肝脏移植手术

评价

初步评价, 称为第一阶段评估, is the first step in determining if transplantation is an appropriate treatment option for you. 评估期间, the transplant team also assesses the medical factors related to your liver failure.

The appointment takes a full day, from about 7 a.m. 到下午4点.m.而且会很累. We ask that you bring at least one family member or other support person to help you process the significant amount of information you'll receive about the transplant process.

为你将要接受的测试做准备, do not eat or drink anything after midnight the day before your appointment. Please bring these items to your appointment:

• 零食
• 你服用过什么药物吗?
• 两种形式的识别
• 您的健康保险信息
• 你的医疗记录，如果有的话

测试

You'll undergo a series of tests during your evaluation, including:

• Blood tests to determine how well your liver and kidneys are working
• Ultrasound scan to view the blood flow to and from your liver and to look for any abnormal masses in the liver
• Chest X-ray to look for lung infection and to assess the status of your bones
• Electrocardiogram to look for any changes in your heart rhythm
• Pulmonary function test to measure your lung capacity

You'll also be evaluated by a liver specialist, called a hepatologist, and a surgeon. 肝病专家将进行全面检查, review your health history and discuss the transplantation process.

You can discuss your test results with the hepatologist and surgeon and ask any questions you have. Many patients find it helpful to write down a list of questions before the appointment.

You will also meet with a financial counselor to review your insurance information.

在世和已故捐赠者

Liver transplantation can be performed using a portion of liver taken from either a deceased or a living donor. 后 活体供肝移植, both the donor's remaining liver lobe and the transplanted lobe grow to full size.

Living donors allow patients to receive a transplant without the sometimes lengthy wait for a liver from a deceased donor to become available.

During the transplant evaluation, living donor transplantation will be discussed. 捐赠者必须身体健康, have a compatible blood type and want to donate for altruistic reasons. 如果你有潜在的活体捐献者, their evaluation will begin after you've completed all your testing. If the transplant team determines that the donation would work, a surgery date will be scheduled for both you and your donor. 这个过程需要六个月的时间.

If you will receive a liver from a deceased donor, you'll be placed on a national waiting list until an organ becomes available. 这可能发生在任何时间，白天或晚上. The wait for a new liver can take up to three years and you may need to repeat certain tests before your transplant.

If a liver transplant isn't in your best interest, a transplant team member will call you to discuss other options.

社会工作支持

Before your operation, a social worker will talk to you to about adjusting after the surgery. 社工每周领导一次 支持团体 for current and former transplant recipients and their families to address a wide range of issues, and one-on-one counseling is also available during your hospital stay. If needed, a social worker can arrange follow-up services and answer questions about disability.

过程

Liver transplant surgery lasts about four to 12 hours depending on the patient's condition. Surgery often takes longer if the patient's had previous surgeries, due to scar tissue.

During surgery, your damaged liver and gallbladder will be removed and replaced with the donor liver. Your gallbladder isn't necessary and won't be replaced.

复苏

After the transplant, you will be taken directly to the intensive care unit (ICU). Most patients need only a brief stay in the ICU.

During surgery, a breathing tube is inserted to help you breathe. In most cases the tube can be removed shortly after surgery. Many monitoring lines are attached during surgery; these, 太, 会在你变得更稳定时被移除吗. When you're ready to leave the ICU, you will be cared for in our transplant unit.

Everyone recuperates from liver transplantation differently. 病人 typically spend five to 10 days in the hospital. The length of your stay will depend on a number of factors, including how sick you are at the time of transplant, the complexity of your operation and if you experience any complications.

You should have a caregiver available both during your hospital stay and after discharge until you recover.

后续护理

一旦你出院了, you'll initially have weekly follow-up visits at the 肝脏移植手术 Clinic. As you recover, you'll need to be seen less frequently. If you live outside the San Francisco area, you'll likely need to find temporary lodging close to UCSF for the first month after discharge.

You'll have blood tests twice a week following transplantation. Gradually, these will become less frequent.

You'll be notified about any adjustments you need to make to your medications.

并发症和风险

任何手术都可能出现并发症, and patients who've had an organ transplant may face additional risks. Possible complications of a liver transplant include:

• 出血
  One of the liver's jobs is to make clotting factors that help stop bleeding after an injury. When the liver fails, the ability to produce clotting factors is impaired. To correct this problem, you'll receive blood products before and after surgery. It is expected that your new liver will start working very quickly to help prevent any excessive bleeding, but it is possible that you may be returned to surgery to control the bleeding, particularly if it occurs within 48 hours after the transplant.
• 血栓形成
  If a blood clot forms in a vessel leading to or from your liver, it can injure your new liver. This is a serious complication that may require a second transplant. You may receive special anticoagulation medication to prevent thrombosis.
• 拒绝
  Your body's immune system protects you from invading organisms. Unfortunately, it also views your new liver as foreign and will try to destroy it to protect you. 这就是所谓的拒绝. To prevent this, you must take special immunosuppressive medication for the rest of your life.
• 复发性疾病
  Some liver diseases can come back after a transplant. Your provider will discuss this with you if it's relevant to your case.

免疫抑制药物

免疫抑制药物, 也被称为抗排斥药物, 帮助预防和治疗排斥. You will need to take these medications for the rest of your life. 手术后立即, the dosages will be high since the probability of rejection is greatest at this time. We will lower your dosage quickly if there are no signs of rejection.

These medications have side effects, some of which are dose-related. 病人 typically experience the most side effects right after transplantation, 当剂量最高时. As your dosage is lowered, the side effects will probably lessen. Side effects may occur in some patients and not in others.

Be aware that anti-rejection medications also impair your body's ability to fight off infections. You'll be given medication to help prevent infections, but you'll need to use caution and avoid contact with people with infections, especially during the first three to six months after transplant.