Immunosupressants. These medications are used to help prevent your body rejecting your new liver.
They do this by reducing the body's immune response. You need to take three of the following medications:

Active ingredient
Brand name
Cyclosporin or Tacromilus
And 
 Azathioprine
and
Prednisolone
Neoral or prograf
and   
Imuran
and
Deltacortil



It may be necessary for you to take immunosuppressant drugs indefinitely.
* Immunosupressants must not be discontinued suddenly except on the advice of the doctor in the liver unit .


7- A final word

The aim of Liver Transplantation is to return the individual to a normal lifestyle or as near normal as possible.
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.
The 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.
In the 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 live.



Pedro Soares 2002 | Updated: 10/15/2002

E-mail: p_hmsoares@yahoo.co.uk