About Liver Transplant

A liver transplant is a surgical procedure done to replace the diseased liver with a healthy one. During this process, either a part of a liver or whole liver is transplanted. The liver or a part of it may come from a brain-dead organ donor or a healthy living donor.

The liver is the only organ of the human body that can regenerate. The liver of the donor will soon grow back to normal size post-surgery. The part of the liver which is received as a new liver will also grow to normal size within few weeks.

Need for Liver Transplant

Various acute and chronic ailments may affect the functioning of the liver and may require liver transplants. It is usually offered to patients with end-stage liver disease which may not respond to other treatments. Some of the similar conditions are listed below:

Acute liver failure Acute liver failure, also known as fulminant hepatic failure. There is a loss of liver function which occurs rapidly within a few days or weeks. It is usually occurs in a patient with no pre-existing liver disease.

Viral hepatitis It is an infection that leads to inflammation or damage of the liver.

Alcoholic liver disease It is a condition that occurs as a result of alcohol consumption, which damages the liver and leads to the build-up of fats, inflammation, and scarring. This condition may even be fatal.

Non-alcoholic fatty liver This is a condition where there is an accumulation of fat in the liver. This may eventually lead to inflammation and scarring in the liver.

Primary liver cancer Primary liver cancer is when cancerous growth are detected in the liver. Treatments for liver cancer may vary and may include chemotherapy, radiation therapy, removal of part of the liver, and transplant.

Type of Liver Transplant

Mainly there are two ways a liver transplant is carried out.

Living donor liver transplant During this procedure, a section or part of the liver is taken from a living donor. As the liver has the potential to regenerate itself, both the transplanted and the remaining section of the donor’s liver are able to grow to its normal size in some time. Usually over 2-4 weeks.

Deceased organ donation transplant This procedure involves transplanting a liver from a person who died recently. Either the entire liver may be used for a single recipient or it can be split into two such that it benefits two recipients.

Pre-Liver transplant evaluation

Before undergoing this procedure, you may need to undergo rigorous evaluation, which includes:

General health exam This consists of a physical examination and screening tests to evaluate your overall health.

Biopsy A liver biopsy may be done for evaluating its function or to assess for disease involvement.

Blood tests There are different blood tests that you may need to assess the overall health of various organs, including the liver.

Imaging tests Various tests like computerised tomography (CT) scan, magnetic resonance imaging (MRI) scan, positron emission tomography (PET) scan, or ultrasound of liver may be recommended.

Social and psychological evaluation These evaluations include various measures to assess your stress, financial issues, and support by friends and family.

Nutrition counseling You may need nutritional counseling where a dietician will assess your nutritional status and make suggestions regarding nutritional intake before and after the transplant surgery.

Heart test There are various tests performed to determine the health of the cardiovascular system.

Waiting Period

There are more people in need of a liver transplant than the liver donated. Hence, the waiting list is long in India. While you are on the waiting list, your doctor will start the other treatment and plan a treatment that will keep you in stable condition and prepare you for your upcoming transplant procedure.

Keep your doctor informed about any changes your experience about your health and get a consultation.

The Liver Transplant process

The liver transplant is done in the following steps depending upon whether it is a deceased donor transplant or living donor transplant:

Deceased-donor liver transplant

Living-donor liver transplant

Complications of a Liver transplant

As with every surgery, the risk of complications is there, and a liver transplant is no exception. However, not all patients develop complications, but it is good to be aware of them. Below are some of the common complications linked with liver transplant:

Surgical Complications

Certain complications may occur during or shortly after the surgery, such as:

• Wound infection
• Blood clot in the artery or vein of the lungs, heart, spleen, pancreas, or liver.
• Bile leakage from the bile ducts
• Uncontrollable bleeding

Infection

You will be prescribed immunosuppressants to suppress the action of the immune system to aid the adjustment of the new organ in your body. However, taking immunosuppressants may expose you to various infectious diseases.

