Liver Transplant Surgery is the substitution of a harmful liver with a healthy liver. A liver transplant surgery may be a cure for a last-stage disease and severe liver failure. Despite the fact that the accessibility of contributor organs is a noteworthy constraint.
The most widely recognized method for Liver Transplant Surgery is orthotopic transplantation. In this process, the local liver is evacuated and supplanted by the contributor organ in an indistinguishable position from the original liver. The surgery is unpredictable, requiring cautious collect of the donor organ and careful implantation into the recipient.
Above all, liver transplantation is exceedingly controlled. It is performed at assigned transplant medicinal centers. However, liver Transplant is done by exceptionally prepared transplant doctors and supporting therapeutic groups.
The time taken for the surgery is 4 to 18 hours depending upon results. Ideal results require concentrated screening for a qualified recipient, as well as aligned live or cadaveric donor coordination.
Above all, Liver Transplant Surgery at Medicover Hospitals follows a certain procedure, which will be explained here in this blog post. For Liver Transplant Surgery at Medicover Hospitals, Dr. Sachin Daga, who is a consultant surgical gastroenterologist specialist in Hepatobiliary and Gastrointestinal surgeon.Article context:
- Liver Transplant Overview
- Functions of the Liver
- Types of Liver Diseases
- What is Liver Transplant Surgery
- Ways of getting a liver
- Who needs Liver Transplant
- Types of Liver Transplants
- When to prefer Liver Transplant
- Eligibility for Liver Donation
- Tests required before opting for Liver Transplant
- Liver Transplant Waiting List
- Requirements of Donor for Liver Transplant
- Pre-procedure of Liver Transplant
- Liver Transplant Procedure
- Outcomes after Liver Transplant
- Liver Transplant Success Rate
- Liver Transplant Recovery
- Diet after liver transplant
- Frequently Asked Questions
Liver Transplant Overview:
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 patients 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. In order 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 in 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.
What are the 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, they may have an effect on your whole body.
- 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
- Converts Glucose into glycogen. This Glycogen can later be converted as Glucose and utilized for energy.
What are the types of Liver Diseases?
What is Hepatitis?
A patient suffering from Hepatitis has symptoms like nausea, fatigue, abdominal pain and etc.
Hepatitis typically cures on its own in one or two months. Avoid alcohol.
What is Cirrhosis?
Cirrhosis means not functioning of 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.
A patient suffers from weakness and weight loss. Later stages Jaundice will attack. We can also see abdominal swelling.
A patient must immediately concern the doctor if they are suffering from the above symptoms. If suggested, Liver Transplantation must be done.
What is 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.
The patient suffering from Liver Cancer may see weight loss, stomach pain, vomitings, and skin become yellow.
Treatment for liver cancer is different in different cases. Cases may include Liver Transplantation, radiation, chemotherapy, removing a part of the liver.
Liver failure means the Liver not performing its normal metabolic functions.
- Yellow skin
- Stomach pain
The patient will be under medication, diet changes and in some cases, Liver Transplantation is done.
What is Ascites?
Ascites means storage of Water or Fluids in the stomach which causes Abdomen Swelling.
A small, solid material formed in the Gallbladder. There are mainly two types of Gallstones, Cholesterol Gallstones, and Pigment Gallstones.
- Primary sclerosing cholangitis
- Primary biliary cirrhosis
Gallstones may or may not show any symptoms. In some cases, the patient feels pain in the back or upper right abdomen.
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?
Once the transplant is decided, there are two ways of getting the Organ.
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, the normal healthy human being, minimum Liver is needed for the survival is 30% and remain 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 and 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 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 to the patient who is in need of 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 they 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.
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, they need a Liver Transplant Surgery. Patients who develop complications like Ascites which is water inside the stomach or 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?
- Orthotopic or Cadaveric Liver Transplant Surgery
- Living Donor Liver Transplant Surgery
- Split Type of Liver Transplant Surgery
- Cardiac Dead Liver Transplant Surgery
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 is in need of 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 is in need of 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 it 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 are in need of Liver Transplant. 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
- Wilson’s disease
- Alpha-1 antitrypsin deficiency
Who are 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 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 to the recipient
- A person whose Liver, Kidney, Lungs, and Heart are functioning normally.
Who are not eligible to donate 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
- A donor who is having health complications
- The person who is overweight
Tests required before opting for Liver Transplant:
- Imaging scans
- Blood Tests
- Diagnostic tests
- Consults and exams
- 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
- Mammogram or Pap smear for women
- Other testing and blood work
What is Liver Transplant Waiting List?
