Liver Transplantation

What is a liver transplant? 

A liver transplant is the process of replacing a sick liver with a donated, healthy liver. Liver transplants require that the blood type and body size of the donor match the person receiving the transplant. Currently about 600 liver transplants are being performed each year in India.

Who needs a liver transplant?
A liver transplant is needed when a person’s liver fails to perform its functions and there is no hope that the functions will recover with medical treatment. Many diseases can cause liver failure. The commonest indication for a liver transplant is 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

What are the results of liver transplantation?
Most patients return to a regular lifestyle six months to a year after a successful liver transplant. Eating a healthy diet, exercising regularly, and taking recommended medications are important factors to staying healthy. Nearly 90 percent of liver transplant patients are alive at one year after their transplant and nearly 75 percent alive five years after their transplants.

What are the signs of advanced liver disease or cirrhosis? 
People who have advanced liver disease may have many of the following problems:
Jaundice – yellowing of the skin or eyes
Dark, tea-coloured 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 a liver transplant? 
Most transplant livers come from a donor who has died. This is known as cadaveric liver transplantation or deceased donor liver transplantation.  Sometimes a healthy person donates part of his or her liver for a specific patient. This is known as living donor liver transplantation. All donated livers and living donors are tested before transplant surgery. The testing makes sure the donor liver works as it should, matches your blood type, and is the right size, so it has the best chance of working in your body.

Adults usually receive the entire liver from a deceased donor. Sometimes only a portion of a whole liver from a deceased donor is used to fit a smaller person (split liver transplantation). In some cases, 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.

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.  Avoiding a long wait is possible if a person with liver disease has a living donor who is willing to donate part of his or her liver. This procedure is known as 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 amount of liver that is donated will be about 50% of the recipient’s current liver size. Within 6-8 weeks, both the donated pieces of liver and the remaining part in the donor grow to normal size.

Both types of transplants usually have good results.

Who will evaluate me for a liver transplant? 
If a liver transplant is recommended, a team of doctors from the Integrated Liver Care team will perform a transplant evaluation. The ILC Team consists of a transplant coordinator, a hepatologist (liver specialist), transplant surgeons, dietician, physiotherapist and social worker. It may be necessary to other specialists depending on the recipient’s age and health problems.

A social worker assesses and helps develop the patient’s support system, a central group of people on whom the patient can depend throughout the transplantation process. A positive support group is very important to a successful outcome. The social worker also checks to see that the recipient is taking medications appropriately.

On completion of evaluation, the ILC team discusses the case in a multidisciplinary meeting and takes a decision on whether the recipient is suitable for a transplant.

The liver specialist and the primary doctor manage the person’s health issues until the time of transplantation.

What is done during a surgery for liver transplantation? 
Liver transplantation is a major operation that takes place only in specialized transplant centers. During a liver transplantation, the surgeon removes the diseased liver and replaces it with a healthy one.  The diseased liver is removed through an abdominal incision. The liver’s blood supply (portal vein, inferior vena cava, and hepatic artery) and the biliary system are all connected to the new liver after it is placed into the abdominal cavity. Persons who have liver transplants require intensive care and close monitoring after their operation.

After surgery, the patient is taken to the intensive care unit, 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. Once the patient wakes up and can breathe alone, 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 intensive care unit once he or she is fully awake, able to breathe effectively, and has a normal temperature, blood pressure, and heart rate, usually after about 3-4 days. The patient is then moved to a room with fewer monitoring devices for a few days longer before going home.

How long will I stay in hospital after transplantation?
The average hospital stay after surgery is 1-3 weeks. The patient may be required to remain in Bangalore for up to three months for close follow-up.

What medications does one need to take after transplantation?
The patient will be on immune suppressive medication for the rest of his or her life to prevent the body rejection of the new liver. The patient may also require vitamins and calcium and other mineral supplements.

What are the common complications after a 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.
Recurrence of liver disease. The diseases that damaged your liver in the first place may come back in the new liver. They can damage the new liver a little bit or a lot. The disease can often be treated easily, but sometimes a second transplant is needed.
Cancer. People who have organ transplants are at a higher risk for some cancers, especially skin cancer. These cancers may spread faster than they do in people without transplants. Because of this, the patient will need to get screened for cancer.
Medical complications. Transplant patients can get infections, high blood pressure, diabetes, high cholesterol, thinning of the bones, and become obese.

What medical follow-up is required after liver transplantation?
Lifelong medical follow-up is required. You will be required to remain in contact with our transplant centre. Our coordinators will contact you periodically and advise you about blood tests and follow-up visits. We will maintain a database of all your laboratory results so that we can follow you closely and advise changes in dose of medications over time. We will also advise you general health checks on your follow-up visits.