Liver Transplant

A Liver Transplant is a surgical procedure in which the non-functional/failed liver is removed and replaced by a healthy liver from a donor. A liver transplant is essential in case of chronic liver disease or liver failure. The most common reason for this is Cirrhosis is which the liver fails to function properly. The donor can be deceased or there are living donors as the liver can regenerate and grow back to its original size.

There are three main types of liver transplant – Orthotopic, Living Donor, Split Donation, depending upon the donor. It is essential that the donor liver is compatible with that of the recipient to prevent organ rejection.  

Know More About Surgery

The signs and symptoms that indicate the necessity of a Liver Transplant are- 

  • Fever
  • Diarrhea
  • Jaundice
  • Abdominal Pain
  • Pale stools 
  • Dark urine
  • Itching

Liver failure and Liver diseases can be diagnosed by blood tests, liver tests and kidney function tests. Urine, Sputum, Bile and Blood samples are also checked for virus, bacteria and various other diseases. Pre transplant tests are carried out to assess the severity of the requirement of a Liver Transplant. CT Scan and Ultrasound of the liver is carried out to determine the size of the liver and detect tumors and other abnormalities.

There are several types of treatments for this on the basis of the donor available such as: 

  • Orthotopic Transplant is the most common type of liver transplant in which the whole liver is taken from a person who has recently died but has an uninjured liver.
  • Living Donor Transplant is when a close relative donates a part of his liver to the recipient. If the patient is an adult, the right lobe is donated whereas, in case of children, the left lobe is donated due to its smaller size. The donor’s liver regenerates from the remaining part of the liver within 2-3 months.  
  • Split Donation is when a recently deceased person donates a part of his liver to an adult and another to a child, usually right and left lobes respectively. 
The donor liver has to be preserved in saline solution and it can be from a live donor or a cadaver donor. 
In this surgery, the patient is connected to several catheters and breathing is facilitated by the help of a ventilator. The diseased liver is removed after cutting its connections with blood vessels and is replaced by the donor liver. The blood vessels and bile ducts are reconnected and the incision is closed with the help of stitches.

Liver Transplantation involves several risks and complications. The donor liver may be rejected by the body as the immune system of the body detects it as foreign. There are possibilities of some infections and diseases to occur again post transplantation, especially jaundice. Bleeding and swelling may also occur. There are chances of leakage of bile ducts and blocked blood vessels to the liver. The donor liver may not function properly for some time after surgery. Hence, it is essential to take the proper follow up medication to decrease the chances of such kind of diseases.

In the case of liver transplant, post the surgery the patient is in the recovery room for at least one week and the blood pressure, oxygen level and breathing rate is regularly monitored. The patient cannot eat solid food during this period. Blood samples are taken regularly and the functioning of all body systems is checked thoroughly. Immunosuppressant medicines are taken in order to prevent organ rejection. It takes several months to recover completely; however after that time period, the patient can live a normal, healthy life.   

It is essential to call your doctor in case of observing symptoms of liver rejection such as-  
  • Jaundice
  • Fever
  • Dark urine
  • Fatigue
  • Swollen belly
  • Upset stomach

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Liver Transplant

A Liver Transplant is a surgical procedure in which the non-functional/failed liver is removed and replaced by a healthy liver from a donor. A liver transplant is essential in case of chronic liver disease or liver failure. The most common reason for this is Cirrhosis is which the liver fails to function properly. The donor can be deceased or there are living donors as the liver can regenerate and grow back to its original size.

There are three main types of liver transplant – Orthotopic, Living Donor, Split Donation, depending upon the donor. It is essential that the donor liver is compatible with that of the recipient to prevent organ rejection.  

Symptoms

The signs and symptoms that indicate the necessity of a Liver Transplant are- 

  • Fever
  • Diarrhea
  • Jaundice
  • Abdominal Pain
  • Pale stools 
  • Dark urine
  • Itching

Diagnosis

Liver failure and Liver diseases can be diagnosed by blood tests, liver tests and kidney function tests. Urine, Sputum, Bile and Blood samples are also checked for virus, bacteria and various other diseases. Pre transplant tests are carried out to assess the severity of the requirement of a Liver Transplant. CT Scan and Ultrasound of the liver is carried out to determine the size of the liver and detect tumors and other abnormalities.