Liver Problems

Your new liver may acquire the previous diseases that were present earlier due to the malfunctioning in the body. This may call a need for a second transplant apart from regular medical care. However, this is not very common and is seen in less than 0.5% cases.

Rejection

Sometimes, your new liver may not be accepted by the body and hence may not be able to function appropriately. Our immune system recognizes the foreign particles or organisms like bacteria or viruses, and it may not accept the new organ as well, leading to rejection. Mild to moderate rejection is easily treatable. Being regular with medications will help avoid rejection.

Anti-rejection medications side effects

You will be prescribed certain anti-rejection medications for the proper functioning of the liver and overall health. These medicines can behave certain major side effects such as:

• Weight gain
• High blood pressure
• Diabetes
• Effect on kidneys
• Cholesterol imbalance

Post-liver transplant Procedure

After the surgery is completed, you will be taken to a recovery room for few hours, where you will be under observation. Once your doctor feels you are in stable condition, you will be shifted to the intensive care unit (ICU), where you are observed closely for several days, and your vitals will be monitored.

Frequently blood samples will be taken to check the new liver. The doctors will also keep a check that other organs like the kidney, lungs, and circulatory system are all working. Anti-rejection medicines will be administered and closely watched to be sure that the patients are getting the right dose and mixing the right medicines.

When the doctor feels you are stable, you will be shifted to a normal ward. Gradually, you will be able to move and walk around for a long duration. The doctor will then teach you how to take care of yourself when you go home.

Life after Liver Transplant

A liver transplant can significantly improve the quality of life of the patients. However, there are certain practices and measures that you need to follow to live a normal life.

• Regular follow-ups: You will also be suggested to visit your transplant team for regular follow-ups, including the psychological expert, apart from the surgeon and doctor. This may continue for the initial few months after the transplant. They will keep a check on the body's response to transplant and any complications which may arise.
• Immunosuppressants: As our body tends to reject the foreign body or object. You may have to take immunosuppressant medicines to avoid the possibility of rejection.
• Hygiene and lifestyle: Practising good hygiene and staying active is an excellent contributory factor for recovery. Live a healthy lifestyle by engaging in any form of physical activity, eating a balanced diet, avoiding smoking, etc. You will be strictly asked not to consume alcohol and watch out for what you eat. Getting a consultation with a dietician will be helpful as she can plan a diet based on the requirements.

Note: Overall outcomes of Liver transplants are extremely good but may vary depending on the indications for a liver transplant and factors linked with a donor.

• Survival rate: 88-90% at 1 year from surgery

Success rate and life expectancy of a liver transplant

With progress in medicine, the life expectancy of patients undergoing liver transplants is also progressing. In comparison to the last decade, the life expectancy of patients has improved.

Life expectancy

• Increased lifespan of 1 year: 88-90%
• Increased lifespan of 3 years: 78%

Choosing the ideal liver transplant center

It is essential to learn about different transplant hospitals and centers before finalizing the one. Here are few things to keep in mind while choosing a transplant hospital/center:

• Consult more than one doctor and talk to patients who have undergone liver transplants in the hospital and know about their experience.
• Whether the center/hospital has expertise in living or deceased donor transplants.
• The reputation of hospital/center and it’s mortality rate for liver transplant patients.
• If the hospital/center is covered under your insurance policy.
• Total-experience the hospital/center hold in dealing with liver transplant cases.

Cost analysis of liver transplant

Living with a disease that badly affects your life is an extremely painful experience both for the patient and his family. Getting a liver transplant can certainly improve the quality of life of the patient. The average cost of liver transplants in India varies between 20 lakh approximately. It is important to check with the insurance company whether the transplant cost is covered in your plan. Various factors that will affect the cost are:

• Hospital infrastructure and location
• Length of stay in hospital
• Expertise of surgeons, their team, and use of advanced technology
• Any health complications
• Recovery and rehabilitation
• Post-transplant medications

A patient who travels away from home to hospitals for transplant also needs to keep the cost of stay near the hospital in the new city. The cost of staying also adds up over the course of a few months.