What is Liver Transplant?

Dr Priya Sharma

Dr Priya Sharma

BDS (Bachelor of Dental Surgery), 6 years of experience

November 7, 2021 Liver Section 440 Views

English हिन्दी Bengali

What is Liver Transplant?

A Liver Transplant Surgery is a surgical procedure wherein a liver that no longer functions properly is removed and replaced by a healthy liver taken from a deceased or living donor. The liver is the largest organ of the human body, and it performs essential functions necessary for survival. The main functions of the liver include –

  • Conversion of carbohydrates, proteins, fats, and vitamins into energy
  • Storage of many substances such as glycogen, iron, folic acid, amino acids, etc.
  • Secretion of bile which plays important digestive, absorptive and secretory functions.
  • Excretory functions- The liver excretes cholesterol, bile pigments, heavy metals (like lead, arsenic, and bismuth), toxins, bacteria, and viruses through bile.
  • Production of glucose and formation of clotting factors, steroids, heparin, etc.
  • Detoxification of toxic substances

Hence, it is very important to have a liver that functions normally to lead a healthy and long life. If your liver fails to perform these functions (liver failure), a liver transplant may be necessary. 

Let us explain in detail about the liver transplant in this article.

  • Why is a Liver Transplant needed? 
  • What are the signs and symptoms of Liver Failure?
  • What investigations are done before a Liver Transplant?
  • Liver Transplant Waiting List
  • What are the types of Liver Transplant?
  • Liver Transplant Team
  • What is the procedure of Liver Transplant?
  • How to take care after a Liver Transplant?
  • What are the complications of Liver Transplant?
  • What are the anti-rejection medication side effects? 
  • What is the survival rate after Liver Transplant ?
  • What is the cost of Liver Transplant in India?

Why is a Liver Transplant needed?

A liver transplant is recommended for people with liver failure whose condition cannot be controlled with other treatment options. There are many causes of liver failure, such as –

  • Liver cirrhosis, in which scars are formed in the cells and tissues of the liver. Cirrhosis is one of the ten leading causes of death in the western world and is the commonest cause of end-stage liver disease. ( Know more about- What is Liver Cirrhosis ? )
  • Viral hepatitis- infection of the liver caused by hepatotropic viruses B and C.
  • Liver failure induced by drugs such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, etc.
  • Alcoholic liver disease due to excessive intake of alcohol
  • Nonalcoholic fatty liver caused by a buildup of fat in the liver. (Know more about- What is Fatty Liver? )
  • Wilson’s disease, in which there is excessive copper in the body, and hemochromatosis, which means excessive iron in the body.  ( Know more about- What is Wilson’s Disease ? )
  • Diseases affecting the bile ducts- primary biliary cirrhosis, primary sclerosing cholangitis, and biliary atresia which is the most common cause of liver failure in children.
  • Liver carcinoma such as hepatocellular carcinoma.( Know more about- What is Liver Cancer? What is Liver Cancer Treatment? )
  • Autoimmune hepatitis, a condition where the body’s own immune system attacks the liver.
  • Alpha-1 antitrypsin deficiency – Alpha-1 antitrypsin is an enzyme that prevents the breakdown of enzymes in other organs and its deficiency is a common cause of liver disease.

What are the signs and symptoms of Liver Failure?

  • Jaundice- yellow pigmentation of the skin and sclera (white outer layer of the eyeball) by bilirubin
  • Nausea, vomiting, loss of appetite, and abdominal pain. In some cases, there might be vomiting with blood.
  • Hepatic coma, which includes disturbed consciousness, personality changes, intellectual deterioration, slurred speech, tremors, coma, and lastly death.
  • Decreased synthesis of clotting factors due to liver failure can lead to clotting disorders in which the ability of blood to clot is impaired, such as in hemophilia.
  • Ascites, i.e., fluid accumulation in the abdomen, and edema, i.e., swelling in the legs and feet.
  • Clay-colored stool and dark-colored urine. In some cases, blood is also present in the stools. ( Know more about- What is Blood in Stool? )
  •  A sweetish pungent smell of the breath is found in severe cases of acute and chronic liver diseases. 

If you have any of these symptoms, please contact your doctor at the earliest.

What investigations are done before a Liver Transplant?

Before moving forward with the liver transplant, you will be asked to do the following investigations-

  • Blood tests help determine your blood type to find a good donor match and assess the health of your organs. You will also be screened for HIV, herpes, hepatitis, and other diseases.
  • Urine analysis
  • Imaging tests such as ultrasound and computed tomography (CT) scans of the liver
  • Echocardiogram to check your heart health.
  • Pulmonary function tests to check how well your lungs function.
  • General health examination to check for any other illnesses that may impact your eligibility and success of a liver transplant. 