Meanwhile, Liver Transplant Waiting List means, if a person needs Liver Transplantation, then he/she must be placed on the National Waiting List. This list will be under United Network Organ Sharing (UNOS). UNOS will gather and manage all the information related to the patient’s waiting list.
What are the requirements of Donor for Liver Transplant?
- 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.
- Age of the donor must be in between 18 years to 60 years
- A donor should not have any health complications
- 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 meld score. Depending upon your clinical history and blood reports, they calculate child score and the complications.
Collectively when these combined together, 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 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. Recipients body accepts its new healthy organ which also grows as single lobe to become newly complete liver.
If you are getting Living Donor Liver that is from family members or friends or 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 plus or minus 5-10% will be removed from the donor. That removed part will be placed to the patient who is in need of 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 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.
- In order 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 in order 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 and 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. 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:
By following simple steps in eating habits will make you stay healthy 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
Frequently Asked Questions:
First of all, Liver transplant depends on the basic clinical conditions of the patient. It varies from individual to individual. Best judgment can be done by the doctor who is treating the patient whether he/she can wait for the Liver Transplant or not.
First Degree Relatives in India are Mother, Father, Brother, Sister, Grand Father, Grandmother, Son, Daughter, and Wife. In India, first degree relatives are Legally Permissible to donate their part of the Liver.
Regarding Family Donation, as it is immediately available in the family, we can go ahead.
It is very difficult to predict when can we get Cadaveric Liver. Because most of the Cadaveric Donations are from the Brain Dead People. Apart from all these things, the problem is, we don’t know when can it is going to happen? Which Blood Group is going to be? Whether the Liver which we are going to take out is suitable for the patient or not?
We have many If’s and But’s in Cadaveric Donation and Uncertainty is there. Apart from that, on average depending the volume of the Brain Death happening in particular hospitals, we can say that an average period of around 3 months plus or minus 4 weeks you may able to get Brain Dead or Cadaveric Organ.
The risk after the liver transplant would be around 8-10%. Meanwhile, after a liver transplant, life is very good. You can do normal work, you can do activities like other people, you can go for your work, you can earn for your family. If you are a sports person, you can play for your country.
Above all, you have to follow a few basic precautions like whenever you go outside, try to wear a mask. Because you don’t the person adjacent to you has any viral fever or infection and you are at the high risk of grabbing it. For the reason, that street food might contain any infection it might affect you easily. For instance, avoid street foods. Compare to the normal persons you are having a high risk of all these infections. Simple steps like if you go outside and come home have a bath, wash your hands, legs which prevent the major life-threatening problem in your life.
Meanwhile, after Liver Transplant, a patient can have normal Family Life. Many patients are there those who have conceived after Liver Plantation. After Liver Transplantation Life is beautiful. Only thing is, you have to be Principle and should take care of yourself.
In general, donors can get back to their normal life after discharge from the hospital. For instance, they can do simple and daily activities.
Meanwhile, the living donor should stay at the hospital for around 5 to 8 days, depending upon the patient’s condition it will rely on.
Above all, living Donors can get back to their normal work in 8 weeks. However, the Doctor suggests they go in 8 to 16 weeks.
If you are having any doubts regarding Liver Transplantation, risks and etc please mention your doubts in the comments box given below. We are very happy to reply to your doubts.
About Liver Transplant Surgeon:
Dr. Sachin Daga is a consultant surgical gastroenterologist specialist in Hepatobiliary and Gastrointestinal surgeon in Hyderabad, India. He is having special expertise in Laparoscopic or Minimally Invasive Surgery, liver, bile duct and pancreatic Surgery including a liver transplant. Apart from this, Sachin Daga has 10 years of experience in the field of Surgical Gastroenterology and Hepatobiliary and Pancreatic Surgery. Dr. Sachin Daga has special skills in Liver Transplantation.
- → MBBS (Bachelor Of Medicine And Bachelor Of Surgery) Shivaji University (Kholapur), 1999 Institute – Dr.V.M.Govt.Medical College, Solapur.
- → MS (Master Of Surgery) 2002- 2005 Nagpur University (Nagpur), 2005 Institute – Govt. Medical College, Nagpur. REGI.
- → DNB Surgical Gastroenterology at Nizam’s Institute of medical sciences, Hyderabad.
- → Fellow HPB and Liver transplant, Indraprastha Apollo Hospital, New Delhi.
- →Consultant Surgical Gastroenterologist (Advanced Laparoscopy) and HBP and liver transplant, Asian Institute of Gastroenterology, Hyderabad.
- Diploma In Neuroendocrine tumors, Uppsala University, Sweden.
- RESIDENCY (2002 –2005)
- POST-MASTERS SURGICAL EXPERIENCE