Treatment

There are several types of treatments for this on the basis of the donor available such as: 

  • Orthotopic Transplant is the most common type of liver transplant in which the whole liver is taken from a person who has recently died but has an uninjured liver.
  • Living Donor Transplant is when a close relative donates a part of his liver to the recipient. If the patient is an adult, the right lobe is donated whereas, in case of children, the left lobe is donated due to its smaller size. The donor’s liver regenerates from the remaining part of the liver within 2-3 months.  
  • Split Donation is when a recently deceased person donates a part of his liver to an adult and another to a child, usually right and left lobes respectively. 
The donor liver has to be preserved in saline solution and it can be from a live donor or a cadaver donor. 
In this surgery, the patient is connected to several catheters and breathing is facilitated by the help of a ventilator. The diseased liver is removed after cutting its connections with blood vessels and is replaced by the donor liver. The blood vessels and bile ducts are reconnected and the incision is closed with the help of stitches.

Risks

Liver Transplantation involves several risks and complications. The donor liver may be rejected by the body as the immune system of the body detects it as foreign. There are possibilities of some infections and diseases to occur again post transplantation, especially jaundice. Bleeding and swelling may also occur. There are chances of leakage of bile ducts and blocked blood vessels to the liver. The donor liver may not function properly for some time after surgery. Hence, it is essential to take the proper follow up medication to decrease the chances of such kind of diseases.

After Procedure

In the case of liver transplant, post the surgery the patient is in the recovery room for at least one week and the blood pressure, oxygen level and breathing rate is regularly monitored. The patient cannot eat solid food during this period. Blood samples are taken regularly and the functioning of all body systems is checked thoroughly. Immunosuppressant medicines are taken in order to prevent organ rejection. It takes several months to recover completely; however after that time period, the patient can live a normal, healthy life.   

It is essential to call your doctor in case of observing symptoms of liver rejection such as-  
  • Jaundice
  • Fever
  • Dark urine
  • Fatigue
  • Swollen belly
  • Upset stomach

FAQ Section

1) What are the physiological functions of the liver?

The major function of liver is filtering the blood of the digestive tract, before passing it to the rest of the body. The liver also functions as an organ of detoxification, helping in for detoxification of chemicals and metabolizes drugs.

2) What are the common liver diseases?

  • Hepatitis: Inflammation of the liver is known as hepatitis. Hepatitis is usually caused by viruses like hepatitis A, B, and C. Hepatitis can also be due to other causes which are non-infectious like heavy drinking, drugs, uncontrolled consumption of over the counter medications, allergic reactions, or obesity.
  • Liver Cirrhosis: Severe damage to the liver from any untreated cause may lead to permanent scarring, called cirrhosis.

Cirrhosis is a serious degenerative disease that occurs as a result of alcohol abuse or chronic hepatitis. As liver cells develops tough scar tissues, liver loses its ability to function well. 

  • Hepatocellular Carcinoma

Hepatocellular Carcinoma is the cancer of liver cells caused by severe liver cirrhosis. Cancer of liver is a serious condition, which interferes with all other metabolic functions of body.

          Hemochromatosis

Hemochromatosis is a disease of liver due to which there is iron deposition in the liver causing damage to the liver.

  • Liver Failure

Liver failure is a life threatening condition that occurs when the liver become damaged beyond repair and is no longer able to function. Liver failure is of two type depending upon duration of damage.

  • Chronic liver failure is one where liver damage takes place gradually over months to years.
  • Acute Liver Failure is a condition characterise by sudden liver failure.

3) What are the causes of liver failure ?

The common causes of Chronic liver failure  include:

-Long-term alcohol consumption

-Cirrhosis

-Hepatitis

-Hemochromatosis

-Malnutrition

The causes of Acute liver failure are different from that of chronic liver failure, the are:

-Acetaminophen (Tylenol) overdose

-Viruses including hepatitis A, B, and C

-Reactions to certain prescription and herbal medications

-Ingestion of poisonous mushrooms

4) How are the diagnostic tests before Liver Transplant?

There are two types of medical tests namely blood and imaging tests.

Blood tests:

The blood tests includes administration of marker substances. They are

  • ALT (Alanine Aminotransferase)
  • AST (Aspartate Aminotransferase)

Elevated ALT and AST indicates liver function is inadequate.

  • Alkaline phosphatase: Indicator of bile dysfunction.
  • Bilirubin
  • Albumin
  • Ammonia
  • Hepatitis A tests: detect the hepatitis A virus.
  • Hepatitis B tests:  determine if you have been infected with the hepatitis B virus.
  • Hepatitis C tests: determination of hepatitis C virus.
  • Prothrombin Time (PT):  checks for blood clotting problems.
  • Partial Thromboplastin Time (PTT) to check for blood clotting problems.

Imaging Tests:

Ultrasound: An abdominal ultrasound can test for liver diseases, including cancer, cirrhosis, and gall stones.

CT scan : A CT scan of the abdomen gives detailed pictures of the liver.

