Memorial Atasehir Hospital - Organ Transplantation

Memorial Atasehir Hospital Organ Transplantation Center provides services with its world class operating rooms, laboratories, experienced team and technological equipment. Liver transplantation from a living or cadaveric source is performed under the supervision of Dr. Kamil Yalcin Polat while kidney transplantation from a living or cadaveric source is performed under the medical supervision of Dr. Murat Tuncer. 

THE MOST EFFICIENT TREATMENT OF LIVER FAILURE IS LIVER TRANSPLANTATION

The procedure of removing a diseased liver and replacing it with a healthy one is called “liver transplantation”. The liver, unlike all other organs, demonstrates regeneration and regrowth. This ensures the regeneration of both livers of the recipient and the donor in a short time as 6 to 8 weeks in living donor transplantation.

Hepatitis B and C are the primary causes

Hepatitis B and C are considered among the primary causes of liver tumor and failure. Fifteen percent of patients with Hepatitis B may develop tumors or failure in the later stages. In Turkey, liver failure occurs primarily due to Hepatitis B. In the west, liver failure associated with alcohol is more common. If the patient has end-stage liver failure transplantation is inevitable. Therefore, one should have Hepatitis B vaccination in order to be protected against Hepatitis B. At the present time, Hepatitis C vaccine still remains to be developed. Transplantation is inevitable for patients with end-stage liver failure. It is ensured for the patient to lead a longer life with improved quality after transplantation.

From living or cadaveric sources

Transplantation may be performed from a blood type compatible (ABO) relative or a brain-dead person whose organs have been donated (from cadaver). A living-donor liver transplant involves removing the diseased liver and transplanting a portion of the liver from a living donor into a recipient.

Liver transplantation without blood reduces risks

The physiology of the patient should be taken into consideration in the event of transplantation. The more byproducts are used, the more patient’s metabolism is deteriorated. Each blood draw is a trauma for the patient. Using a small amount of blood in transplantation would deteriorate the patient’s body balance to a lesser degree, contributing positively to the healing process. However, there may be cases requiring the utilization of a larger amount of blood in liver transplantation.

The liver gets back to its original size in approximately 2 months

The liver has certain properties that other organs do not possess. One of them is the ability of the liver to regenerate itself, which is called “Regeneration”. For instance, the operations performed in tumor cases involve removing 70% of the liver, and the remaining 30% regenerates itself thus reaching its original size in approximately 2 months. This applies for both the recipient and the donor in the transplantation procedures performed. The portion of the liver that is given to the recipient and the one that remains in the donor reach their original sizes in time.

Transplantation is a team effort

Although a physician’s experience is certainly fundamental for liver transplant surgery, being a good surgeon is not enough for a successful operation. This is a team effort. It requires a well-established infrastructure and a well-equipped intensive care unit. Postoperative care should also be well-supervised as much as the operation itself. In addition, for subsidiary branches of hospitals performing organ transplants qualification is mandatory.

Complaints may vary depending on the stages of the disease

Liver failure may present with weakness, abdominal swelling, gastrointestinal bleeding, and impairment of consciousness. In case of liver tumor-failure comorbidity, symptoms, including weight loss and jaundice, may also develop. In a patient feeling unwell and weak, accompanied by weight loss and jaundice, liver or bile duct diseases should be investigated. In general, the disease causes weakness. Depending on the active or chronic stages of conditions such as Hepatitis B and C, the symptoms and complaints may vary.

Timing is important in liver transplantation

Timing is substantial for liver transplantation. For example, if the patient has end-stage liver failure (Child C) liver transplantation is strictly indicated. “MELD” score, as determined based on the patient’s test results, is a crucial guide in the decision-making process for transplantation. MELD is the most widely used scoring system worldwide. If MELD score is ≥15 a liver transplant is considered necessary for the patient. The next step depends on the examination of the other systems of the patient. Transplantation is avoided in the presence of severe heart and lung failure, active infection and extrahepatic tumor spread. Conditions such as splenomegaly, esophageal varices, ascites and encephalopathy, defined as the manifestations of decompensation, help in this decision-making process.

