What is a Liver Transplant and who needs it?

Liver Transplant is a surgical procedure. In this procedure, the surgeon removes a liver that has lost its functionality and replaces it with a healthy liver from a deceased donor or a portion of a healthy liver from a living donor.

As the liver is the largest internal organ of the human body, it performs several important functions such as:

  • Producing Bile: Bile helps the body in absorbing fats, cholesterol, and fat-soluble vitamins.
  • Producing nutrients, hormones, and medications.
  • Making Proteins to help with a blood clot.
  • Removing harmful toxins and bacteria from the blood.
  • Regulating immune responses.
  • Preventing infection.
  • Liver Transplant is usually the last treatment resort for people with serious complications due to end-stage chronic liver disease. It is also a treatment option in some cases of sudden failure of a healthy liver.

    Why is it done?

    Liver Transplant is usually a treatment option for those whose conditions can’t be controlled with other treatments. It is also an option for those with liver cancer. There is no specific time or age for a liver failure as such as it may happen quickly or over a long period. When liver failure occurs quickly in a short span, it is known as acute liver failure. Acute Liver Failure arises due to complications from certain medications. Liver transplant is more often used to treat chronic liver failure however, it can treat acute liver failure as well.

    Many conditions are responsible for chronic liver failure. The most common cause is cirrhosis or scarring of the liver. In cirrhosis, the scar tissues replace the normal liver tissues and prevent the liver from functioning properly. It is the most frequent reason for a liver transplant.

    Some other major causes of cirrhosis
    • Alcoholic Liver Disease: In this condition, the liver is damaged due to excessive alcohol consumption
    • Non-Alcoholic Liver Disease: In this condition, fat builds up in the liver leading to inflammation or liver cell damage .
    • Genetic Diseases: Some diseases such as hemochromatosis affect the liver by causing an excessive iron build up in the liver
    • Diseases affecting the bile duct:Bile Atresia is the most common reason among children for a liver transplant.
    • Hepatitis B & C.

What is the difference between Acute Liver Failure and Chronic Liver Failure?

Acute Liver Failure

Acute Liver Failure occurs when a healthy liver suffers from massive injury-causing symptoms of liver insufficiency. Although several things can lead to acute liver failure, the most common causes are acetaminophen overdose, ingestion of poisonous mushrooms or other toxins and viral infections. This condition usually comes to notice within eight weeks after the yellowing of the skin due to jaundice and is called confusion. Confusion occurs when the toxins get metabolized by the liver accumulate. Many acute liver failure patients die within a few days if not transplanted. They are placed on the highest priority on the national waiting list for a donor's liver.

The impressive quality of the liver is its ability to repair itself in response to an injury. However, repeated injury and repair over a long period scars the liver permanently. Cirrhosis, which is the end stage of scarring, is a condition where the liver can no longer repair itself. When the person with cirrhosis shows inadequate liver function, it is termed as decompensated liver disease. Even though medicines can help in reducing the symptoms, the only permanent cure is a liver transplant.

What are the signs and symptoms of liver disease?

Gastrointestinal Bleeding

Due to scarring in the liver tissue, there is increased pressure on the venous system due to resistance in the blood flow. This pressure causes the blood to flow from alternative routes to return to the heart. Small veins through the abdomen lying outside of the liver become thin-walled and enlarge due to the high amount of blood flow under increased pressure. This causes fragile veins in the portions of the gastrointestinal tract to rupture and bleed. This bleeding in the intestinal tract can be life-threatening.

When the liver fails to clear ammonia and other toxins from the blood, these substances accumulate and result in cognitive dysfunction varying from sleep-wake cycle patterns to mild confusion to coma.

One of the primary functions of the liver is to eliminate the degradation products of hemoglobin. Hemoglobin is responsible for carrying oxygen in our blood. Bilirubin, that is one of the degraded products processed and excreted by the liver, is not cleared from the body in case of liver failure. When the levels of bilirubin increase, the skin, and tissue of the body assume a yellow color.

The liver synthesizes many proteins that circulate in our body such as albumin. Low levels of albumin in the blood flow force fluid out of the bloodstream which can’t be reabsorbed. Due to this, fluid accumulates in the tissues and body cavities. It can also accumulate in the legs or the chest cavity. This is treated by strict limitation of dietary salts intake, medications to force out salt and water loss through kidney and lastly through intermittent drainage through needle insertion into the abdominal or chest cavity.

How does the liver transplant waiting list work?

If you’re an active candidate for a liver transplant, your name will be registered on the national waiting list. The list is maintained according to the blood type, body size, and model of end-stage/ pediatric end-stage liver disease score.

Also called the MELD/PELD score, it is calculated through a simple blood test and those with the highest score are assigned organs first. The transplant team determines the suitability of the donor organ. If the patient's health deteriorates, their scores increase to allow the most serious patient to be transplanted first. It is not possible to determine how much time it will take for the liver to be available however a transplant coordinator is always available to answer any queries regarding the same.

What happens once a matching organ is found?

Once an organ is identified for you, the transplant coordinator will contact you to let you know of any additional instructions. When you reach the hospital you are required to get additional blood tests, an electrocardiogram, and a chest x-ray before the transplant operation. If the donor organ is found suitable, only then you can proceed with the transplant. If not found suitable, then you will have to continue waiting.

Is liver donation safe?

Liver Donation is a very safe process as the liver can regenerate itself to its original size within 2 to 3 months after a part of it is removed. There are no long term effects and the patient can get back to his normal routine within a few months.

What are the tests required for a liver transplant?

Those who will go through liver transplant will need to bring all their medical records, x-rays, liver biopsy, operative reports and a list of medicines during the pre-evaluation round.

Some of the other tests which are performed during the evaluation
  • CT Scan: Also known as computed tomography, CT Scan uses X-rays and a computer to show the size, shape, and blood supply of the liver.
  • Doppler Ultrasound: This is done to determine if the blood vessels of the liver are open.
  • Echocardiogram & Stress Testing to evaluate the heart
  • Pulmonary Function of the lungs: This checks the ability of the lungs to exchange oxygen and carbon dioxide.

If these reveal some specific issues, the patient may be required to perform additional tests.

What happens during the operation?

Liver Transplant varies between 6 hours to 12 hours. During this time, the surgeons remove the liver and replace it with the donor's liver. As this is a major procedure, surgeons place several tubes in the body of the patient as the tubes help the body in carrying out certain functions during and a few days after the operation.

The tube is placed through the mouth into the trachea to help with breathing during the operation and up to two days after. The tube is attached to a ventilator which expands the lungs mechanically. Another tube, called nasogastric tube is inserted through the nose into the stomach to drain secretions from the stomach. It is kept in place until the bowel functions are restored. A catheter, which is another tube, is placed into the bladder to drain urine until a few days post-operation. Another set of tubes is placed into the abdomen to drain blood and fluid around the liver.

What measures are needed to be taken post-liver transplant?
  • Stay in the intensive care unit for a few days: During this time, the doctors and nurses will monitor the condition to watch for any signs of complications. They will also check for signs to see if the new liver is functioning properly.
  • A few days rest in the hospital: Once stable, the patient should stay in the hospital for a few days for transplant recovery.
  • Regular Check-ups: Regular Check-ups are a must such as blood test, a few times a week.
  • Continuous Medicines: The patient is required to take several medicines, some of which will continue for life. These medicines will keep the immune system from attacking the new liver and reduce the risk of other complications.

The recovery can take up almost six months or more before the patient can resume normal activities.