Liver biopsy

5) What is the treatment for liver failure ?

The treatment for liver failure is Liver Transplant. A Liver Transplant is considered when the liver no longer functions adequately. 

6) Who needs Liver Transplant?

Anyone with a long-standing (chronic) or sudden onset (acute) severe liver disease leading to liver failure needs to be considered for a liver transplant

7) What is the procedure of liver allocation ?

There is a scoring system followed by most hospitals to determine how sick a patient is. This system is known as MELD (Model for End-stage Liver Disease), identified as highly predictive of the risk of death.

The MELD score is determined by the results of three tests:

1.) Total bilirubin, a measure of jaundice

2.) Prothrombin time, a measure of clotting ability

3.) Creatinine, a measure of kidney function

Further, a MELD calculator is used to calculate the MELD score by putting in the values of these tests.

8) How can donate liver?

Any organ donor can be classified into following two types.

1) CADAVERIC DONOR which includes brain dead organ donors and cardiac dead organ donors.

2) LIVING DONOR are living individuals donating a part of their liver.

9) Who can be a living donor?

The donor must be a close relative aged between 18-55 years, have a matching blood group, and weigh between 50-90kg (but not obese)

10) How can a living person donate his/her liver ?

Although each person has only one liver and would die without it, it is possible to donate a portion of the liver for transplantation into another individual.

The liver has a segmental anatomy. This segmental anatomy allows the experienced surgeons to create grafts of varying size by the process of grafting, depending upon the recipient's requirement for liver tissue.

The partial liver in both the donor and the recipient will grow to provide normal liver function for both the donor and the recipient.

11) Is every patient eligible to receive a new liver ?

A patient cannot receive a new liver in following conditions:

  • carcinoma in any other part of your body
  • serious heart, lungs or diseases of the nervous system
  • active alcoholics etc.

12) How is matching of liver done ?

The donor and recipient liver needs to be of the same size, and compatible blood type. Other than that no other matching is required.

13) How safe is liver donation ?

Liver donation is a very safe procedure because of liver's innate capacity to regenerate quickly. Liver also has a great reserve and it grows to its normal size in a short span of time. Donor can also continue any strenuous physical activity in approximately 2 to 3 months of surgery.

14) Are there any major risks involved post surgery ?

After surgery, the complications such as bleeding, poor functioning of the grafted liver, and infections could be some major risks. The patient is also carefully monitored for several weeks for signs of any complications.

15) What are the chances of survival after Liver Transplant?

The chances of survival after Liver Transplant are good. 80 to 90 per cent recipients respond well to the treatment.

16) How long will the Liver Transplant Surgery take ?

Liver Transplant surgery takes around 4 to 14 hours.

17) What happens during Liver Transplant surgery ?

During the surgery, doctors will remove the diseased liver and will replace it with the donor liver.

The surgeon will disconnect the recipient’s liver from  bile ducts and other blood vessels before removing it. The surgeon will then put the healthy liver in place and reconnect it with bile ducts and blood vessels. The blood flow will then take place into the new liver.

As Liver Transplant is a major procedure, several tubes are connected to the body during operation and will remain for a short time afterwards. These tubes are helpful to body in carrying various functions.

Following tubes are connected:

  • A tube will be placed through your mouth into your trachea (windpipe) to help you breathe during the operation and for the first day or two after.
  • A nasogastric tube will be inserted through your nose into your stomach to drain secretions from your stomach. It will remain in place for a few days until your bowel function returns to normal.
  • A tube called a catheter will be placed in the bladder to drain urine. This will be removed a few days after the operation.
  • Tubes will be placed in your abdomen to drain blood and fluid from around the liver. These will remain in place for about a week.

18) Do recipients of new liver have to take medications for the rest of their lives ?

Usually, yes. However, as the body adjusts to the new liver, the amount of medication required to control rejection can be decreased gradually. Usually the medications given are immuno-suppressive agents which help in preventing rejection.

19) What are the precautions one has to take after Liver Transplant Surgery ?

Walking requires some assistance at first. Coughing and deep breathing are very important to help the lungs stay healthy. Diet may at first consist of clear liquid and finally solids. It is important for the patient to abstain from alcohol and taking over the counter medications is also not advised.

20) When can I return to work after Liver Transplant Surgery ?

It normally takes about 3-6 months and a person may return to work if he feels ready and is approved by the primary doctor.

21) What is the expected cost of Liver Transplant Surgery in India?

Liver Transplant surgery only cost around INR 18 lakhs to INR 20 lakhs on an average, it can be as minimum as INR 5 lakhs and rise up to INR 35 lakhs in some deluxe hospitals.