"The main advances in liver transplantation lie in the experience of health care teams, in the handling of medicines and in the new drugs available to us".
DR. JOSÉ IGNACIO HERRERO SANTOS SPECIALIST. LIVER AND PANCREATIC CANCER AREA
Liver transplantation involves the removal of the patient's diseased liver and its replacement with a healthy organ from a deceased or living donor, either the entire organ or a part of it.
The Clinic is one of the two Spanish hospital centers expert in adult living donor liver transplants.
Our survival rates of transplanted patients, above 90% per year and 82% at five years, is about ten points above the national average, according to the Spanish Registry of Liver Transplantation.
In the last years, the new protocols in the surgical operation of a transplant have made it safer and present less complications.
The postoperative period of the patients has been reduced considerably and, the next day or two after the operation, it is already on the floor.
To this we must add the considerable decrease in the average hospital stay of the transplant recipient, which has gone from a month or a month and a half to, at present, be below 10 days.
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When is liver transplantation indicated?
Liver transplantation is the only curative treatment for several serious diseases and is indicated mainly in four groups of diseases: severe acute liver failure, liver cirrhosis, liver tumors and metabolic diseases in which the liver produces an abnormal substance that is responsible for a disease of another organ.
In general, liver transplantation is indicated when liver disease offers lower life expectancy than transplantation.
As for the parameters applied to liver tumors by the Clinic's specialists, they establish the indication of transplantation in patients with a nodule up to 6 cm or two or three nodules up to 5 cm. These criteria are wider than those traditionally applied.
Liver transplantation is absolutely contraindicated when the patient's symptoms are not due to liver disease or when the patient has other diseases with poor prognosis and no treatment. Moreover, there are a number of relative contraindications: relatively advanced age, diabetes, renal failure, which increase the risk after transplantation.
In any case, to know if there is a possibility in your case, it should be the specialist who makes a complete evaluation and decides if it is possible or not.
Do you have any of these diseases?
You may need a liver transplant
Learn more about liver transplantation
The Clinica Universidad de Navarra has a survival rate of 85% at five years.
The donation of a deceased person is the salvation for terminally ill liver patients. It represents the curative treatment of chronic and irreversible liver diseases.
Since its beginning and up to the present, the most common liver transplant is that of a deceased person's organ, although this tendency could change with transplantation between living persons.
The surgical technique of liver transplantation has gained in speed. Nowadays, the whole transplant is done in 4 or 5 hours, as opposed to 8 or 9 hours in the beginning. There is also less need for transfusion. Moreover, the recipients arrive at the transplant in a better state.
Likewise, the anesthetic technique has advanced notably. Patients' recovery after transplantation is significantly faster, as their condition after the operation is much better than before.
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).
- 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.
Where do we do it?
IN NAVARRA AND MADRID
The Hepatology Unit
of the Clínica Universidad de Navarra
We are pioneers in the application of gene therapy in the treatment of liver tumors and hereditary metabolic diseases, and we have extensive experience in the diagnosis and treatment of viral hepatitis and in the treatment of liver cancer using radioembolization systems with Ytrium-90 microspheres.
The Clinic is at the forefront in Spain in performing liver transplantation between living people.
Diseases we treat
Why at the Clinica?
- Highly specialized team of professionals with more than 25 years of experience.
- Nursing team specialized in hepatic patients.
- Important research activity on the molecular mechanisms that cause some of these diseases.