Is non-relative organ transplantation possible?

Transplantation between up to 4th degree relatives may be performed as required by the relevant Ministry of Health regulation. Non-relative organ transplantation is also possible upon the relevant approval from the regional Ethics Committees. Donor exchange, also called cross-transplantation, may also be performed within the limits of the law. However, this practice is unlikely in liver transplantation with respect to the team and organization.

A safe operation for the donor is significant

A donor for liver transplantation undergoes several tests in order to determine if his/her medical condition is eligible or not. All system functions of the donor should be normal. The person is considered a donor only after it is certain there would be no additional risks for the individual. This is solely on voluntary basis. The safety of the donor health is indispensable.

Pay attention to the foods you consume

Consuming high energy foods and beverages are hazardous for the liver. The hazard is done through the constant tiring of the liver. It is suggested to consume these types of nutrients in well-adjusted portions. One of the vegetables that are pointed out to be liver-friendly is the artichoke. The artichoke protects against tumors by virtue of its antioxidant properties.  It promotes the quality and fluidity of bile, thus helping with digestion. It eliminates the toxins accumulated in the body. Another beneficial vegetable for the liver is the red pepper.  Most drugs taken are metabolized by the liver. Irrational drug use is considerably hazardous for the liver.

Posttransplant life

Following transplantation, most people are able to go back to work and return to their daily lives. However, there are some considerations regarding the postoperative period. The first year following the transplantation is vital. Both infections and organ rejection are common during this period. In the first 6 weeks lifting heavy things should be avoided until the incision site is recovered. At the end of week 12, one may travel to any place at will. After the operation, in the absence of specific conditions such as diabetes and high cholesterol one may get back to routine dietary habits without the need of a special diet.

KIDNEY TRANSPLANTATION PROMOTES PATIENT’S QUALITY OF LIFE

Presence of chronic renal failure can be extremely challenging for maintaining daily life. Being on a dialysis machine for 4-5 hours, on three days a week, being unable to perform any intended activity, drink water or eat anything they may want, as well as the negative effects of dialysis, will definitely impair the patients’ quality of life to a substantial extent. However, following a successful organ transplant, with a raised awareness regarding posttransplant life, the individuals may resume their social lives.

Renal functions return to normal after transplantation

Patients on dialysis need kidney transplantation to lead healthier and longer lives. Kidney transplantation may be performed from two types of sources: living (close and distant relatives, spouse) and cadaveric. Patients commence a new period in terms of both health and social life due to the recovery of renal functions following transplantation.

Dialysis is a temporary solution

Dialysis is a temporary treatment model for patients with kidney failure; however, the ultimate recovery for these patients may be delivered through kidney transplantation. Patients cannot avoid negative effects that dialysis and kidney failure have on the other systems and organs.  It is not an accurate approach to keep on dialysis an individual who has a chance for transplantation. Kidney transplantation is the best treatment for end-stage kidney failure.

The four main reasons for kidney failure

According to recent research, diabetes ranks first among the factors causing kidney failure in Turkey. The second most important cause of kidney failure is uncontrolled or untreated high blood pressure, i.e. hypertension. Another one is presence of unpreventable primary diseases of the kidney that are designated as “glomerulopathy” in medical terms. They may also introduce kidney failure. Apart from these, other causes of kidney failure may include infections, congenital polycystic kidney disease, the retrograde flow of urine from the bladder to the kidneys (reflux) and incorrect drug use.

When to consider transplantation?

There are three modes of treatment for kidney failure. They are called “renal replacement” therapies. They are hemodialysis, peritoneal dialysis and/or kidney transplantation. The main goal of treatment is to prolong the lifetime of patients while maintaining their life standard at an optimum level. If the patient has progressed into end-stage kidney failure, kidney transplantation is determined. The patient does not necessarily have to be on dialysis to be eligible for transplantation. It is adequate for the patient to be at the dialysis phase (preemptive).

