Liver Transplant

Medica’s Liver Transplant Programme

Liver transplant is a surgical procedure where the surgeon removes the diseased liver and replaces it with either a full liver from a deceased donor (cadaveric transplant) or a portion from a donor liver (living donor transplant). It is usually the treatment recommended for people with several complications resulting from end stage liver disease or liver cancer. It may also be an option for people with sudden liver failure. It vastly improves quality of life.

What does your liver do?

The liver performs several critical functions which give you alive and well

• Processes nutrients and medications
• Produces bile that helps your body absorb fat, cholesterol and some vitamins
• Makes blood clotting proteins
• Removes toxins from the blood
• Regulates immune responses thus preventing infections

Liver failure requiring transplant can be caused by

Liver failure usually occurs over a period of time. This is a chronic condition that normally takes years to develop. Sometimes certain factors can cause sudden liver failure (acute condition).

The most common cause of chronic liver failure is cirrhosis or scarring of liver that can be a result of:

• Hepatitis B or C
• Excess alcohol consumption leading to alcoholic liver disease
• Fatty liver unrelated to alcohol – non-alcoholic fatty liver disease caused by fat building up in the liver, a condition usually related to lifestyle
• Genetic reasons – that may cause building up of excessive iron or copper in the liver
• Diseases affecting the bile duct – primary biliary cirrhosis, primary sclerosing cholangitis, biliary atresia

Types of transplant

Deceased donor (cadaveric) transplant: Healthy liver from a person who died recently is transplanted whole into the recipient.

Living donor transplant: Our liver is a unique organ. It has the ability to regrow from a part of it. Living donor transplant is a procedure where a portion of the healthy liver from a donor who is alive is transplanted into the recipient. Both portions of the liver grow back to the normal size over a period.

Split donation: This is a procedure where the healthy liver from a deceased donor is split into two and the pieces are transplanted into two recipients, which then grow back to the normal size.

Liver transplant is may not recommended in the following situations:

• For a patient with other severe complications/co-morbidities which makes the surgery life threatening
• The patient is unwilling to make the necessary lifestyle changes – giving up alcohol, regularizing diet – post transplant
• The patient has cancer that has spread beyond the liver

Possible Risks

The outcome of a liver transplant has been seen to be quite good with the patient surviving for 10 to 20 years post the surgery, leading a normal life within certain restrictions. However, like any major surgery there are some risk factors you need to be aware of:

• Rejection of the donor liver by the recipient’s body
• Internal haemorrhaging or bleeding
• Primary non-function (the new liver not working in the first few hours). This would require a second transplant as soon as possible
• Bile duct complications
• An increased risk of new infections
• Impaired kidney function
• Some patients may show an increased risk of certain types of cancer

Preparing for the transplant

You doctor will evaluate your readiness for transplant to understand:

• Whether you are healthy enough for the surgery and the post transplant medications that will need to be taken life-long
• If you have any medical condition that may impact the transplantation
• Your willingness to make the necessary lifestyle changes – giving up alcohol, making the dietary corrections recommended by the doctor
• Your willingness to strictly adhere to the treatment programme outlined by the medical team before, during and after the transplant
• Your emotional strength in handling the wait for a donor and post transplant treatment/complications
• Your network of family and friends who can serve as your support group who can help you deal with the stress

Evaluations that you may need to undergo

• Blood and urine tests to access the health of your organs
• Ultrasound of your liver
• Tests to understand your cardiovascular (heart) health
• A complete health check to evaluate your overall health, including cancer screening
• Nutritional evaluation to understand your dietary habits and advise on the changes/adjustments required pre and post transplant
• Psychological evaluation to understand and treat any underlying anxiety disorders including depression
• Evaluation of addiction disorders – alcohol and tobacco – and counseling to help you deal with the withdrawal symptoms

Post the evaluation if the liver transplant team finds you suitable for transplant then the financials of the entire process are discussed with you and you are placed on the transplant wait list with your consent.

How is a donor match determined?

