A liver transplant is the standard of care for patients with end-stage liver diseases, acute liver failure and selected cases of liver cancer (hepatocellular carcinoma). The most common reason for a liver transplant in adults is cirrhosis and/or liver cancer. Cirrhosis is scarring of the liver that prevents the liver from working well and can worsen to liver failure.
The most common causes of cirrhosis are:
- Non-alcoholic fatty liver disease
- Long-term alcohol abuse
- Liver damage from poisoning or medicines
- Problems with the drainage system of the liver (the biliary tract) e.g., primary biliary cirrhosis or primary sclerosing cholangitis
- Long-term infection with Hepatitis B and/or Hepatitis C
- Metabolic disorders of copper or iron (Wilson disease and hemochromatosis).
Who needs liver transplantation or do all cirrhotic need transplantation?
Liver cirrhosis results due to long term liver disease and liver scarring. This in itself may not cause liver failure at the outset but over time the liver gradually loses its functions and may require to be replaced by transplantation. So,
- Compensated cirrhotic may push the need for liver transplantation or can get registered for DDLT
- Decompensated/ complicated cirrhosis should undergo liver transplantation as early as possible.
Complications include
- Refractory Ascites/SBP (recurrent accumulation of fluid/infection of fluid within the abdomen)
- Encephalopathy (affliction of the brain due to liver failure)
- Variceal hemorrhage or bleeding per rectum (bloody vomitus or black stool)
- Hepato-renal syndrome (decreased urine output and high creatinine)
- Hepatic hydrothorax (accumulation of fluid within the thorax)
What Are The Types Of Liver Transplant?
A liver transplant replaces a diseased liver with a healthy liver. Main types of liver transplant:
Deceased Donor Transplant :
The liver is obtained from a recently deceased donor (Family of a brain dead agrees to donate organs.) Prior to the operation, doctors ensure that the liver is healthy and that the donor did not have any transmissible diseases or cancers.
Living Donor Transplant :
A healthy family person/close relative will donate part of his or her liver to a person with a diseased liver. The new and remnant livers can regenerate and both the patient and donor will end up with fully functional livers after a successful transplant.
For patients waiting for a life-saving liver transplant, living donor liver transplantation offers many benefits including shorter wait time, faster recovery, and comparable outcomes with deceased donor liver transplant.
The Process Of Liver Transplant- From Evaluation To Recovery
Before the Procedure
Before undergoing liver transplantation, patients must complete a series of pre-transplant work-up to ensure their suitability for the procedure. This includes, diagnostic imaging tests, blood work and consultations. Results of these pre-assessments will help doctors check how severe the illness is, how urgent the need for a transplant is.
In Living Donor liver transplant, the most appropriate donor will be selected, counselled and undergo a series of pre-transplant assessments to ensure their suitability for the procedure. The blood group type and size of the donor liver are crucial. In cadaveric liver transplantation, donor blood group should match the recipient blood group.
During the Procedure
During transplant surgery, the transplant team replaces the diseased liver with a donated, healthy liver. Liver transplant surgery usually takes between 10 - 12 hours.
What Happens After Liver transplantation
After the transplant surgery, the recipient may need to stay in the hospital for several weeks while the transplant team monitors how well the body is accepting the new liver. Medicines will be given to control any pain and prevent infection. The recipient will start taking immunosuppressive medicine to prevent rejection of the new liver. Community gatherings are restricted for the recipients for at least 6 months.
Donor usually stays about a week.
It is important for the recipient and caregivers to be familiar with the medicines and to report any side effects. After a liver transplant, the recipient will undergo regular blood tests and occasional liver biopsies to make sure there is no rejection of the new liver. It is very important to have regular follow-up with transplant team.
FAQ-Liver Transplantation
What is the difference between Deceased donor and Living donor Liver Transplant?
If deem suitable, the hospital will identify the brain-dead patient as a potential donor. This is the commonly performed transplant procedure in which the liver is procured from a patient after brain death is certified. The recipient will be the most suitable patient on the top of the SOTTO list, prioritized by the medical urgency and waiting time.
In Living donor liver transplant, a relative (as per THOTA 2011), can be considered as potential donors. The most appropriate donor will be selected, counselled and undergo a series of pre-transplant assessments to ensure their suitability. This can be performed for all patients including foreign patients. Living donor transplant provide an alternative for patients as there is a shortage of deceased donors.
What Are the Risks and Side Effects of a Liver Transplant?
A liver transplant, like all major surgery, has possible serious risks such as bleeding, infection, vascular issues, biliary problems and complications from anesthesia. In addition, people who have a liver transplant may have side effects from the immunosuppressive drugs they need to take. This means that a patient may be at increased risk of developing infections. Some of the immunosuppressive drugs can also cause high blood pressure and cholesterol, diabetes, and weaken the bones and kidneys. Regular health checks with the transplant team are important after a liver transplant.
How well do liver transplantations work?
Liver transplantation is generally very successful. Most people are able to return to their daily routine within a few months after the transplant. Transplant success depends on a number of variables, including health status, age, timing of the transplant since advised and nature of disease. The overall survival of patients at 1 and 5 years is above 90% and 70% respectively. Without the transplant, many patients will not survive for more than 3 months due to severe decompensations.
A common cause of organ failure following a transplant is due to patients not following the prescribed immunosuppression medication regimen. Careful attention to medication schedules, lifestyle changes, diet and close follow-up with the transplant team and primary care physician is important.
What are the advantages of a Living donor Liver Transplant?
Living donation significantly decreases the time a patient has to wait for a liver on the waiting list, prior to the worsening of the patient’s condition. Livers from living donors are usually of excellent quality because donors are carefully evaluated prior to donation and are only allowed to donate if they are in good health. This way of liver transplantation is very handy for uncommon blood groups i.e. A and AB The average waiting time for an available deceased organ is about 5-6 months (except in A and AB blood group where it is even more) vs. 15 days for a living donor liver transplant once a donor is deemed suitable.
Are there any risks to the living donor?
All potential living donors will be informed and well counselled about the donation process, possible outcomes, risks and post-donation care.
Can the transplant team help the patient find a donor?
The transplant team is not allowed to find a donor on behalf of the patient. Anyone who is involved in the buying or selling of organs can be prosecuted by law.
Can a potential donor decide who to donate to?
Yes, a person can choose who the intended recipient is, as long as the assessments have deemed that the person is healthy and a match to the recipient, and a completely voluntary decision is made without force or financial promises. Once the evaluation is complete and cleared, the application will be reviewed by the Transplant Ethics Committee (TEC) under the auspices of the Ministry of Health(MOH) to ensure it is appropriate. The transplant surgery can go ahead after the TEC’s approval.
A donor can withdraw from organ donation any time, for any reasons and the decision will be kept confidential.