There is no increased risk of development of kidney failure following transplantation

Individuals who are living donors in kidney and other transplants undergo thorough examinations. All vital functions of the donor should be intact. Transplantation is performed only after it is certain there would be no additional risks for the individual. Before organ transplantation, it is ensured that the both kidneys are in good condition and that the single remaining kidney would be adequate for the living donor. As such, the living donor may live a healthy life with one kidney. Moreover, being a donor is not associated with increased risk of development of kidney failure. Donors are just as much at this risk as any other person. It is not in any way related to being a donor.

Are all patients with chronic kidney failure eligible for kidney transplantation?

Not every patient with chronic kidney failure is eligible for kidney transplantation. Severe cardiac and respiratory failure and the presence active infections may preclude from organ transplantation.

PEDIATRIC ORGAN TRANSPLANTATION

Kidney and liver failures may affect infants and children, may be congenital or develop in the later stages in life. Organ failure may lead to loss of appetite as well as growth and development failure in children. In cases of organ failures, the most effective mode of treatment that applies to both adult and pediatric patients is organ transplantation.

Children with organ failure do not grow properly

Children facing kidney and liver failures at a young age may not grow and develop properly. Children may fall behind in sexual development stages and start having reduced learning capacities. Children with organ failure cannot eat properly and gain weight since they generally experience loss of appetite. Apart from that, introversion and depression may also be seen during this period. Transplantation should be performed before growth retardation and persistent problems occur. A successful transplant surgery and a well supervised follow-up process help children continue living healthy lives. Children with kidney and liver failure are able to hold on to life again by means of organ transplantation.

Pediatric end-stage kidney failure requires transplantation

In children, causes of kidney dysfunction may include severe urinary tract infections, urinary bladder reflux and urinary stone disease. End-stage kidney failure requires kidney transplantation in children. Kidney transplantation may be performed from living or cadaveric donors for children, and by using special surgical techniques for infants younger than 1 year of age. The collaborative work of organ transplantation and pediatric nephrology departments provides preparation for the transplantation process and follow-up afterwards. In children with chronic kidney failure, it should be investigated whether the necessary conditions are met or not, and the transplantation should be considered the first choice of treatment. Statistical outcomes demonstrate high level of success following kidney transplantation from living and cadaveric source in pediatric cases.

Progression of liver failure might be sudden and rapid

Liver failure may occur during infancy or later, and may progress suddenly and rapidly in a chronic or healthy child. The most common reason for liver transplantation is congenital absence of the common bile duct in children. Bile duct disorders and several hereditary diseases may lead to liver failure. For such manifestations, the most effective treatment method is liver transplantation. The first sign of the disease is persistent and non-healing jaundice. Based on the examinations conducted, a small portion of the liver is collected from an eligible donor to perform liver transplantation.

Pay attention to the following signs in children!

• • Fatigue
• • High blood pressure
• • Urinary changes
• • Nausea and vomiting
• • Muscle cramps
• • Pruritus
• • Back pain

Special surgical techniques are used for pediatric organ transplantation

Pediatric (0-5 years) kidney and liver transplantation utilizes specific surgical techniques. Since their anatomy is smaller than adults, their veins are also smaller requiring a more precise work. Consanguineous marriage is one of the major causes of organ failure related to inherited diseases in children. Consanguineous marriages should be avoided in order to prevent the hereditary persistence of diseases.

A healthy future is waiting for children through transplantation

Organ transplantation offers a healthy future for children. Children may return to their normal lives in a short time through posttransplant infection protection and regular medication intake. During the disease period, many children may have to discontinue their education; however, they may resume soon after transplantation. Parents play critical roles at this point. They should demonstrate conscious attitude in this respect and educate their children on to what they should pay attention to for the rest of their lives.