Your placement on the wait list for transplant depends on the severity of your condition. In case of a deceased donor, the match will depend upon the blood type and the seriousness of your condition. While you are waiting for the donor your treating team would continue to monitor the condition of your liver and other organs. They may periodically change the medications and advise you on your dietary and exercise routine to keep you fit. If the ongoing treatment plan fails to support your vital organs as you wait, your doctor may recommend liver dialysis, which is often referred to as bridge to transplantation.

Living donor transplant is an alternative to waiting for a deceased donor. For this the donor has to undergo an evaluation process. The donor’s age, health condition, size of liver and blood group are the criteria that are critical for this. Living donors are usually close family members or friends willing to donate.

As you wait

As you wait for a donor liver, work towards keeping yourself healthy. Strictly follow your doctor’s recommendations and the medications prescribed. Keep talking to your counselor and support group. Since the surgery is a major one, you will need to stay strong physically and mentally to ensure its success. As soon as the hospital receives information of a donor liver that is a good match for you, you shall receive a call. You have to be mentally prepared to receive the call any time of day or night and go to the transplant centre immediately.

In the hospital you will be evaluated by the transplant team to test your readiness and will undergo a pre-anaesthesia check up. If the team is satisfied, then you will be prepared for the surgery.

The Procedure

Liver Transplant is an open surgery, done under general anaesthesia. It may take up to 12 hours depending upon the complications. Your surgeon will make a long incision on your abdomen to remove the diseased liver and replace it with the healthy donor liver. He/she will then connect your blood vessels and bile ducts to the donor liver. The incision is then sewn up or stapled.

In case of a living donor, the transplant surgery is pre-planned. Surgery is first performed on the donor to remove a portion of his/her liver, it is then implanted into the recipient in replacing the diseased liver. Post the completion of the transplant the liver portions (both inside the donor and the recipient) regenerate within a few weeks to reach the normal size.

Post Surgery

You shall need to remain in intensive care for the first few days after the transplant. The ICU team will monitor you and keep an eye on signs of post surgery complications. You liver function will be tested frequently to ensure you new liver is working. You will be shifted to the designated transplant ward when the team feels you no longer require ICU care. Here the rehab team will work with you to mobilize you and enable you to function independently.

At the time of your discharge you doctors will make a follow-up plan for you. You shall need to frequently undergo blood tests to check your liver function. You will be prescribed a number of medications to help reduce post surgery complications, some of these will need to be continued for life. You will be given immunosuppresants to prevent your body’s natural immune system from perceiving your new liver as an enemy and attack it.

Provided there are no further complications, you will be able to return to normalcy in 6 to 7 months.

Life-long Care Plan post Transplant

Please understand the success of the transplant surgery and your quality of life post transplant will depend a lot on sustaining the long-term adjustments you will be required to make. The lifestyle changes that you are recommended to make will be for life, and non compliance would make you vulnerable to future complications and liver failure.

Medications and lifestyle adjustments will become a part of your daily routine. Your doctor will advise you on the necessary adjustments you shall need to make in your diet and exercise routine. You will need to completely give up tobacco and alcohol.

Do not make any changes in your medications without talking to your doctor and keep him/her informed about any other health condition that may develop and you are prescribed a new medicine.

Rehabilitation is an important part of your recovery process. Specialized therapists will start working with you while you are in the hospital to help you get back to your normal routine and activities as soon as possible.

Studies have shown the success rate of liver transplants is quite high, and most people experience a vast improvement in their quality of life. You will be able to go back to most of your earlier activity routines. Please remember the success of you transplant will depend largely on your willingness to make the necessary lifestyle adjustments.

Medica’s Liver Transplant Programme

Among the most advanced in the region, Medica’s Liver Transplant Programme comprises an in-house team of highly skilled surgeons, critical care specialists, specially trained nurses and technicians, along with a rehab and nutritionists’. Dedicated operation theatres and Critical Care unit fitted with latest life support and monitoring technology, provide comprehensive coverage and post transplant support. We also facilitate air-ambulance transfer of critical patients, nationally and internationally.