Your evaluation will also include-

  1. Nutritional counseling with dietitians who will make recommendations on how to plan healthy meals before and after your transplant.
  2. Psychological evaluation to treat anxiety, depression, personality disorders, and the general fear of major transplant surgery
  3. Addiction counseling to aid people quit smoking, alcohol, and drug abuse
  4. Financial counseling to help you understand the costs of transplant surgery and the care after the operation.

Liver Transplant Waiting List

Based on the results of the above tests, your doctors will assess the severity of your disease and your general well-being and place your name on the transplant waiting list.

The transplant waiting list priority is determined by two scoring systems known as Model for end-stage liver disease (MELD) for adults and pediatric end-stage liver disease (PELD) for children less than 12 years of age. Higher the MELD/PELD score, the better chance of you being at the top of the transplant waiting list (minimum score is 6 and maximum is 40). If your condition deteriorates, your name will be moved higher on the waiting list.

The number of people in need of a transplant greatly exceeds the number of donors available, and hence it can take days, months, or years to get a liver transplant. In such cases, while waiting for a donor, your doctor will prescribe you medications that will help reduce the symptoms of liver failure and make you feel as comfortable as possible. It is also extremely important to exercise, follow a healthy diet, take all prescribed medications, relax and stay healthy while waiting for a liver donor.

You may NOT be eligible to have a liver transplant if you-

  • Have a serious heart or lung disease.
  • Have a severe chronic infection.
  • Have cancer that has spread to other organs of your body.
  • Drink too much alcohol and are taking narcotic drugs. 

What are the types of Liver Transplant?

There are two types of liver transplants-

  1. Cadaveric donor transplant – In this, the liver is received from a person who has died. A deceased person can only be a donor if he/she has signed a consent form allowing organ donation after his/her demise. The identity of the donor and the cause of death is kept confidential.
  2. Living donor transplant- A section of the liver is removed from a healthy living donor and transferred into the recipient’s body. The liver is an organ that is capable of regenerating, therefore, the liver of both the donor and the recipient will grow to an adequate size in a few weeks. Living donors provide an alternative to waiting for a deceased donor and reduce the complications faced by the recipient while waiting for a donor. The living donor can be a healthy family member, relative, friend, or an unknown individual who is willing to donate. The living donor will have to undergo extensive testing before they can be eligible for liver donation. Blood type and body size are important factors in determining who can be an appropriate donor. 

Liver Transplant Team

For a transplant, not just one doctor but an entire transplant team is required, which includes-

  1. Transplant surgeon
  2. Hepatologist- A doctor specializing in treating the liver. 
  3. Transplant nurses 
  4. Transplant coordinator, who will be your main contact with the transplant team.
  5. Social workers to discuss your support network of family and friends and financial needs.
  6. Psychiatrists to help you deal with anxiety and depression associated with the liver transplantation experience.
  7. Anesthesiologists to discuss potential risks to anesthesia.
  8. Dieticians to help plan healthy meals.

What is the procedure for Liver Transplant?

As soon as a donor is available, you will be called to the hospital, and a general examination of your overall health will be carried out. After this, you will be prepped for a liver transplant. A liver transplant takes about 8-12 hours.

  1. You will be asked to remove your clothes and wear the hospital gown. During the operation, you will have to lie on your back on the operating table.
  2. An IV, i.e., an intravenous line, will be started on your arm or hand, and a catheter will be inserted into your bladder to drain the urine.
  3. Before starting the surgery, general anesthesia will be administered that will make you unconscious so that you won’t be able to feel any pain during the surgery. After anesthesia, the anesthesiologist will put a tube in your lungs so that you can breathe with the help of a machine, i.e., a ventilator. The anesthesiologist will also keep a check on your vitals, such as heart rate, blood pressure, and oxygen saturation.
  4. The skin over the surgical site will be cleaned with an antiseptic and then a large incision or cut will be made under the ribs on both sides of your belly. 
  5. The doctor will locate the liver and carefully separate the diseased liver from the nearby organs and other structures. The arteries and veins attached to the liver will be clamped to stop the blood flow to the liver.
  6. The diseased liver will be removed from the body after being cut off from the blood vessels and will be replaced with the donated liver.
  7. The donor liver will be reattached to the blood vessels and connected to the bile duct. 

The incision will then be closed with the help of stitches or surgical staples. The patient is then taken to the ICU for recovery.

