Concept of liver.
Most of the human liver is located in the upper right part of the abdominal cavity and is the largest substantial organ in the body, generally weighing about 1200-1600 g, accounting for 2%-3% of body weight. The normal liver has a rich blood supply, is reddish-brown in color, soft and brittle in texture. The liver is the largest digestive gland in the body and the central station of metabolism in the body, and is an essential and important organ for maintaining life activities.
Its main functions are: nutrient metabolism (sugars, fats, proteins, etc.), synthetic functions (e.g. proteins needed for human growth and most coagulation factors), synthesis and secretion of bile, biotransformation functions, detoxification, defense and immune functions.
Liver transplantation.
When liver disease becomes life-threatening at an advanced stage, surgical procedures are used to remove the diseased liver, which has lost its function, and then implant a healthy liver with vitality to save the patient’s dying life. Liver transplantation has become the only effective treatment for end-stage liver disease and is a routine treatment for advanced liver disease.
Pro-life liver transplantation.
It is a development based on split liver transplantation. It is a surgical procedure in which a portion of the liver is removed from a healthy human body and transplanted to the patient as a donor liver. If there is a blood relationship between the donor and the recipient of the liver, it is called a parental liver transplant.
Significance of parental liver transplantation.
Pro-life liver transplantation involves cutting out a healthy person’s liver as a donor, and the person who is the donor “innocently” undergoes a major surgery, which is costly. The ethical debates that have accompanied this method have never ceased from the first day of its creation and have permeated every detail of clinical practice with great intensity. The medical approach of parental liver transplantation exists to alleviate the shortage of donor livers and to reduce the waiting time for transplantation in patients with end-stage liver disease.
From a medical perspective, parental liver transplantation is the pinnacle of liver transplantation technology and has had a profound impact on the development of liver transplantation and liver surgery. Intensive studies of the internal anatomy of the liver have contributed to advances in surgical techniques and have allowed other liver surgical procedures to benefit as well. Research in liver regeneration, liver function reserve, and liver function protection has advanced hepatology. The comprehensive introduction of microsurgical techniques in pro-life liver transplantation has promoted the crossover and integration of related disciplines. In conclusion, pro-liver transplantation has had a profound impact on the development of transplantation medicine and surgery.
From the patient’s perspective, it provides a new way to end the long and painful wait for a liver source and the threat of death, and to soon receive a liver transplant and regain a new life with the help of a loved one. Unfortunately, even with the support of loved ones and volunteers willing to donate, only about 1/3 of patients are ultimately fortunate enough to receive a pro-liver transplant. Most end up not being able to undergo the surgery due to various reasons such as blood type mismatch and physical condition.
If you donate a portion of your liver, can the rest grow back?
The answer is yes. The liver is the only substantial organ in the body that can regenerate and has a strong regenerative potential. Normal liver cells are in a non-proliferative state, but immediately after removal of a portion of the liver, the remaining liver cells exhibit an amazing ability to proliferate, with rapid compensatory proliferation beyond the average person’s imagination. It has been observed that in a rat with 70% of its liver removed, its liver grew back to its original size after 10-14 days. The human liver grows relatively slowly, usually returning to near its original size 3 months after removal, and once it reaches its original size, it stops growing. The donated portion of the liver will also grow to the weight of the whole liver in the recipient.
Does someone want to donate a liver but fear the impact on their health and the terrible complications?
This is a common question for many people who want to donate their liver: a healthy person is not a healthy person after having part of their liver cut out, right? Or that it is too costly for a family to have two people facing the possible risks of the surgery at the same time …… In fact, any kind of surgery, including the seemingly simple appendectomy, has the potential risk of complications, and parental liver transplantation is no exception. Of the tens of thousands of pro-liver transplants performed worldwide, 19 liver donors have died, some of these deaths were not related to the transplant procedure but rather to unintentional injuries and other illnesses, and these represent only 0.2% of the total number of pro-liver transplants and far less than the normal mortality rate of about 1% for lobectomies (e.g., liver cancer). Thankfully, most of these cases occurred in the early years of performing pro-life liver transplantation, and with today’s improving technology, no further surgery-related deaths of liver donors have been reported. However, general complications still exist, the most common ones being biliary fistula, infection, and bleeding, which can be cured with appropriate treatment.
After liver donation, the donor can usually be discharged from the hospital in 10 days, and can resume simple tasks 1 month after surgery, and can fully resume daily work and life in 3 months.
Advantages and disadvantages of parental liver transplantation (introduce several cases, blood related, non-blood related)
Many patients and families, when choosing liver transplantation, constantly ask their doctors whether parental liver transplantation or traditional cadaveric liver transplantation is better. In fact, early pro-liver transplantation is performed primarily to alleviate the donor shortage, especially in pediatric liver transplant patients. In Europe, approximately 15-20% of children with liver disease die each year while waiting for a liver transplant, and the advent of pro-liver transplantation has greatly alleviated this tension between supply and demand. As parental liver transplantation continues to be performed, it has been found that this technique has great advantages over traditional cadaveric liver transplantation. First, the short ischemic time greatly reduces biliary complications caused by ischemia-reperfusion injury. Secondly, the histocompatibility is good, because pro-liver transplantation is mainly performed between relatives, and there is a certain blood relationship between the donor and the recipient, so the chance of rejection after transplantation is reduced, and some patients even develop immune tolerance, which means that there is no need to take anti-rejection drugs, and the recipient already treats the transplanted liver as “his own family”. For non-related relatives, such as husband and wife, the risk of rejection is the same as for conventional liver transplantation between non-relatives. Third, adequate preparation is required. Since the surgery is elective, we can fully understand the donor’s and recipient’s internal and external vascular and biliary tract images, adjust the recipient’s nutritional status, improve the function of important organs, and conduct sufficient preoperative discussions to develop a thorough treatment plan.
