Liver Transplant – Procedure, Risk and Treatment

Liver Transplant – Procedure, Risk and Treatment

What is Liver transplant?

A liver transplant is a surgical operation in which a damaged liver that is no longer in a working condition is replaced with a healthy liver. The healthy liver can be taken from a deceased person or a portion of a healthy liver taken from a volunteer who is either known to the patient or is a third-party reference.

Liver Anatomy and Functions

Located in the upper right part of the abdominal cavity, the liver is the largest internal organ in the human body. It is underneath the diaphragm and above the stomach, intestines, and right kidney. The gallbladder and parts of the pancreas and intestines sit under the liver. The liver along with these organs work together for digestion, absorption, and processing of food.

Functions of the Liver

The liver plays a vital role in the human body. It performs various important functions, without which, life is not possible. Some of its most important functions include –

• During digestion, it produces bile, which helps in carrying away the waste and breaking down fats (metabolism) in the small intestine to help the human body in making energy.
• Produces protein needed by the body.
• To prevent the shortage of nutrients, the liver stores vitamins, minerals, and sugar. It converts and stores the extra glucose in the form of glycogen to balance the amount of glucose in the body.
• Also responsible for regulating blood-clotting.
• Removes the drugs and toxic substances from the blood.
• Helps our body in fighting against infections by eliminating the bacteria from the blood.
• Regulates the blood cells of amino acids and also processes the hemoglobin to use the iron present in it.

Liver Transplant

In humans, the liver is the only organ which can regenerate i.e., it can replace lost or injured tissue and grow back to the normal size in a span of a few months. This means the donor who donates a portion of his liver will have his liver grown back to its normal size after surgery. Similarly, the liver part which you have received will also grow to normal size in a short while.

Generally, livers are taken from registered donors who have expired/passed away. a family member or someone whose blood type matches yours. And their part of the liver and your new liver will grow back to its normal size in a few weeks time.

Why is Liver Transplant done? What are the reasons for liver failure?

Liver Transplant is done if your liver is damaged and is not in working condition any longer (liver failure). Causes of liver failure could be acute as well as chronic problems.

Acute Liver Failure- Also known as Fulminant Hepatic Failure, acute liver failure occurs quickly, in a few week’s time. It could be a result of an infection or health disorder due to certain medication.

Chronic Liver Failure- More than Acute liver failure, liver replacement is used to treat chronic liver failure. Chronic liver failure happens slowly, and it might take months and years to scarring or liver, known as Cirrhosis. It is the main cause of chronic liver failure.

In Cirrhosis, the liver stops working as all the normal and healthy liver tissue gets replaced with scar tissue. After this, the liver can no longer heal itself.

Major reasons for Cirrhosis are –

• Chronic Hepatitis
• Liver damage due to excessive consumption of Alcohol
• Fatty liver disease, a condition in which fat builds upon the liver and leads to inflammation or damaging of liver cells.
• Genetic diseases like Hemochromatosis (excessive iron build in the liver),  Wilson’s disease (excessive copper build up in the liver).
• Scarring, narrowing, or damaging of bile ducts.
• Biliary atresia, a liver disease that affects babies.

How are people selected for Liver Transplant?

If none of the treatments work, your doctor may recommend you to get a liver transplant. After evaluating your health condition to check whether you are fit for the surgery, tests are conducted to see if you can get a transplant. There are some medical conditions that reduce the chances of liver transplant success. In these cases, a liver transplant is not possible. They are-

• Untreatable infection
• Overuse of drugs and alcohol
• Cancer outside of the liver
• Severe heart or lung conditions 

The doctor will explain all the post-surgery care instructions and the medication that you need to take for the rest of your life.

Before it is confirmed that you need a liver transplant, there are certain tests and procedures which you have to go through. They are-

• Laboratory tests, like blood and urine tests, are done to evaluate your health along with your liver. Blood tests help to find a liver donor match and your place on the waiting list for liver replacement.
• Diagnostic tests include liver biopsy, ultrasounds, X-rays, heart and lungs tests, dental exams, and colonoscopy. These tests are done to check your liver and evaluate your general health. It is also done to check for any other health conditions that may hamper the liver transplant success rate.

Psychological and social evaluation might also be done to check stress, financial conditions. It is also checked if post-surgery you will have someone to support you or not. They could be family, friends, or relatives.

Once all these tests are done, and it has been decided that you can undergo a liver transplant surgery, you are placed on the waiting list based on how urgently you need a liver transplant.

Your position on the waiting list depends upon your score on two scoring systems-

• MELD – Model for End-Stage Liver Diseases, for adults.
• PELD – Pediatric End-Stage Liver Disease, for children under the age of 12.

