Liver transplantation

The Clinic is one of the three Spanish centers that perform transplants between living people.

In recent years, the increase in waiting lists for liver transplants has favoured transplants between living people. It is performed in only three Spanish centers, -the Clinic is one of them-, since it is a very demanding transplant that requires a significant dedication from the health team that performs it.

It is a surgical technique in which approximately half of the liver is removed from a living donor, usually a family member, although not necessarily, and implanted in the patient. Due to the great capacity of regeneration of the liver, both donor and recipient can have normal long-term liver function. Total recovery is 6 to 8 weeks.

With a new surgical procedure, the Clinic has managed to increase the number of possible liver transplants among living people by 15 to 20%. It uses the posterior area of the donor organ as a graft.

In order for a live liver transplant to be viable, there must be compatibility of blood groups, good health of the donor - confirmed by thorough medical examinations and compliance with some anatomical requirements. Thus, the most appropriate time for the transplant is chosen and the risk for the donor will be as close as possible to zero.

The hospital stay ranges from 8 to 10 days.

This protocol assesses the patient's conditions with different tests:

• Complete physical examination.
• Chest X-ray.
• Respiratory function tests.
• Abdominal computerized axial tomography (TAC).
• Electrocardiogram.
• Echocardiogram.
• Abdominal ultrasound.

The medical team-surgeons, hepatologists, and other physicians who collaborate in the evaluation and treatment-review the analyses, tests, and examinations included in the evaluation protocol of the transplant candidate and decide whether he is a candidate for liver transplant.

In general, absolute contraindications for liver transplantation are considered those situations that technically prevent the transplantation or significantly reduce the chances of survival or functional recovery after it.

Liver transplantation is absolutely contraindicated when the patient's symptoms are not due to the liver disease or when the patient has other diseases with a poor prognosis and no treatment.

There are a number of relative contraindications: relatively advanced age, diabetes is renal failure, which increase the risk after transplantation. In cases where several relative contraindications coincide, transplantation is also contraindicated.

For a live-liver transplant to be viable, there must be compatibility of blood groups, a good state of health of the donor, which is confirmed by thorough medical examinations, and some anatomical requirements.

This careful selection results in the choice of the most appropriate time for transplantation and the risk to the donor is as close to zero as possible.

The improvement in immunosuppressive treatment and technique, together with the accumulated experience, make the results of liver transplantation much better.

Rejection is a major complication after liver transplantation. However, at present, an important arsenal of immunosuppressive drugs is available. These drugs decrease the immune reaction of the body against foreign structures, which may facilitate infections or tumor development. The most widely used of these immunosuppressive drugs are cyclosporine, tacrolimus, azathioprine, mycophenolate mofetil and glucocorticoids.

Along with pharmacological treatments, it is important to observe a series of care in the diet and lead an active life that includes physical exercise.

The survival rate at the year of transplant, in the more than 400 transplants performed at the Clínica Universidad de Navarra, is 90% (80% at 5 years after the transplant), ten points above the national average according to the Spanish Registry of Liver Transplants.