How to take care after a Liver Transplant Surgery?

  • After surgery, you will be kept in the Intensive Care Unit (ICU) for a few days. In the ICU, you might be on a machine (ventilator) that helps you breathe until you can breathe on your own, and tubes will be attached to your nose to administer fluids. The doctor and nurses will monitor your condition to watch for any signs of post-surgical complications and keep a check on your heart rate, blood pressure, breathing, and oxygen levels via monitors. They will also regularly check the liver function as well as the functioning of other organs to make sure everything is working well.
  • Once stabilized, you will be moved out of the ICU and into the transplant recovery area for recuperation for about 5-10 days.
  • After being discharged from the hospital, your first return appointment will probably be after 1 to 2 weeks. You will then be asked to come after every 3 months and ultimately once every year for the rest of your life. You will also undergo frequent blood tests at first to check your overall health and liver function, but these tests will reduce over time.
  • You should inform your primary healthcare physician about your transplant surgery. Though most of your transplant-related problems will be dealt with by your transplant team, your primary healthcare provider will remain an important part of your medical care.
  • After a liver transplant, you will have to take many medications, some of which will continue for the rest of your life. These drugs prevent your immune system from attacking your new liver and reduce the risk of complications after the transplant.
  • It may take up to six months for the patient to fully recover after a liver transplant. You may resume your normal activities and go back to work a few months after surgery as decided by your doctor.
  • Self-care: Remain healthy by exercising, eating healthy meals, maintaining good hygiene, and avoiding smoking and alcohol consumption to increase the success of your liver transplant and reduce post-surgery complications. Joining support groups and talking with others who have shared your experience can help ease anxiety and fears. It is also important to be realistic and accept that life after transplant may not be the same as before. Having realistic expectations regarding the results and recovery time can help reduce stress.

 If you experience the following symptoms after the liver transplant, contact your doctor immediately.

  • Jaundice
  • Fever, which can be a sign of rejection or infection.
  • Fatigue
  • Redness, swelling, or bleeding from the site of incision.
  • Pain around the incision site
  • Diarrhea and vomiting 

What are the complications of Liver Transplant Surgery?

Liver transplant is a major surgical procedure and has a significant number of complications which include-

  1. Bile duct complications such as bile duct leakage or shrinking of the bile duct.
  2. Bleeding
  3. Blood clots in the body
  4. Failure of the new liver
  5. Infection – After the surgery, immunosuppressive drugs are administered to prevent the immune system from fighting against the new liver, and hence the patient is more prone to infections.
  6. Rejection of the new liver by the body – The body has a mechanism of rejecting any foreign body. Although anti-rejection medicines are prescribed to prevent rejection, in some cases, these do not work.
  7. Seizures and mental confusion. ( Know more about- What is Epilepsy? )
  8. Return of diseases that cause liver failure such as hepatitis, primary sclerosing cholangitis, fatty liver, etc.

What are the anti-rejection medication side effects?

After the liver transplant, medications will be prescribed for the rest of your life to prevent your body from rejecting the donated liver. The side effects of these anti-rejection medications include-

  • Thinning of bones, i.e., decreased bone density.
  • Diabetes, i.e., increased blood glucose
  • Diarrhea 
  • Headache 
  • Elevated blood pressure 
  • Elevated cholesterol ( Know more about- What to Eat to lower cholesterol? )
  • Infections as these drugs weaken the immune system. 
  • Damage to the kidneys
  • Fatigue 
  • Fever 
  • Jaundice 

What is the survival rate after Liver Transplant Surgery?

About 85% – 90% of children and adults do well enough to be discharged from the hospital after the transplant and 75% of those people live for at least 5 years. However, your chances of a successful liver transplant and long-term survival depend on your present condition.

What is the cost of Liver transplants in India?

The total cost of liver transplant surgery in India can range from around INR 19,00,000 to INR 25,00,000. However, this cost may vary across different hospitals. 

If you are coming from abroad, in addition to the cost of the liver transplant surgery, there will be some other expenses, such as the cost of living in a hotel, and the cost of local travel. Apart from this, after surgery, the patient must stay in the hospital for 22 days and in the hotel for 40 days for recovery. So, the total cost of liver transplant in India comes to be around INR 30,00,000 to INR 40,00,000. 

We hope that we could answer all your questions regarding Liver Transplant Surgery through this article.

If you want more information and treatment of Liver Transplant Surgery, you can contact a Liver and Hepato-Biliary Surgeon

We only aim to give you information through this article and do not recommend medication or treatment in any way. Only a doctor can give you the best advice and correct treatment plan. 

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