Liver Transplant Surgery
A Liver Transplant Surgery is a surgical treatment that detaches a liver that no longer works appropriately and restores it with a healthy liver. Liver Transplant Surgery will be easier if the donor is ready to donate their part of the Liver.
Meanwhile, if there are no donors, then the patient has to wait for Cadaveric Liver. Cadaveric Liver means Brain Dead/ Cardiac dead patient’s liver. However, this will take time and the patient will be kept on a waiting list of UNOS. Based on the criticality the patient will be given a Liver.
For example, in many parts of the world, the major Liver is coming from Brain Dead people. As a result of which, many Liver Transplant Surgery waiting list is increasing. To decrease this shortage, other procedures had come into existence like Split Liver Transplant, Living Liver Donor Transplant, and donating liver after Cardiac Death.
Meanwhile, Liver Transplant Procedure involves 4 to 8 hours depending upon severity. After Living Liver donation, a donor can get back to his normal life by following some precautions, medications, and guidelines prescribed by the doctor.
Functions of the Liver
- Your Liver will do plenty of things that keep you healthy. It turns nutrients into chemicals your body desires.
- Filters out Poisons
- It helps food to convert into energy. So if your Liver doesn’t work well, it may affect your whole body.
The liver is the largest internal organ and its functions are:
- Producing the Bile and excreting the bile
- Excreting Bilirubin, hormones, and drugs
- Activates the Enzymes
- It acts as storage for vitamins, minerals
- Produces blood proteins for blood plasma
- Regulates clotting of blood
- Produces Cholesterol to assist in carrying fats throughout the body
Types of Liver Diseases
Hepatitis
Hepatitis means the Swelling condition of the Liver. It is mainly caused because of infected food or water. There are 3 types of Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E.
Symptoms
A patient suffering from Hepatitis has symptoms like nausea, fatigue, abdominal pain, etc.
Treatment
Hepatitis typically cures on its own in one or two months. Avoid alcohol.
Cirrhosis
Cirrhosis means not functioning the Liver because of long-term damage. The last stage of Fibrosis is nothing but Cirrhosis. In this case, the Liver gets a failure due to several reasons.
Symptoms
A patient suffers from weakness and weight loss. In later, stages Jaundice will attack. We can also see abdominal swelling.
Treatment
A patient must immediately concern the doctor if they are suffering from the above symptoms. If suggested, Liver Transplantation must be done.
Liver Cancer
Cancer that starts in the cells of the Liver is known as Liver Cancer. Major reasons for Liver Cancer are Hepatitis B, Hepatitis C, and Alcohol.
Symptoms
The patient suffering from Liver Cancer may see weight loss, stomach pain, vomitings, and skin become yellow.
Treatment
Treatment for liver cancer is different in different cases. Cases may include Liver Transplantation, radiation, chemotherapy, removing a part of the liver.
Liver Failure
Liver failure means the Liver not performing its normal metabolic functions.
Symptoms
- Jaundice
- Yellow skin
- Stomach pain
- Swelling
Treatment
The patient will be under medication, diet changes and in some cases, Liver Transplantation is done.
Gallstones
A small, solid material formed in the Gallbladder. There are mainly two types of Gallstones, Cholesterol Gallstones, and Pigment Gallstones.
Symptoms
Gallstones may or may not show any symptoms. In some cases, the patient feels pain in the back or upper right abdomen.
Treatment
In general, gallstones don’t need any treatment. But in case if they are suffering from any symptoms then gallbladder removal surgery should be done.
What is Liver Transplant Surgery?
Firstly we should know that the Liver is a vital organ in our body. Without the Liver, we cannot produce useful fats, Glucose, some proteins, etc. In some cases the Liver gets diseased. That means the Liver gets affected because of excess intake of Alcohol, Hepatitis, and many other reasons. As a result, the affected Liver must get transplanted either fully or partially depending upon the patient’s condition.
How do we get Liver From?
Way-I
One way is Relatives Donating. That means 1st Degree Relatives can donate part of the Liver. In this case, the part of the Liver usually takes out is around is 60% plus minus 5-10 Percent. The taken Liver will then give to the patient who is in the need of the Organ. For instance, for a normal healthy human being, the minimum Liver is needed for survival is 30%, and the remaining 70% he/she can donate.For a donation to be done, the first donor will go through rigorous tests of blood tests. In the first stage, all blood tests are done to check whether he/she is having any problems. For instance, Thyroid, Blood Sugar, lipid profile test, etc. If any have seen, then they are rejected for Liver Donation.
Once these tests are done, they will check the volume of the Liver that is a CT Scan and MRI. Based on these reports, we can see virtually whether we can make 2 parts of the Liver. Other conditions like, take it out safely, put it on the patient who needs an organ, can they both do well with this Operation?. We have to calculate the maximum and see that the harm should be minimum. The minimum should be with both the individuals, then only we will accept the Donor. This is one way of Donating.
