Facts on Liver Transplant

Your liver is diagnosed as diseased when it stops performing its functions optimally. Alcohol overuse, hepatitis, non-alcoholic fatty liver, liver cancer are some factors that may be responsible for liver damage. Over time, this damage results in its scarring (cirrhosis) which can lead to liver failure, a life-threatening condition.

A liver transplant surgery is also called a hepatic transplant. It helps save your life when your liver is not in a position to function anymore. The treatment involves replacing it with full, or part, of a healthy liver. This may come from a living or deceased donor.

1. What are the types of Liver Transplant?

The three main ways how a liver transplant surgery can be performed:

• Deceased organ donation involving transplantation of a liver that has been removed from a person who has died recently
• Living donor liver transplant involving removal of a section of liver from a living donor. This is because the liver is the only organ in the human body that can regenerate. The transplanted and the remaining section of the donor’s liver regrow into a fully functional, normal-sized liver
• Split donation involves removal of liver from a person who died recently and splitting into two pieces; each piece is transplanted into a different person where they grow back to a normal size

2. When do people need a liver transplant?

A liver transplant surgery is required when someone is suffering from irreversible liver failure. Irreversible liver failure may be a result of Acute Liver Failure or Chronic Liver Disease resulting from Chronic Hepatitis, Cancer, or Liver Cirrhosis in adults.
In children, genetic causes may lead to acute liver failure and severe complications needing a transplant. Also, those diagnosed with early-stage Liver Cancer are most likely to benefit from Liver Transplant.

3. How are patients for liver transplant surgery determined?

Assessment by liver transplant specialists analyzes if a liver transplant is an appropriate treatment for a particular person. The assessment includes an analysis of the medical history and other tests. The transplant team makes the decisions about whether you require a transplant and if it can be done safely. Other aspects of your health conditions, like lungs, heart, kidneys, mental health, and immune system also need to be checked. That way, the guiding healthcare team can ensure that you are a safe candidate for the surgery.

4. Can anyone with liver problems get a transplant?

You cannot undergo a liver transplant if you:

• Have cancer in any other part of your body
• Have major heart, lung, or nerve diseases
• Consume alcohol or take illegal drugs
• Are unable to follow doctor’s advice

5. How is a transplant decision made?

The liver transplant decision is taken in consultation with everyone who is involved in the patient’s care, including liver transplant surgeons and the patient’s family. The patient and family’s consent is essential to understand that they are aware of the risks & benefits involved.

6. How long does it take to get a new liver for a patient who’s on the transplant list?

For a liver transplant patient, his/her name gets uploaded on a waiting list. Patients are listed based on the type of blood, size of the body, and other medical conditions. A priority score is given to the patients based on three blood tests, i.e. creatinine, bilirubin, and INR (measures the time for the blood to clot).

Patients with the maximum scores are the priority candidates for transplant. With time, as they become more ill, these scores increase which in turn increases their priority for a transplant.

7. How does a liver transplant get available?

There exist two types of liver transplant options – Living donor liver transplant and deceased donor liver transplant.

Living donor liver transplants involve eliminating a section of the liver from a healthy living donor and then, implanting it into the patient who is the recipient with end-stage liver disease. Both the donor and recipient’s liver portions grow back to normal size in a few weeks.

The donor could be a relative, spouse, or friend; they will have to undergo medical and psychological assessments to ensure the lowest possible risks. The living donors and livers to be donated are tested before transplant surgery. The testing ensures the liver is healthy, matches the blood type, and is the right size so it has the best chance of working in your body.

A deceased donor liver transplant involves a donor who could be a victim of an accident, or who has a brain hemorrhage or any kind of head injury. In such cases, the donor’s heart still beats, but the brain stops functioning. A person is then considered legally dead as his or her brain permanently and irreversibly stops functioning. At this stage, the donor usually is in a critical care unit and the liver is donated, with the consent of the next of kin. Such a donor is referred to as a cadaveric donor.

8. Will the donor and the recipient need to have the same tissue type, sex, age, etc.?

The only requirements for liver transplant surgeries are that the donor and recipient need to be of approximately the same size and compatible blood types. No other match is required.

9. How safe is a liver donation?

Liver donation is safe. After a part of the liver is removed, it grows back to its original size quickly within 2-3 months. The donor does not have to take any medication beyond 2-3 weeks and does not suffer from any long-term effects. He or she gets back to normal life in a month.

10. What are some of the risks of pre and post-surgery?

The prime risk before the surgery is the development of acute complications resulting from liver diseases. With transplantation too, there are a few risks that are common to all forms of major surgeries.

One of the major risks a patient would face is not having any liver function for a brief period. Some major risks immediately after surgery are bleeding, poor function of the grafted liver, and infections. The patient is also kept under careful monitoring for several weeks for any signs of rejection of the liver.

11. How to take care of my liver after being discharged from the hospital?

After your discharge, you will have to visit your liver transplant specialist as per the instructions given to be sure that your new liver is functioning properly, not being damaged by rejection, infections, or problems with blood vessels or bile ducts. You will have to be careful about avoiding people with infections and must immediately report any signs of illnesses to your liver transplant specialist.

You may need home care assistance at home, like while walking. Coughing and deep breathing are essential to help the lungs stay healthy and to prevent pneumonia. A proper diet from a dietician is a must. After 3-6 months, a person may resume work if he/she feels fit and gets permission from a physician. Besides maintaining a healthy diet and exercising, abstain from excessive alcohol consumption.

12. Can I resume my normal activities?

Most people can go back to their normal activities after a liver transplant surgery. Getting the strength back takes some time, depending on the intensity of the illness before the transplant. Liver Transplant Specialist would be telling you how long your recovery period is going to take.

Most people go back to eating as they did before. A few medications may cause weight gain, diabetes, or a rise in cholesterol. Therefore, meal planning and a balanced low-fat diet will help you remain healthy. Liver Transplant patients tend to gain weight because they retain water. It is advised to lower their intake of salt to reduce or eliminate the problem.

Most individuals can easily engage in physical activities after a successful liver transplant. People can resume a normal sex life post their liver transplantation. Women need to avoid conceiving in the first year after transplantation. You should talk to your liver transplant specialist and a gynaecologist about reproduction after transplantation.