Liver Transplant and Hepatobiliary Sciences

The liver plays a vital role in filtering toxins, digestion, and regulating metabolism. Diseases or any injury to the liver can cause it to deteriorate in its function. Then, a liver transplant is the only ray of hope for survival. For a successful liver transplant, an apt donor is mandatory, and it involves the replacement of the diseased liver with a healthy one. 

What is a liver transplant? 

In liver transplant, a damaged/failing liver is replaced by a healthy liver from a donor. The donor for a transplant can be a deceased (brain-dead) individual whose liver is still functional and healthy or a living individual whose organs can match the recipient in order to avoid rejection or any reactions. 

Liver transplant is a complex and high-brow procedure that requires precision, expertise, and good post-operative care to ensure a fruitful recovery. Since the liver is the only organ that can regenerate, a portion of a healthy liver can hypertrophy to  function as a  normal organ. 

Liver transplant is often indicated for individuals with end-stage liver disease or with acute liver failure. The ultimate aim of a successful liver transplant is to enhance the patient’s quality of life. 

Causes that warrant a liver transplant

1. Cirrhosis: This occurs due to chronic alcohol consumption or viral infections like hepatitis. Cirrhosis of the liver often leads to scarring of the liver tissue, which leads to the inability of one’s liver to regenerate on its own. For decompensated cirrhosis, a transplant is the only solution. 
2. Chronic hepatitis B or C: Chronic viral infections, such as hepatitis B or C, can damage the liver over time. This can cause long-term inflammation, and persistent inflammation induces the body’s healing response. As a result, there is scarring of the liver tissue. 
3. Acute liver failure: Acute liver failure can result from drug overdose, autoimmune conditions, or alcohol consumption. Certain drugs, such as acetaminophen, can lead to toxicity when taken in excessive amounts. The liver metabolises this drug into its toxic metabolites that deplete the liver’s glutathione levels, resulting in massive liver cell death. Byproducts of alcohol metabolism – such as acetaldehyde – can lead to alcoholic hepatitis, which, in chronic cases, can cause inflammation and death of liver cells, necessitating transplant. 
4. Non-alcoholic steatohepatitis (NASH): NASH involves fat accumulation in the liver along with inflammation and liver cell damage, which, over time, can cause chronic inflammation of the liver. This can lead to scarring, followed by cirrhosis. 
5. Inherited liver disease: Genetic conditions, like Wilson’s disease or hemochromatosis, can cause irreversible liver damage wherein the liver fails to perform its basic essential function. 
6. Liver cancer: Patients with hepatocellular carcinoma may require liver transplant, when cancer is confined to the liver and satisfies certain selection criteria. 

Alarming signs:

• Icterus (yellowing) of skin and eyes 
• Loss of appetite and weight loss 
• Abdominal swelling and pain 
• Chronic fatigue
• Dark urine/pale stools 
• Confusion/Agitation/Forgetfulness due to encephalopathy 

Benefits of early diagnosis

Early detection has the following advantages: 

1. Slowing of disease progression:

Diseases like hepatitis, non-alcoholic fatty liver disease (NAFLD), and alcoholic liver disease can progress very slowly over the years. Early diagnosis brings therapeutic interventions, like antiviral therapy, lifestyle modifications, and alcohol abstinence, have the potential to stop the progression towards more serious diseases of liver cirrhosis or failure.

Cirrhosis, or the permanent scarring of the liver, occurs via slow scarring of the liver over a period of years as a response to chronic liver injury. Early diagnosis, along with timely management, can prevent or defer cirrhosis and ensure better liver function.

1. Early treatment and better management:

Once a person is properly diagnosed, then it becomes possible for the managing healthcare provider to tailor the treatment plans.

Early interventions alleviate symptoms, like jaundice, fatigue, and pain, that serve to enhance the quality of life of the patient.

1. Reduction in complications: 

It prevents liver failure from occurring. Early intervention prevents the liver from being reduced to its point of failure. Since liver failure is a medical emergency that usually necessitates liver transplantation, early treatment greatly mitigates this risk.
Prevention of the development of liver cancer is closely linked to chronic diseases in the liver, such as hepatitis B or C and cirrhosis. Tumours can be found in the early stages among those at high risk of having cirrhosis due to liver disease. This allows for various forms of curative surgery, transplantation and ablation.

Prevention of variceal bleeding in cirrhosis and the formation of portal hypertension can lead to enlarged blood vessels in the oesophagus or stomach, known as varices, which can rupture and result in life-threatening haemorrhage. Early detection and treatment of liver disease prevent the development of varices or reduce bleeding risk through medications or procedures.

1. Increased therapeutic response:

Most diseases of the liver are much easier to treat before they advance and have progressed into severe stages. For example, antiviral medication for hepatitis C can be very effective before much damage is done to the liver. Similarly, lifestyle modification for NAFLD or NASH works best if the disease is still at an early stage and has not yet reached fibrosis and cirrhosis.
For some of the earliest stages of liver disease, lifestyle interventions or other non-invasive treatments may be adopted. At later stages, more invasive interventions - such as surgical procedures, liver transplantation, or long-term medication therapy - may become necessary.

