Liver Transplantation
The liver is one of the largest and most important organs in the human body, located in the upper right side of the abdomen and under the ribs. The liver is essential for digesting food and ridding the body of the effects of toxic substances. The liver performs numerous functions that are necessary for survival. Almost all the blood from the digestive system, which is full of nutrients, passes through the liver. The nutrients absorbed from the small intestine are converted in the liver into substances that are necessary for life.
The liver also secretes bile, which helps digest and absorb fats, and thus this organ plays an effective role in regulating the levels of sugar, fat and protein. In addition, the liver plays an effective role in storing vitamins and is responsible for the metabolism of most drugs and is an effective organ in detoxifying the body. Due to the vital role of this organ, its failure is accompanied by numerous symptoms.
Having a healthy liver is essential for longevity because the liver is responsible for filtering the blood and removing toxins from the body. Liver diseases can have different origins. Some liver diseases have a hereditary (genetic) background. Also, some viruses, alcohol consumption and even obesity can cause disease in the liver. Over time, diseases that cause irreversible damage to liver tissue (scarring or cirrhosis) can lead to liver failure. If these damages are identified in the early stages and action is taken to eliminate them, the liver can be improved and healed, otherwise, in some cases, the progressive damage to the liver will reach a stage where the person's liver is no longer able to perform its inherent functions.
Liver transplantation is a treatment option for people who suffer from liver failure and their condition is no longer controllable with other treatments and medications. In liver transplant surgery, usually all or part of the donor's liver is placed in place of the patient's liver and the patient's liver is removed from the body. In most cases, the transplanted liver is taken from a person who has suffered brain death, but the transplanted liver can also be taken from the patient's immediate family members.
Symptoms of liver diseases:
- Yellowing of the skin and eyes
- Abdominal swelling and pain
- Swelling in the lower extremities
- Itching skin
- Darkening of urine color
- Paleness of stool (straw-colored)
- Chronic fatigue
- Nausea and vomiting
- Loss of appetite
- Bruising of limbs without a history of trauma
The most common diseases leading to chronic liver failure and requiring liver transplantation in the end stages of the disease include:
- Chronic hepatitis with cirrhosis
- Primary biliary cirrhosis
- Sclerosing cholangitis
- Biliary atresia
- Alcoholism
- Wilson's disease
- Hemochromatosis
- Alpha-1 antitrypsin deficiency
- Viral hepatitis
The first human liver transplant surgery was performed in 1963 in Denver, Colorado, USA by a surgeon named Thomas Starzl. Although this operation was unsuccessful and the patient died in the operating room due to severe bleeding, Dr. Starzl continued his efforts in this field and in 1967 the first successful liver transplant in humans was performed. Currently, about 21,000 liver transplants are performed annually in 200 centers around the world. Most transplant recipients will return to a fully productive life, even young women who have undergone transplantation will be able to become pregnant and have children after the transplant.
The first living donor liver transplant was performed in 1988 by Dr. Christoph Broelsch at the University of Chicago Medical Center. In this type of operation, 55 to 70% of the right lobe of the liver is received from a living donor. Repair will occur within 4 to 6 weeks. Transplantation from a living donor is a difficult operation that is associated with complications such as bleeding, infection, bile leakage, transplant rejection, etc. up to ten percent.
The first liver transplant in Iran and the Middle East was performed in May 1994 at Namazi Hospital in Shiraz by Dr. Seyed Ali Malek Hosseini and colleagues. This transplant was performed from a brain dead donor in Tehran and the transplanted organ was transferred to Shiraz after removal. Dr. Malek Hosseini completed a liver transplant training course at the University of Pittsburgh Medical Center (Pennsylvania, USA) under the supervision of Dr. Starzl.
The cost of a liver transplant in the United States is estimated at about 580 thousand dollars. In regional countries such as Turkey, the cost of this procedure is about 100 thousand dollars, and in India it is reported to be about 50 thousand dollars. However, in Iran, with the support of the Ministry of Health and HOA in the Treatment of Patients, this procedure is performed at a much lower cost within the country.
Considering that one of the operational programs of the Board of Trustees in order to achieve the lofty goals of establishing this board regarding creating a platform for the treatment of all patients within the country is to support the quantitative and qualitative growth and development of liver transplant operations in medical centers affiliated with the country's universities of medical sciences. By the end of 2023, the Board of Trustees has supported more than ten thousand liver transplant operations. Also, in 2023 alone, it has supported 855 liver transplant operations that have been performed in 9 transplant centers in the country.
Currently, liver transplantation is performed in nine educational-therapeutic centers in the country:
- Abu Ali Sina Organ Transplant Hospital, Shiraz
- Hazrat Imam Khomeini Hospital Complex, Tehran
- Ayatollah Taleghani Educational and Therapeutic Center, Tehran
- Shahid Afzalipour Educational and Therapeutic Center, Kerman
- Montasarieh Organ Transplant Hospital, Mashhad
- Al-Zahra (SA) Educational and Therapeutic Center, Isfahan
- Golestan Educational and Therapeutic Center, Ahvaz
- Firoozgar Educational and Therapeutic Center, Tehran
- Masih Daneshvari Educational and Therapeutic Center
The support of the Board of Trustees for patients who are candidates for liver transplantation is carried out in the following three areas:
- Assisting in providing part of the cost of hoteling and hospital treatment
- Providing the items needed to perform liver transplant operations (such as tissue preservative solution and bags)
- Equipping new centers and replacing old devices in existing transplant centers
The statistics of liver transplant operations performed between 2008 and 2023 are presented in the following table and chart:
