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:
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