The score ranges between 6 to 40. People with a high MELD score and acute liver failure are placed on the top of the waiting list. If someone’s condition worsens and their MELD score rises, their place goes up. As soon as a donor liver is available, it is allocated in accordance with the MELD score and blood type. There is no fixed time for which you might have to wait for the donor liver. Some people might wait for only a few days, whereas others might have to wait for months or may never get a donor liver from a deceased person. Meanwhile, the doctor will try to ease your liver complications to make the wait as comfortable as possible.

There is also an option of liver from living donors. In this, a small portion of the liver from a healthy and living person is transplanted into your body. As time goes by, the donor and your new liver grows back to their natural size. This is an alternative to waiting for a liver from a deceased person. Factors that determine the possibility of a liver transplant from a living donor are- age, blood type, health, and others. Usually, these people are close family members or friends. The percentage of living donor liver is very less, as the donor has to go through an extensive evaluation to make sure/ensure that their liver matches yours. Liver transplant surgery is also risky for the donor.

Liver Transplant Procedure

If the doctor has received a liver from a deceased donor, they will notify you. Or, in the case of a living donor, once they have taken a small portion of their liver they will transplant the liver into your body. 

• After examining your health, to check if you are fit for the surgery, you will be taken for surgery.
• You will be given general anesthesia, which will put you in a temporary sleep until the transplant surgery is complete.
• The surgeon will now make an incision across your abdomen to reach your liver.
• During the procedure, several tubes will be placed in your body to help it perform certain functions. These tubes are not removed for a few days, post surgery.
• The diseased liver will then be replaced with the donor liver, and the surgeon will connect the blood vessels and the bile duct to the new donor liver. 
• After the incision will be closed, you will be put in the Intensive Care Unit for recovery.
• This surgery takes from 6 to 12 hours, depending on your situation.

Post Procedure 

• You might have to stay in the ICU for 1-2 weeks or more, depending upon your condition. Where, you will be hooked to monitors to keep a continuous check on your heart rate, blood pressure, oxygen level, and more. 
• Once the doctors are satisfied with the functioning of your new liver, you will be sent home.
• Though, you will have to come for regular check-ups.
• And you will be prescribed a medication, known as immunosuppressants, which you need to take for the rest of your life.
• The minimum time of recovery from a liver transplant is 6 months.

Results

Survival rate after the liver transplant varies from patient to patient. 

Self care at home

• Eat a healthy and balanced diet with enough fibre and limit the intake of salt, sugar, cholesterol and fat.
• Stay hydrated.
• Exercise regularly.
• Don’t drink or smoke.
• Don’t consume grapefruit in any form, as it affects the work of immunosuppressants.
• Don’t eat raw eggs, fish, fish, or unpasteurized milk products.

What are the risks of getting a Liver Transplant?

A procedure as complex as a liver transplant carries a lot of complications and risks. They could come soon after the transplant or after many years. They are-

Rejection

There are cases, in which your body might reject the liver transplant in your body. Your immune system sees that liver as a foreign object and tries to fight against it. Rejecting a foreign object is a normal task of your immune system. To prevent your immune system from attacking the new liver, you have to take anti-rejection medication (immunosuppressants). This medication weakens your immune system’s attack. You have to take this medication for your entire life ahead.

Surgery Risks

Even after the liver transplant surgery is completed, there are some risks that might arise. They could be-

• Blockage in the vessels carrying blood to your new liver. 
• Leakage of bile from the bile ducts into your belly or blockage or shrinking of bile ducts.
• Infection at the surgery site.
• Bleeding   

Infection

A liver transplant can result in a higher risk of infection. The medication which you have to take to stop your body from rejecting the liver transplant makes your immune system weak, which can lead to infection. 

Recurrence of Liver disease

There are cases, in which after getting a liver transplant, the problem (s) that caused your liver failure in the first place might come back. The problems could be-

• Fatty Liver Disease
• Hepatitis C
• Primary sclerosing cholangitis 

Cancer

People who have an organ transplant are at a higher risk of getting cancer than the rest of the world. Anti-rejection medication (immunosuppressants) can make you prone to other cancers, and also a rare condition known as Post- Transplant Lymphoproliferative Disorder (PTLD).

FAQs

What is the liver transplant cost in India?

The cost of a liver transplant can vary anywhere between 20 – 30 lakhs. This cost is significantly very less when compared to the cost of the same treatment and care in clinics in developed countries

What is the liver transplant success rate?

In general, about 75% of people who undergo liver transplants live for at least five years. That means that for every 100 people who get a liver transplant for any purpose, about 75 will live for five years and 25 will die within five years.