Of course pro-liver transplantation has its drawbacks, first of all the safety of the donor liver, 19 donors have died worldwide. The second is that because the anastomosed vessels and bile ducts are thinner than those of a whole liver transplant, they are prone to vascular or biliary complications after surgery, and in addition, there are sections of the donor-recipient liver where bleeding and biliary fistulas may occur. However, with the improvement of technology, especially the application of microsurgical techniques, the above-mentioned vascular and biliary complications have been significantly reduced.
The choice of parental liver transplantation is also evaluated in terms of the family’s financial status, the urgency of the disease and whether the organ is matched and in short supply or not.
What are the donor requirements for pro-life liver transplantation?
First of all, the donor must fully understand the concept of living liver transplantation and related knowledge, and fully volunteer to donate part of his or her liver free of charge. For this reason the physician must repeatedly explain the following to the patient before the procedure: firstly, the current status of pro-life liver transplantation, secondly, the patient’s current condition and the significance and risks of receiving a pro-life liver transplant, and finally, the possible risks and impact on the health status and daily life of the donor during and after the liver donation procedure.
Secondly, the donor must be a healthy adult (18 to 60 years old) and meet the following requirements: Firstly, no major organic diseases or infectious diseases in the whole body. Secondly, the major organs of the body should be in good function, with normal morphology and structure of the liver and its major vessels and bile ducts. The third liver reserve function is good, no previous liver disease, and no long-term alcohol abuse. Fourth blood type should be consistent, or conform to the principle of blood transfusion, such as liver type O can be donated to patients of any other blood type. The fifth has no mental disorder and has the ability to act with full autonomy.
Which liver disease patients are suitable for pro-liver transplantation?
Generally speaking, all diseases that can be done with traditional liver transplantation can be done with pro-liver transplantation, mainly including the following diseases.
1. Substantial liver diseases caused by non-pathogenic microorganisms. Such as alcoholic cirrhosis, acute and chronic liver failure due to drugs and chemical toxins, congenital liver fibrosis, cystic fibrosis, giant liver cyst, Boo-ga syndrome, severe irreversible trauma, autoimmune hepatitis, etc.
2.All kinds of hepatitis and cirrhosis caused by various pathogenic microorganisms leading to liver failure and portal hypertension. These include acute and chronic hepatitis, cirrhosis, schistosomiasis, liver encysticercosis caused by hepatitis B virus (HBV) and hepatitis C virus (HCV), etc. Among them, acute and chronic hepatitis, cirrhosis and liver failure related to HBV infection are the most common indications for liver transplantation in China, accounting for almost 80% to 90% of all cases.
3. Congenital metabolic disorders. For example: hepatomegaly (Wilson’s disease), glycogen accumulation, hyperammonemia, antitrypsin deficiency, familial non-hemolytic jaundice, tyrosinemia, etc. These diseases, which can lead to early death or abnormal development of the child due to abnormal metabolism of certain substances, are the more common indications for pediatric liver transplantation.
4. Cholestatic diseases. Such as congenital biliary atresia, primary biliary cirrhosis (PBC), sclerosing cholangitis (PSC), secondary biliary cirrhosis, Calorie’s disease, intrahepatic biliary atresia (Byler’s disease), etc. In these diseases, patients have jaundice as the main clinical manifestation, which may be very high, but the synthetic function of the liver can remain normal for a long time. Among them, PBC and PSC have the risk of recurrence after transplantation.
5. liver tumor: liver malignant tumor without extrahepatic metastasis and major vascular invasion can also be an indication for liver transplantation. 2000 World Congress on Transplantation held in Milan, Italy, the Congress recommended that liver transplantation for liver cancer should be performed according to the Milan standard, i.e. single tumor less than or equal to 5cm in diameter, multiple tumors not more than 3, maximum not more than 3cm, and no major vascular invasion. According to this standard, the 5-year tumor-free survival rate of liver transplantation for hepatocellular carcinoma can reach 80%, which is significantly better than the traditional treatment methods. Especially in China where the majority of liver cancers occur on the basis of cirrhosis and have HBV or HCV infection background, liver transplantation provides a multi-treatment effect.
Which patients are not suitable for pro-life liver transplantation?
1.Patients with human immunodeficiency disease (AIDS)
2.Patients with advanced hepatocellular carcinoma with extrahepatic metastases
3.Intra- and extra-hepatic bile duct cancer.
4.Severe malformations that are not suitable for liver transplantation
5.Patients with irreversible hepatic encephalopathy.
6.Sepsis and serious systemic infections.
7.Progressive cardiopulmonary disorders.
8.Patients with alcohol dependence.
9.Patients with drug addiction and mental illness.
What should I do if I want to donate a part of my liver to save my loved ones?
First, collect all the patient’s information and go to the hospital transplant clinic for consultation (telephone consultation is also acceptable). After the doctor confirms that the patient has an indication for liver transplantation, the patient can be initially screened for a suitable donor based on the family’s blood type. The main tests include liver CT, liver size, liver vascularity, liver function indicators, hepatology indicators and other epidemiological tests, in addition to heart, lung, kidney and other organ function tests. After confirming that the liver is completely normal, the patient’s and donor’s information and proof of family relationship (such as household register, certificate from local public security bureau, etc.) will be submitted to the hospital transplantation ethics committee for discussion, and if approved, the surgery can be scheduled at a later date.