In the donor before completing Blood Tests and CT Scans, we do rigorous counseling. We will talk with them, we try to understand whether they are willing to donating or not. We will also check, are having any medical complications. For instance, are they using any medication, are they having Thyroid, diabetes, hypertension, or any major surgeries. Meanwhile, donors who are having these conditions are not accepted for Liver Donating.
Way-II
Another way of acquiring the Liver is through Cadaveric Liver Transplant. If any Brain Dead Patient is in the hospital, Social Worker will go and talk to their family members. They ask them their willingness to donate the Liver. If those people are willing to Donate, then after complete the formalities to declare the Brain Death, as a result, the Liver can be taken out for Liver Transplant.
Who Needs a Liver Transplant?
Patients who have Liver Cirrhosis. For instance, let it be because of Alcohol, Hepatitis B, Hepatitis C, Wilson disease or Nash-related Cirrhosis, or Hepatocellular Carcinoma patient. These patients need Liver Transplant Surgery. Patients who develop complications like Ascites which are water inside the stomach or an effect on the Brain that is hepatic encephalopathy. For instance, some patients develop bleeding. Because of which they decompensate in the sense they develop Ascites, Jaundice, or again effect on the Brain. Moreover, the patients who develop infection inside the Ascites or those who develop an effect on the kidney. These are few complications where patients need Liver Transplant Surgery.
What are the Types of Liver Transplants?
Cadaveric Liver Transplant Surgery
Orthotopic Liver Transplant means, taking a liver from the deceased or dead patient. Here the Person’s Liver will be taken and placed to the patient who needs a Liver Transplant. This kind of transplant is also called Cadaveric Liver Transplant.
Living Donor Liver Transplant Surgery
Living Donor Transplantation means, taking a part of the Liver. For instance, either left lobe or right lobe and placed to the person who needs Organ. Living donors come under the first degree of family members like Mother, Father, Brother, Sister, Grandmother, Grandfather, and wife. Any of these persons are eligible to give their part of the liver to the affected person.
Split Type of Liver Transplant Surgery
Split means dividing. The name itself indicating that we have to Split the Liver into 2 parts. As a result, the split live is placed to 2 Liver Transplant needed persons. We can get the split liver from a deceased or dead person.
Cardiac Dead Liver Transplant Surgery
Many Liver Transplantation needed people are waiting on the UNOS Liver transplant waiting List. These patients are waiting to acquire liver from Brain Dead patients. However, it will take more time to get Cadaveric Liver or Brain Dead patient’s liver. However, there is another way to get Liver Transplantation that is Cardiac Dead Liver Transplantation. In this case, patients who are dead due to cardiac arrest can donate their Liver to the recipients who need Liver transplants. Therefore, waiting will be decreased and there is more chance for Liver Transplant recipients to get Liver.
When to Prefer a Liver Transplant?
Firstly, Liver Transplant Surgery is needed, when there is Liver Failure. Liver Failure can occur all of a sudden which leads to Viral Hepatitis, Drug-induced infection. Here is the list of the problems which may cause serious Liver Failure
- Chronic hepatitis with cirrhosis
- Primary biliary cholangitis
- Sclerosing cholangitis
- Biliary atresia
- Alcoholism
- Wilson’s disease
- Hemochromatosis
- Alpha-1 antitrypsin deficiency
Who is Eligible for Liver Donation?
- The donor whose age is between 18 to 20 years
- A person who is physically and mentally prepared for surgery and has undergone doctor counseling
- The candidate whose health condition is good
- A donor who is weighing correctly
- The person who does not take alcohol or drugs
- A candidate whose Blood Group matches the recipient
- A person whose Liver, Kidney, Lungs, and Heart are functioning normally.
Who is Not Eligible to Donate Liver?
Here are some conditions in which the person is not eligible to donate their part of the liver:
- A donor whose age is under 18 years
- A person who is suffering from Lungs disease and heart-related disease
- A candidate whose Blood group does not match
- A donor who is having HIV or Hepatitis
- A person who takes alcohol/drugs
- A candidate who is psychiatrically ill
- The person who is overweight
Tests Required Before Opting for Liver Transplant
Given below are the Clinical Tests that are involved before the Liver Transplant.
- Imaging scans
- Blood Tests
- Radiology
- Diagnostic tests
- Consults and exams
Liver Transplant Tests include:
- Magnetic resonance imaging (MRI) of abdomen/pelvis OR
- Computed tomography (CT) scan of abdomen/pelvis
- A dopamine stress echocardiogram (DSE)
- Ultrasound of abdomen/pelvis
- Electrocardiogram/chest X-ray
- Colonoscopy
- Mammogram or Pap smear for women
- Other testing and blood work
What are the Requirements of Donor for a Liver Transplant?
