Liver Transplant

Overview

The Liver is one of the largest organs in the body. Liver transplantation is a type of surgical procedure done to replace a nonfunctional liver with a functional one. It is a life-saving gift and a proven intervention method for managing patients with liver diseases. This procedure can restore health, enhance the quality of life, and extend the lifespan of the transplanted individual. It is a safe and effective procedure to be done when all other medical interventions have not been successful. 

Indications

Liver transplantation is done when there are severe liver problems and when other treatments like medications have failed. Liver failures can be sudden (acute) or occur over a long time (chronic). It's often done for liver conditions like acute liver failure (due to toxic poisoning or infection), chronic liver failure (end-stage progressive disease), cirrhosis (scarring in the Liver), hepatitis B and C (viral infections), or autoimmune hepatitis, Alcohol-related liver disease, cancers, non-alcoholic fatty liver diseases, and genetic and metabolic disorders where the Liver gets seriously damaged. The decision to transplant is based on factors like how sick the Liver is and the risks of the procedure.

Liver transplant is also indicated in diseases that affect the biliary tract. This includes bile ducts or tubes that carry bile away from the Liver. This includes conditions like biliary atresia, biliary cirrhosis, and sclerosing cholangitis. Healthcare professionals use scores like the Child-Turcotte-Pugh score (CTP), Pediatric end-stage liver diseases (PELD), and the Model of End-Stage Liver Disease (MELD) by taking into account the blood test results to predict how likely someone is to survive without a transplant.

Contraindications

Liver transplant is not indicated in those who have a MELD score of < 15, advanced heart or lung diseases, AIDS, alcohol, and drug abusers, and unable to quit them, Fastly spreading or last stages of cancers, septic shock, cancers outside the Liver, another type of cancer called sarcomas, severe psychologic diseases, and those with severe portal hypertension.

Individuals with general illness, advanced age, previous abdominal surgery, and extensive thrombosis are relatively not indicated for liver transplantation. 

Before the Procedure

A liver transplant is done in a transplant center. Before the transplant, the individual is evaluated for the surgery by some blood tests, physical examinations, imaging studies, psychological evaluation, and any other necessary tests. The entire history regarding previous illnesses, surgeries, medicines taken, and allergies should be shared with the concerned healthcare professional. 

Based on the test results and evaluation, one will be informed if they can be taken for a liver transplant. Sometimes, certain medications, like blood thinners and over-the-counter medications, need to be stopped. Other drugs may be prescribed before surgery. Dietary modifications will be made before surgery.

An individual is assessed using MELD, CPT, and PELD scores to determine the urgency of liver transplantation. These scores help to estimate the risk of death within 90 days if transplantation is not done. 

Matching a donor for transplantation is also very important for a liver transplant. A donor can be living or deceased, related or unrelated. Donors will also be evaluated and subjected to specific tests to check for compatibility. These tests include blood typing (to check if the blood groups of donor as well as recipient are suitable), tissue typing (to check if the transplanted tissue will last for a long time in the recipient's body), crossmatch (to check if antibodies of the recipient will reject the donor tissue). 

Apart from these, the age of the donor and liver size should also be suitable, and the donor should be free of any infections in the body. Deceased donors are also considered for liver transplantation. Based on the MELD scoring, the person with the highest score is sent for a deceased liver transplantation. 

Family members can most likely be living compatible donors, but a transplant can be received from matched relatives, friends, or unknown people. A paired donation can also be done by exchanging compatible donors with other recipients. Sometimes, if the donors are not available, individuals will be kept on the waiting list for the deceased donors. 

An individual has to be active and healthy for a successful liver transplant. Taking the prescribed medications on time, eating regularly, exercising regularly, and relaxing can keep one healthy and fasten recovery after surgery. 

During the Procedure

Liver transplant surgery is done in a hospital under general anesthesia. For a deceased donor, the surgery is done immediately. An extended cut is made on the stomach, the Liver is located, the failed part of the Liver is removed, and the new Liver from the donor is placed inside the recipient. Blood vessel and bile duct connections are made and sutured in the recipient's body. 

If the Liver is taken from a live donor, a part of the donor's Liver is removed initially and then transplanted to the recipient. Necessary connections are made and sutured. 

After the Procedure

After the transplant, an individual is continuously monitored till the vitals are stabilized and also for any complications. Liver function tests are conducted to assess the functioning capacity of the new Liver. Few medications like antibiotics, painkillers, and immunosuppressants are prescribed for pain and infections and to increase the recipient body's acceptance of a new donor liver. 

Dietary modifications will include having a fibrous diet, whole grain foods, eating meats, poultry, and fish, having at least 4-5 meals daily, and keeping hydrated with adequate water and other fluids. Individuals will be advised to keep themselves healthy by regular exercise and physical activity. 

Recovery after Transplant: 

The recovery time varies between individuals and the cause of the transplantation. It may take about six months to recover entirely and resume normal activities. 

Risks and Complications: 

The risks and complications include bleeding, infections, thrombotic clots, failure of the implanted Liver, rejection of the implanted Liver by the recipient, and seizures. The other complications include those arising from immunosuppressant medications like decreased bone density, diabetes, hypertension, increased lipid levels, and diarrhoea. 

Conclusion

Liver transplantation is a successful procedure of replacing a nonfunctional liver with a functional one from a deceased or living donor. By carefully evaluating the individuals using different scoring systems, a liver transplant is planned based on urgency and need. By taking meticulous care, liver transplantation can give successful outcomes.