A liver transplant is a surgical procedure performed to remove a damaged or failed liver and replace it with a healthy liver. Liver transplant is usually only performed for severe, end-stage chronic liver disease, which can no longer be treated by other treatment options. The liver can be transplanted from a deceased donor with a healthy liver or a live donor, wherein a part of the liver is transplanted. The liver can regenerate fairly quickly in the live donor and the recipient. A single donated liver may even be used for two recipients.
The long-term success rates and survival rates following a liver transplant depend on the patient’s condition. Usually, around 75% of people who undergo liver transplants live for at least 5 years.
Why is a liver transplant done?
Liver transplant is usually performed for chronic liver failure, which may be a result of various conditions, the most common cause being liver cirrhosis (liver scarring).
Most common causes of liver cirrhosis leading to liver failure, requiring liver transplant include:
- Hepatitis B and C caused by Hepatitis B virus (HBV) and Hepatitis C virus (HCV), respectively
- Alcoholic liver disease, due to chronic excessive alcohol consumption
- Fatty liver disease (accumulation of fat in the liver, causing inflammation and damage of the liver cells)
- Genetic disorders that affect the liver, such as hemochromatosis (excessive iron build-up in the liver) and Wilson disease (excessive copper buildup in the liver)
- Diseases of the bile ducts (the tubes that carry bile away from the liver and biliary atresia (commonly seen in children)
- Liver cancers
What happens before a liver transplant?
A patient requiring a liver transplant is placed on a waiting list, which is decided by a model of end-stage liver disease (MELD) score. This score is based on blood tests, such as:
- The level of creatinine, indicating kidneys function
- Checking the international normalized ratio (INR), which shows the ability of the liver to synthesize blood-clotting proteins
The blood tests are repeated regularly, and the MELD score is updated accordingly. There is also a score for children under the age of 12 years, called pediatric end-stage liver disease score. The higher the MELD score, the sicker is the patient; hence, they are placed higher on the list. The success of transplant surgery also depends on a good match with a suitable donor; so, the wait time would also depend on the patient’s body size and blood type, which should match the donor.
If two people with the same MELD scores qualify for a liver transplant and have a suitable match, the person who has been on the waiting list for longer would most likely receive the transplant sooner. A person with acute liver failure may be placed close to the top of the list because they have a high risk of facing death sooner. Though the waiting time for a liver transplant may be a long process, once a match is found, the surgery is coordinated quite fast.
Specific tests, procedures, and consultations advised before the surgery:
- Laboratory tests: Blood and urine tests to assess the health of the organs
- Radiological tests: Ultrasound, MRI, CT of the liver
- Cardiac test: To assess heart health
- General health exam: To assess overall health and rule out other
- Diet and nutrition consultation with dietitians to ensure liver and body health before and after surgery
- Psychological support to assess the mental health of the patient and help them cope with their chronic illness
- Deaddiction counseling: To help patients quit alcohol, drug, or tobacco
- Financial counseling to help patients and their family understand the cost of surgery and postoperative care
What happens after a liver transplant?
The patient can expect the following after liver transplant surgery:
- Patients are usually required to stay in the intensive care unit (ICU) for a few days after surgery. The patient is closely monitored to ensure their vitals are stable, and there are no postoperative complications.
- Patients are usually discharged after 7 to 10 days after surgery.
- Patients are required to follow-up regularly with the surgeon as advised.
- Patients are usually prescribed certain medications, which may have to be taken for life, such as immunosuppressants that prevent the immune system from attacking the transplanted liver.
- Patients are advised on an appropriate diet and nutrition plan to ensure good liver and overall body health.
- Patients would be provided with rehabilitation services to help them return to their daily activities.
- Most patients can resume normal activities, including exercise and return to work, a few months following surgery and after consulting with the doctor.
- Complete recovery after transplant surgery can take 6 months or longer. Recovery usually depends on how sick the patient was before liver transplant surgery.
What are the complications of liver transplant surgery?
Liver transplant surgery has a significant risk of complications, such as:
- Blood clots
- Rejection of the transplanted liver
- Failure of the transplanted liver
- Mental confusion
- Damage to the bile duct
- Bile duct leaks
- Recurrence of liver disease in the transplanted liver
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Common Medical Abbreviations & Terms
Doctors, pharmacists, and other health-care professionals use abbreviations, acronyms, and other terminology for instructions and information in regard to a patient's health condition, prescription drugs they are to take, or medical procedures that have been ordered. There is no approved this list of common medical abbreviations, acronyms, and terminology used by doctors and other health- care professionals. You can use this list of medical abbreviations and acronyms written by our doctors the next time you can't understand what is on your prescription package, blood test results, or medical procedure orders. Examples include:
- ANED: Alive no evidence of disease. The patient arrived in the ER alive with no evidence of disease.
- ARF: Acute renal (kidney) failure
- cap: Capsule.
- CPAP: Continuous positive airway pressure. A treatment for sleep apnea.
- DJD: Degenerative joint disease. Another term for osteoarthritis.
- DM: Diabetes mellitus. Type 1 and type 2 diabetes
- HA: Headache
- IBD: Inflammatory bowel disease. A name for two disorders of the gastrointestinal (BI) tract, Crohn's disease and ulcerative colitis
- JT: Joint
- N/V: Nausea or vomiting.
- p.o.: By mouth. From the Latin terminology per os.
- q.i.d.: Four times daily. As in taking a medicine four times daily.
- RA: Rheumatoid arthritis
- SOB: Shortness of breath.
- T: Temperature. Temperature is recorded as part of the physical examination. It is one of the "vital signs."
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