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Liver Transplantation – All you wanted to know

What does the liver do?

The liver, considered to be the largest internal organ in your body, performs a lot of vital functions. The liver is essential for survival and there is no way to compensate for absence of liver. Vital liver functions include:

  • Production of bile, a mixture of chemicals, which help in digestion.
  • Helping in breaking down food to turn it into energy.
  • Liver also acts as a filter and removes harmful substances from your blood.
  • Liver makes chemicals that help in fighting infection.
  • Liver makes chemicals that are important for blood clotting.
  • Liver stores iron, vitamins and other essential substances.

What Is Liver Transplantation?

Liver transplantation is complex surgery performed to remove a diseased liver to replace it with a healthy one. Such surgeries have been done for over 38 years. Many people who have undergone liver transplants go on to lead perfectly normal lives.

What is the History of Liver Transplantation?

Dr. Thomas Starzl was the first to have performed a human liver transplant in 1963. The introduction of ciclosporin, an immunosuppressant medication, by Sir Roy Calne, Professor of Surgery Cambridge, significantly improved patient outcomes, and in the 1980s, liver transplantation was recognized as a standard clinical treatment for both adult and pediatric patients with suitable indications. The liver is currently the second most common major organ that is transplanted, after the kidney.

Who needs a liver transplant?

A liver transplant becomes necessary when the patient’s liver fails to perform its functions and its functions cannot be recovered with medical treatment. Many diseases can cause liver failure. The most common indication for a liver transplant is liver cirrhosis (scarring of the liver). Common causes of liver cirrhosis are

  • Chronic Hepatitis B
  • Chronic Hepatitis C
  • Alcoholic liver disease
  • Fatty liver disease
  • Genetic diseases
  • Autoimmune liver diseases

Liver transplants are also done for treatment of liver cancer, acute liver failure and certain bile duct diseases in both children and adults.

What are the results of liver transplantation?

Most patients lead a regular lifestyle six months to one year after successful liver transplant surgery. Exercising regularly, eating a healthy diet and taking recommended medicines are important factors to stay healthy.

Close to 90 percent of liver transplant patients survived for one year after the transplant and about 75 percent survived five years after their transplants.

 What are the signs of liver cirrhosis or advanced liver disease?

People with advanced liver disease may suffer from many of the following problems:

– Jaundice (yellowing of eyes and the skin)

– Itching

– Dark, tea-colored urine

– Ascites – an abnormal amount of fluid in the abdomen

– Vomiting of blood

– Tendency to bleed

– Encephalopathy – mental confusion, forgetfulness

What are the kinds of liver transplant?

Most livers for transplant come from a donor who has died. This type of donor is called a deceased donor.

On some occasions, a healthy person donates part of his/her liver for a specific patient. In this case, the donor is called a living donor. All living donors and donated livers are tested before the transplant surgery. The tests make sure the donor’s liver is the right size, matches your blood type and works as it should, so it works well in your body.

Generally, adults receive the entire liver from a deceased donor. On some occasions, a liver from a deceased donor is split into two parts. The smaller part may go to a child, and the larger part may go to an adult. This is called split liver transplantation.

Sometimes a healthy living person will donate part of his or her liver to a patient, usually a family member. This type of donor is called a living donor. A long wait for the liver can be avoided if a liver disease patient has a living donor who is ready to donate part of his/her liver. This procedure is called living donor liver transplantation.

The donor must have major abdominal surgery to remove the part of the liver that will be transplanted into the patient. The size of the liver donated will be about 50 percent of the recipient’s current liver size. Both the donated piece of liver and the remaining part in a donor will grow to normal size within 6 to 8 weeks. Both types of transplants usually have good results.

How is liver transplantation done and what happens after surgery?

Liver transplantation is a major surgery that takes place only in specialized transplant centers. During liver transplant surgery, the surgeon removes the diseased liver to replace it with a healthy one. The dead liver is removed through an incision in the abdomen. The liver’s blood supply (inferior vena cava, hepatic artery and portal vein) and the biliary system are all connected to the new liver after placing it into the abdominal cavity. People who have undergone liver transplants need intensive care and close monitoring after their surgery.

Following the surgery, the patient is taken to the ICU (intensive care unit) and is monitored very closely with several machines. The patient will be on a respirator, a machine that breathes for the patient, and will have a tube in the windpipe bringing oxygen to the lungs. As soon as the patient wakes up and is able to breathe on his/her own, the tube and respirator are removed. The patient will have several blood tests, x-ray films, and ECGs during the hospital stay. Blood transfusions may be necessary. The patient leaves the ICU once he/she is fully awake, can breathe effectively, and shows normal temperature, blood pressure, and pulse, generally after about 3 to 4 days. Then, the patient is moved to a room with lesser monitoring devices for some days longer before going home.

How long will a patient stay in hospital post-transplantation?

The average hospital stay post-surgery is 1 to 3 weeks. The patient may be required to remain close by to the hospital for up to three months for close follow-up.

What medicines does one need to take after transplantation?

The patient has been on immune suppressive medicines for the rest of his/her life to prevent the body from rejecting the new liver.

What can be the common complications post liver transplantation?

Acute rejection. Most rejection happens while you are still in the hospital, but it can happen at any time.

Rejection can be treated with drugs. The patient may need a liver biopsy.

  • Liver disease recurrence: There are chances of recurrence of diseases that damaged your liver back into the new liver. They can damage the new liver a lot or a little. The disease can be generally treated easily, but in some cases, a second transplant is required.
  • Cancer: People who have undergone organ transplantation surgery are at a greater risk for some cancers, mostly skin cancer. These cancers can spread faster compared to those without transplants. Owing to this, liver transplant patient may need to get screened for cancer.
  • Medical complications: Transplant patients can get infections, diabetes, high cholesterol, high blood pressure, thinning of the bones and may become obese.

Conclusion

Lifelong medical follow-up is needed after liver transplantation. A patient has to remain in contact with the transplant centre after his/her liver transplantation. Generally, transplant centres maintain a database of all the laboratory results of a transplant patient so that they can follow up closely and advise changes in medications over time.

Transplant centers generally have coordinators who may contact patients occasionally to advise about their general health, blood tests and follow-up visits.

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