Let’s learn about the liver together. The liver is the largest organ in the body weighing nearly 3 pounds. It’s located on the right side of the abdomen below the ribs. The liver’s function is to filter the blood coming from the digestive tract, before passing it to the rest of the body. It removes toxins and bacteria from food as it enters the bloodstream. It defends the body from microorganism invasion. In order to do this, the liver needs a good blood supply which it gets from two sources.
The portal vein supplies most of the blood (70%) and the hepatic artery gives the remainder (30%). The portal vein carries nutrients it receives from the gut (via the superior mesenteric vein) to the liver for detoxification. Once food is detoxified, nutrients leave the liver via hepatic veins. The hepatic veins join the inferior vena cava, which carries blood to the right atrium of the heart. (source)
Now let’s talk transplantation because, as you may have guessed from the title of this post, it looks like that is the next step for Ana. Dr. Laquaglia called us yesterday and said that the artifiact in the right lobe of Ana’s liver was probably tumor and it may also be involving the portal vein as Dr. Wu (the Westchester surgeon) initially indicated. That’s three surgeons who all recommend transplant (including Dr. Kim from Mt. Sinai).
According to eMedicine, the liver is the second most transplanted major organ (kidney is #1).
There are various criteria involved in being on the transplant list which are numerous and daunting, so I’ll just link to them here.
Once a donor is found, the ideal window for transplantation is about 8 hours although the donor liver can be used for up to 24 hours. Patients are given a dose of steroids and antibiotics before surgery. The transplant takes about 6 – 8 hours, and then the patient goes to the ICU.
The incision in the belly is shaped like a reverse Y. Small drains called Jackson-Pratt drains are placed near the incision and remain there for several days to catch fluid. Another drain is placed in the bile duct to allow bile to drain outside the body and this remains in place for about three months. After transplant, the patient is brought to the ICU on a respirator with a breathing tube in place. This is removed once the patient demonstrates the ability to breath on her own. The average hospital stay after surgery is 1 to 3 weeks.
The first three months after transplant are the most delicate for the organ recipient. The body will actively try to reject the liver, so a cocktail of medications must be given to prevent this. Many of the drugs leave the patient’s immune system compromised since the body’s natural defense mechanism must be suppressed so the organ isn’t rejected.
Anti-rejection medication is taken for the rest of the patient’s life.
Slow rejection of an organ is not unheard of and can lead to the need for another transplant later on.
2% of liver transplant recipients suffer immediate rejection.
2-5% of liver transplant recipients suffer slow rejection over time, requiring another transplant.
Transplant recipients may return to work or school within 3 to 6 months after transplant, as long as this is cleared by their physician.
So, there you have it. The basics of what we can expect based numerous Google searches. We are all going to Westchester tomorrow with Ana (Emily included) so she can get her infusion of antibiotics. Dr. Hochberg will meet with us while we’re there and discuss her CT results and also next steps for keeping Ana as healthy as possible while we wait for a liver. This isn’t quite set in stone. We’re still waiting to meet with Dr. Kato from Columbia – the surgeon who does the ex-vivo-operate-on-my-child’s-liver-outside-of-her-body procedure.
Disclaimer: I’m pretty sure I’ll be revising some of the information in this post. I probably confused some important medical details.