Below is the list of requirements:
- A donor must be in Good Health Condition
- Blood Group of the Donor who is ready to donate their part of the Liver must be matched with the recipients.
- The age of the donor must be in between 18 years to 60 years
- A donor should not have any health complications
- The physical size of the donor must be the same or larger than the recipient
What is the Pre-procedure for Liver Transplant?
Firstly you should consult a doctor. He does the workup for the cause of the disease. He will like to know, why this Liver damage has occurred. Then he will know the stage of the damage. He will do some blood investigation try to calculate the meld score. Depending upon your clinical history and blood reports, they calculate the child’s score and the complications. Collectively when these are sizes combined, then we will be able to precisely know whether there is a need for Transplant immediately, or we need to wait and optimize you. Optimization may be in the form of treating the complication, making them well controlled, and then going ahead.
Meanwhile, many of these patients are nutritionally very poor. So building up their nutrition, making them healthy, and then going ahead with the transplantation. Some patients are very sick. They have renal failure requiring Dialysis. Some patients are having infections, some are in ICU, some patients are on Ventilators. In these critically ill patients, we need to optimize them first. Take out these Life Support. When they are without any life support and ready to shift to the room. That is the time we can go ahead with the Liver Transplant.
Liver Transplant Procedure
In Case of Living Donor
However, in the case of a Living Donor transplant, the donor’s procedure will begin first. As the surgeon makes the incision under the rib cage. The healthy liver is carefully divided. In general, the right lobe is usually selected for donation. The gall bladder which is connected to the liver by two lobes is removed along with the lobe to be donated. With this, the donor’s incision will be closed. On the other hand, the recipient’s unhealthy liver part is removed completely along with the gallbladder. Now the donor’s liver is placed inside the empty cavity. However, this will take another 4 to 8 hours to attach the new liver to the recipient’s blood vessels and bile ducts. Once the transplantation is completed, the lobes in both the patients immediately began to regenerate. In around 2 months, the donor’s liver grows back to its original size but with only one lobe. The recipient’s body accepts its new healthy organ which also grows as a single lobe to become a new complete liver. If you are getting Living Donor Liver that is from family members or friends or a person who is matched to donate. Then the surgery will take place in 3 to 4 days. Some tests will be conducted for the donor who is ready to donate their part of the Liver. If the donor qualified in all tests and scans then he/she will be undergone through surgery. In surgery, around 60% and or minus 5-10% will be removed from the donor. That removed part will be placed to the patient who needs the Liver.
Outcomes after Liver Transplant
Apart from all, according to the survey, on average Outcomes of Liver Transplant is excellent. After 1 year of a liver transplant, the survival rate of the recipient is 88%. And after 5 years, recipients survival is 74%
Liver Transplant Success Rate
As we know it is very major surgery and the possibility of developing problems during and after surgery is high. Chances if success rate in the best of the best hand is around 90-92%. So now the question comes, suppose if you overcome this problem of life, the risk of around 8-10% what is the life after this once we are under over Liver Transplant
Liver Transplant Recovery
- The patient will be shifted to the Intensive Care Unit (ICU) after successful liver transplantation for 2 days.
- To assist the patient in breathing, a breathing pipe is inserted. When the patient is stable, then they will be discharged from the hospital.
- After discharge, the patient must visit the hospital once a week for the 1st month. Slowly the visiting time will be decreased. Later you will be visiting the hospital once a year.
- The patient needs to undergo regular medical tests. As a result, you can check your liver is not getting damaged by rejections, infections, etc.
- The patient must be careful while going outside. Meanwhile, every time he/she should wear a mask while going into a crowd to avoid infections.
- While moving with sick people, you must be very careful. Because liver transplant patients are at high risk of grabbing infections. In case if you find any illness, immediately concern the doctor.
- However, recovery is time taking and it’s a long process in Liver Transplantation patients. You should follow simple exercises like walking, deep breathing, etc.
- Diet plays a major part in Liver transplant people. Firstly you should go with ice chips, after that liquids, and finally, you are eligible to take hard foods and solids.
- Meanwhile, 3 to 6 months of rest is compulsory. After this, the patient can go back to normal work if they feel comfortable and ready to do it. Above all, doctors’ consult is also important before going back to work.
- Liver Transplant people should avoid Alcohol.
- Liver Transplant people should not take any medicine without a doctor’s prescription.
Diet After Liver Transplant
- Avoid street foods
- Don’t take raw food items like beef, fish, seafood, etc.
- Shouldn’t eat undercooked food items
- Always eat the hot served food
- Eat well-cooked food
- Avoid food that is not covered
- Eat proteins and mineral containing foods
- Take fresh fruits and vegetables
- Take cereals and food grains
- Don’t take alcohol
- Avoid Grapefruit
- Make sure you are having fiber in your diet
- Avoid taking too much salt and fat-containing food items
- Avoid sugar contained foods and drinks
