Liver transplantation is the surgery performed to replace a diseased liver with a healthy liver from an organ donor.
Types of liver transplantation procedures:
1. Orthotropic transplantation – The whole diseased liver is replaced with a healthy liver. It’s the most common liver transplantation procedure performed.
- Heterotrophic transplantation –Diseased liver is not removed. The additional donor liver is put at another site
- Reduced-size liver transplantation- Whole diseased liver is replaced by a portion of healthy liver donated. This procedure is commonly performed for children.
Why it is needed?
Transplantation of the liver is advised for patients who have last/ end-stage of liver disease, but otherwise fit, fulfilling criteria for liver transplantation. Conditions in which liver transplantation is prescribed includes:
- Liver Cirrhosis – caused due to chronic alcoholism or for some unknown reason
- Chronic liver disease(Hepatitis) which leads to irreversible scarring of the liver and biliary system
- Acute liver failure
- Cryptogenic liver disease
- Biliary atresia –incomplete development of bile duct, is a common reason for transplantation in children
Liver transplantation eligibility is determined on the basis of the patient’s clinical condition and particular laboratory tests.
Diseased liver symptoms:
- Jaundice –yellow skin and eyes
- Black or Clay-colored stool
- Vomiting (blood)
- Ascites –abnormal collection of fluids in the abdomen
- Kidney dysfunction
- Bleeding severely from minor wounds and cuts
- Drowsiness, mental confusion, and forgetfulness
- Excessive fatigue and tiredness, less appetite
Contraindication for liver transplantation
- Active drug or alcohol abuse
- Metastasis cancer outside the liver
- Advanced age with serious diseases (heart or other)
- Severe septic condition or HIV
Facts and figures
- Liver transplantation is easier these days with cross country transportation of liver being possible. The latest tech and use of special chemicals enable the donor liver to be preserved for 10-20 hours before surgery.
- Liver transplantation is the second most common transplanted organ, after kidney
- According to the United Network for Organ Sharing, approx 5,300 livers were transplanted in the US, and presently 17,000 people and more are in the waiting list
- Currently, liver transplantation is the most expensive treatment
· First liver transplant was carried out under Dr. Thomas Starz’s guidance in 1963
- Successful liver transplantation saves the lives of dying patients. Approximately 75-80% of patients live for 3 or more years after transplantation
- Patients can lead a completely normal life after transplantation
- It is very expensive
- Long waiting period for a healthy donor organ
- The patient has to take immunosuppressive drugs lifelong. Transplantation may make patients more susceptible to develop infections.
- Patients might suffer from different side effects due to steroids or medicines
- Transplant rejection. It occurs in approx 2to 5% of all patients
Risk and complications
- Medicinal/Anesthesia reaction
- Damage to biliary duct/ adjacent organs
- Full body physical examination
- Blood test, liver and kidney function tests
- USG of abdomen, CT scan
- Relatives and patient are informed regarding procedure, including risks and follow up care
- Surgeon consultation week before to ascertain medicine required and medicines stopped
- Have arrangement with family and/or friends for help after surgery
- Arrangement of blood transfusion, if required during or post surgery
- Preparation of home as required for recovery after surgery
- Do not drink or eat post after midnight, night before surgery
- Medical tourist is advised to plan maximum time for trip
Post operative care
- Patient is kept in ICU after surgery for 3-4 days. Vital signs are monitored. After patient stabilizes, he/she is shifted to room and monitored. 1-3 weeks hospital stay is required
- Liquid diet post surgery then switched to low salt solids gradually
- Patient is allowed to slowly walk then resume normal life gradually
- Patients are instructed about dressing care, symptoms of infection or rejection before hospital discharge. Patients required to take extreme care for first 3 months after surgery to avoid any infection
Dos, Don’ts and Precautions
- Follow prescribed dietary regimen with care
- Follow up regularly and monitor signs of infection or rejection
- Inform surgeon immediately if sign of rejection/infection is noticed
- Wash the hands frequently
- Take prescribed medication daily
- No swimming for 3 months
- Avoid crowds and poorly circulated areas
- Avoid contact with sick people
Liver transplantation patients have to take prescribed medicines lifelong. Good hygiene, medical care and prevention and treatment of complication with doctor’s guidance ensure healthy and long life post transplantation.
Full recovery is expected between 3-6 months after surgery.