General Surgery

Liver Transplantation
by Prof. Ayhan Dinçkan, M.D.

Irreversible damages in the liver may occur because of some hereditary abnormalities, cancer, viruses leading to hepatitis, excessive use of alcohol and medication.

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Prof. Ayhan Dinçkan, M.D.

General Surgery

Liver transplant is the only option for treatment of patients with end-stage hepatic cirrhosis whose life expectancy is below 1 year since %50 of these patients side because of secondary conditions related to this disease.

It may also be the best option for liver cancers sometimes when tumors cannot be removed with surgery either because of the location of the tumors or since the liver is too damaged to tolerate removing a part of it. By a transplant, the new liver will not only function normally but also the risk of a second tumor development is greatly reduced.

Importance of timing

When the surgery is performed before the patient deteriorates, the surgical risks related to treatment decrease vastly and expected lifetime of the patient after surgery the prolongs. Unfortunately for late transplantations survival time shortens, so timely referral to transplant is vital.

Complex Surgery

Overall condition of patient already creates a risk in addition to the procedure which has high risk due to complexity of the surgery and post-surgery period care with high probability to face complications. Just the surgical procedure may take up to 18 hours in complex cases.

Donors

Since only a part of liver from a living donor is sufficient for transplant, in most of the cases liver of people who have just died (cadaver) is not essential.  The donor is not affected by the loss of a part of liver because this organ can regenerate its lost functions over time and can function properly sufficiently immediately after procedure, liver transplants from living donor is the preferred method in Turkey.

For transplants blood type compatibility is required in addition to overall healthiness of the donor. Based on calculations some amount of donor’s liver that both meets the needs of the recipient and sufficient to let the healthy life of donor, is transplanted to recipient. The liver left in donor generally regenerates itself to reach its full size within 6 weeks.

Due to different regulations about transplant surgery in different countries, the relation degree in between the donor and the recipient may differ. In Turkey, documents that prove relation degree up to 4th degree are required for transplant to be executed.

Procedure

Success rate in liver transplantation is over 80% unless it is performed timely. During the procedure generally the right lobe of the donor is taken that is around 60% of the liver and transplanted for adult recipients. Sometimes the left lobe may be used as well for adults. For pediatric cases on the other hand 20% which correspond to 20% of the donor’s liver is transplanted.

Just like the donor, the recipient’s new liver is expected to reach its regular size within 6 to 8weeks following the surgery.

Discharge

The donor will recover soon to let an unproblematic discharge within several days.  They are not expected to face any health problems but in rare occasions complications such as jaundice or atherosclerosis of arteries may occur with a probability of less than 1%.

The recipient on the other hand will be moved to ICU first and after stabilization to regular patient room. The patient is expected to be discharged on day 10 when there are no problems in the postoperative period. They may engage their routine daily activities within 1 month after discharge and sports related activities within 3 months.

Just like all organ transplant patients, kidney transplant recipients start on immunosuppressive medications till the end of their life. These medications are used to ensure the new organ is not rejected by recipient’s own defense system.

Prof. Ayhan Dinçkan, M.D.

General Surgery
  • Medical School, Trakya University
  • General Surgery, Akdeniz University
  • Organ Transplantation, Akdeniz University Organ Transplantation Institute
  • Professor since 2014
  • Works in İstanbul
  • Head of İstinye University Bahçeşehir Medicalpark Organ Transplantation Center

As a surgeon he has performed nearly 6.000 operations, he focused on organ transplantation for the last 15 years. Besides kidney operations which constitutes the majority of this practice, he also reached above 1.000 liver and pancreatic transplants.

Prof. Dinçkan highlights the new generation immunosuppressive care protocols and developments in surgical and anesthesia procedures, supported 1-year survival rates to rise up to 90% in well-established and experienced centers.

“Immunosuppressive medication is a double-sided blade”

He emphasizes the importance of close monitoring of the patient at the post-surgery period since immunosuppressive while trying to prevent rejection of the new organ, drops the immune system of the patient down and leaves him/herself open to infections. Most of the unsuccessful cases are related to complications at his stage.

Prof. Ayhan Dinçkan states that the contemporary immunosuppression strategy is to design individualized medication protocols (houte couture) for each and every patient according to his/her demographical conditions such as age, gender, ethnic origin, genetic conditions, etc. and also risk factors regarding kidney failure, cardiovascular and metabolic complications, malignity and such.

Other than regular pediatric and adult cases, he receives complex cases such as obese patients who require dual-lobe-living-donor procedure where 2 living donors are involved. In 2020, one of his international patients from Saudi Arabia who is obese (155 kg) had a successful operation to receive parts of liver from 2 of his nephews.

Prof. Dinçkan highlights Turkey as one of the best destinations for Liver Transplant addressing quality and cost: “Organ Transplant Centers in Turkey have very high medical quality and very successful surgical results. We are number 2 of the World in liver transplant and among the leading countries in kidney transplants”. Referring to the cost of treatment of liver transplant, he states the treatment it is almost 4 times less costly when compared to other developed countries is kidney transplant is in our country. “

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