1. Increased survival prognosis: 

• Long-term survival: Early stages of liver disease can improve survival. Thus, for example, if hepatocellular carcinoma is diagnosed early when still localised and such patients are radically treated by either resection or transplantation, then their survival prospects are much better than at a later stage of diagnosis when metastases appear.
• Avoiding Transplant: In some cases, timely interventions prevent the need for transplanting the liver by treating the cause before it becomes too late to cause irreparable damage to the liver.

1. Prevention of extrahepatic complications:

• Multi-system involvement: Liver disease, in an advanced stage, involves complications of other organs and systems, like renal failure or hepatorenal syndrome, encephalopathy, hepatopulmonary syndrome and cardiovascular diseases. Early diagnosis and treatment of liver disease can help avert or minimise extrahepatic complications.
• Lowered infection risk: Infections among patients with advanced diseases of the liver include spontaneous bacterial peritonitis through dysfunction of their immune systems. Early treatment lowers this risk by maintaining the patient’s immune system.

1. Cost reduction: 

Liver diseases, when in their early stages, are usually inexpensive to treat as compared to later stages or complications. For example, early treatment of hepatitis C might prevent cirrhosis and liver cancer, preventing the acute costs associated with managing those conditions, such as hospitalisation and even possibly a necessary liver transplant.
Early diagnosis could lead to fewer hospital admissions because complications of advanced liver diseases, like variceal bleeding, ascites, and hepatic encephalopathy, are prevalent in patients.

1. Improved quality of life: 

Early treatment helps maintain the symptoms of the patient, including tiredness, jaundice, and stomach pain, hence bettering a patient’s quality of life.
Early treatment allows patients to keep performing their daily activities and working as long as possible without the restrictions that inevitably accompany the progression of liver diseases. 

Benefits of liver transplant 

A liver transplant can be lifesaving and offers multiple benefits in the physical and mental planes of a patient. Some of the other important advantages include:

1. Improved survival rates: 

For patients suffering from end-stage liver disease, liver transplantation remains the only hope for surviving long enough to consider meaningful survival. Indeed, many such patients who have undergone transplantation go on to live healthy and productive lives post-transplantation.

1. Better quality of life:

These include chronic fatigue, pain, and cognitive decline, symptoms often associated with liver disease patients. These are notably diminished after a successful liver transplant, and patients regain their energy and vim.

1. Superior physical function:

It is known that liver failure causes a slew of other physical problems, including fluid retention, muscle wasting, and digestive issues. Restoring normal processing functions and removing toxins in the body facilitates general overall health improvement.

1. Restored liver functions: 

The liver performs over 500 significant functions in the body. Some of these functions include uptake of wastes from the blood, help with blood clotting, and metabolising nutrients within the body, among many others. Once such functions are restored, the body can function normally once again.

1. Freedom from chronic treatments: 

Most patients with liver diseases have to rely on medicines, dialysis, or some other treatments just to cope with their condition. Once the transplant is made, the need for these treatments oftentimes reduces, and patients get to live more freely and comfortably.

1. Regain control of life:

For many patients, the recurrent liver disease forces them to ‘put life on ice’ because of constant medical treatment; however, once an organ transplant is successful, most can go back to their workplace or hobbies, which will allow them to lead an active and fulfilling life again.

How team Fortis helps you after a liver transplant?

Fortis is recognised for its world-class clinical facilities and a dynamic team dedicated to providing comprehensive post-transplant care. Throughout the recovery, Fortis supports you by: 

1. Multi-disciplined post-transplant care: 

Fortis ensures that a team of experts from different disciplines work collaterally to ensure the smooth recovery of the patient. This team comprises transplant surgeons, hepatologists, intensivists, anesthetists, dieticians, physical therapists, psychologists and transplant co-ordinators to monitor your disease progress and make necessary adjustments to the care plan. 

1. Immunosuppressive therapy management: 

In order to prevent the body from rejecting the transplanted liver, one might need to take multiple immunosuppressants. Fortis offers personalised medication plans to closely monitor your disease progression and ensure minimal side effects and optimal therapeutic outcomes. 

1. Regular monitoring and follow-ups:

Fortis ensures that the patients get regular check-ups post-transplant to monitor or detect any early signs of rejection or infection. Fortis also ensures access to ongoing monitoring through blood and imaging tests to identify any potential issues as soon as possible. 

1. Nutritional guidance: 

Diet plays a vital role in post-transplant recovery. At Fortis, dieticians customise personalised nutritional plans to promote healing, manage weight and ensure that one gets the necessary vitamins and minerals. 

1. Psychological support:  

In order to overcome emotional challenges post-transplant, Fortis provides the required psychological support to help one cope with the physical and emotional aspects of recovery. 

1. Education for long-term care: 

Fortis educates both patients and caretakers from medical management on early recognition of signs of infections or rejection. 

Conclusion 

A liver transplant is a real life-transforming surgery for chronic liver disease patients. Early detection, along with advanced care, can result in the best possible outcome. Since Fortis is known for its quality clinical care, proper care from the initial time of diagnosis till post-operative recovery will help patients have a healthy future.