Liver Transplant

The liver is a crucial organ responsible for numerous vital functions in the body. It regulates chemical levels in the blood, produces bile for waste removal, aids digestion by processing nutrients, regulates blood clotting, detoxifies cells, and metabolizes medications. Additionally, it plays a role in storing toxins and generating red blood cells. The liver's importance is highlighted by its ability to regenerate if partially removed, underscoring its critical role in maintaining overall health.

Liver transplantation is a surgical procedure performed on individuals with end-stage liver disease or acute liver failure, involving the replacement of the diseased liver with a healthy one from a donor. Conditions that may necessitate a liver transplant include hepatitis B and C, liver cancers, Wilson’s disease, hemochromatosis, acute liver disease, polycystic disease, autoimmune hepatitis, alcoholic liver disease, primary biliary cirrhosis, fatty liver disorder, or previously failed liver transplant. This procedure is considered curative for end-stage liver disease when other medical treatments have been ineffective.

The symptoms related to liver failure may include the following:

The initial stage of liver failure is a mild stressful condition that may last for several months. This involves mainly the accumulation of a certain amount of toxins and waste products in the body. The second stage includes symptoms relating to impaired protein metabolism and decreased levels of vitamins like vitamin K, folic acid and B12. In some patients there is an increase in blood clotting which can lead to bleeding from small cuts or larger bleeds in the intestines.

A liver transplant is recommended when the liver no longer functions adequately to keep a person alive. A successful liver transplant is a life-saving procedure for people with liver failure. Liver failure can happen suddenly, as a result of infection or complications from certain medications, or it can develop slowly over months, years, or decades. Chronic liver failure is usually the result of cholangitis, which is a condition in which healthy liver tissue has been replaced with scar tissue making the liver unable to carry out its normal functions.

Liver transplant evaluation involves multiple tests and consultations to assess the candidate's health and suitability for the procedure:

• General health, laboratory, imaging, and heart tests are conducted.
• Nutrition counseling and psychological evaluation are carried out.
• Antibody tests are performed to identify potential complications.
• This process helps determine the candidate's readiness for transplant and any associated risks.

There are many areas that affects the condition of a good liver donor such as:

• Same blood group.
• The donor must be between 18 to 50 years old.
• The donor must not be obese or have fatty liver.
• The donor should be in good physical and mental health.
• Biological siblings are usually the best donors alive because of matching.

• Auxiliary Liver Transplant: Partial liver transplantation where only a portion of the liver is replaced. The remaining damaged part may recover over time.
• Orthotopic Liver Transplantation: Involves the entire liver from a deceased donor being transplanted to the recipient. Blood flow is restored, and a bile duct connection is made.
• Heterotopic Liver Transplantation: Living donor liver transplantation where the healthy donor's liver is placed alongside the recipient's diseased liver. The donor's liver may take over if the recipient's liver fails.
• Reduced-sized Liver Transplant: Commonly performed in children, where a portion (15-20%) of a healthy donor's liver is transplanted into the recipient's abdomen to replace damaged tissue.

• Sewing: After attaching the new liver, all blood vessels and bile ducts are connected, followed by closure of the incision.
• Incision: The abdominal area is opened to access the liver.
• Transaction: The diseased liver is cut and removed.
• Adequate Control: Ensuring bleeding control and incision closure.
• Abdomen Evaluation: To prevent post-transplant complications.
• General Anesthesia: Administered to block pain during surgery.
• Mobilization of The Native Liver: Involves isolating important structures like veins and arteries.

Complications in Liver Transplant:

• Bile Leakage
• Bleeding (Hemorrhage)
• Loss of kidney function
• Rejection of the new liver by the body
• Increased risk of infections
• Blood flow problems to and from the liver
• Increased risk of certain cancers
• Primary non-function of the new liver, requiring re-transplantation

Post-Liver Transplant Evaluation:

• Recovery Room Monitoring: After surgery, the patient is closely monitored in the recovery room.
• ICU Observation: The patient is transferred to the ICU for further monitoring for several days.
• Vital Sign Checks: Regular blood tests and monitoring of vital signs.
• Medication Management: Administration and monitoring of anti-rejection medications.
• Transition to Normal Ward: When stable, the patient is moved to a regular ward.

Benefits of Liver Transplant:

• Improved Quality of Life: Helps patients maintain an active lifestyle and longer life.
• Potential Life Expectancy Increase: Can extend life expectancy significantly.
• Living-Donor Option: Provides an alternative to long waiting lists.

Survival Rate of Liver Transplant:

• Success Rate: Approximately 80% success rate for liver transplants in India.
• Life Expectancy Increase: Many patients see a significant increase in life expectancy post-transplant.