Liver Transplant: What you should know

Liver Transplant : What you should know?

​Liver Transplant is a surgical procedure where an unhealthy/diseased liver is removed from a persons body (called recipient) and replaced with a healthy liver from another person (called Donor). The incredible success of Liver transplants over the course of last 2 decades has revolutionised and changed the management of patients with irreversible liver disease as it offers them a chance at leading a healthy life and resuming their routine daily activities.

​The liver though the only organ with immense regeneration potential, some diseases can destroy liver cells and replace these cells with scarred tissue that ultimately leads to decreased liver functions (known as Cirrhosis) which manifests as yellowish discolouration of eyes/urine (Jaundice), accumulation of fluid in the abdomen (Ascites), bleeding from large veins that form in food pipe (Variceal bleeding) and confusion/coma (Hepatic encephalopathy). Additional symptoms in these patients may include fatigue, loss of muscle mass and frequent bruising. Patient with Liver cirrhosis may have had years of progressive and disabling symptoms such as these or may present abruptly with these symptoms at times leading to life threatening situation which may necessitate an urgent liver transplant. Common causes of end stage liver disease are prolonged unhealthy consumption of Alcohol, fatty liver disease, viral infections (Hepatitis B and Hepatitis C) in our country.

​Liver transplants may also be needed for acute Liver failure (rapid deterioration of liver functions in a previously healthy liver manifesting as jaundice, bleeding and confusion/coma) which is an uncommon condition caused usually due to consumptions of drugs (bad reactions to prescription medicines, illegal drugs and herbal medicines), viral hepatitis (Hepatitis A and Hepatitis E) and rarely as a complication of pregnancy.

​Liver transplant may be necessary in a child too, most common cause of which is Biliary atresia (a condition manifesting as progressive jaundice developing in second/third week of life with initial normal growth in first month but thereafter ) and some other metabolic/ genetic conditions.

​The donated liver can be from a living person or a deceased (brain dead) donor. From a living donor part of the liver is harvested usually from close relatives of recipient. A living donor transplantation is successful and well tolerated because of unique qualities of a healthy liver (even ~30% of liver can carry out liver functions adequately for the body and the liver grows back to its usual size in as little as 2-3 months of transplant in the donor as well as the recipient). The deceased donor is a brain dead person. Adults typically receive the entire liver from a deceased donor. However, surgeons may split a deceased donor’s liver into two parts. The larger part may go to an adult, and the smaller part may go to a smaller adult or child.

​The liver transplant process requires many steps such as diagnosis and evaluation by the treating doctor and once it is felt that a transplant is necessary, the patient needs to be referred to a transplant centre where a thorough evaluation of both recipient and suitable living donor is carried out.

​Getting the new liver is just a part of the transplant process. On an average a 3 week hospital stay is usually needed after transplant and during this time the transplant team assess the success of the transplant and manages complications if any. Thereafter on discharge the recipient usually takes approximately 6 months to return to carrying out routine daily activities and needs to have frequent checkups as scheduled by the doctors. A number of medicines will be needed post transplant most notable of which are lifelong immunosuppressants that helps protect the liver from attack by the recipients immune system.

​People who undergo liver transplant usually do well and 9 patients out of 10 recipients survive at least for a year and 7 out of 10 go on to live for the next 5 years. Incredibly half of these patients go on to live for 20 years and more