Introduction to Liver Transplant

Surgery to replace a sick or diseased liver with a healthy liver from another person is known as a liver transplant. You can either transplant your entire liver or just a portion of it. The majority of the time, a brain dead organ donor will provide the healthy liver. If only half of the liver is donated then it comes from living donor which usually is the patients relatives.

The only organ in the body that can regenerate lost or damaged tissue is the liver (regenerate). After surgery, the donor’s liver will soon regain its normal size. In a few weeks, the portion that was given a new liver will also enlarge to its typical size.

Need for Liver Transplant

  1. After all other forms of treatment have failed, patients with end-stage liver disease may be offered a liver transplant. Common factors leading to liver transplants include the following:

    Acute Liver Failure : Sustain 80% to 90% damage to the liver cells and may lead to coma.

    Viral Hepatitis : A highly contagious liver disease that causes the liver to fail completely.

    Alcoholic Liver Disease : Due to Alcohol abuse, scars and cirrhosis occurs, causing the liver to stop the functioning.

    Non-Alcoholic Fatty Liver : built-of fat in the liver that causes inflammation and damages  cells in the liver.

    Liver Cancer : Cancer cells that have grown deep into the tissue halting any function of the Liver

Types of Liver Transplant

  1. There are three main ways a liver transplant can be carried out:

    Deceased organ donation transplant – involves transplanting a liver that has been removed from a person who died recently

    Living donor liver transplant – a section of liver is removed from a living donor; because the liver can regenerate itself, both the transplanted section and the remaining section of the donor’s liver are able to regrow into a normal-sized liver

    Split donation transplant – a liver is removed from a person who died recently and is split into two pieces; each piece is transplanted into a different person, where they will grow to a normal size

Pre-Liver Transplant Evaluation

Every patient who requests a liver transplant must go through a thorough evaluation process. One may go through the following tests, procedures, and consultations:

Physical examination:

For the purpose of assessing general health, routine cancer screening tests are included.

Lab examinations:

including examinations of the blood and urine to judge the condition of the organs, including the liver

Imaging examination:

a liver ultrasound and a CT scan of the abdomen.

Heart examinations:

to evaluate the patient’s cardiovascular system’s condition

Lung Assessment:

Tests to ascertain off the lungs are healthy.

Other Systems involvement:

Tests will be done to make sure all other systems and organs are functioning well and there is no evidence of any infection.

Nutritionist  counselling :

who evaluates nutritional status and offers advice on dietary intake both before and after transplant

Psychological assessment :

to determine whether the patient is aware of the risks of a liver transplant and to assess and treat any underlying conditions, such as depression or anxiety.

The Liver Transplant Process

The general procedure that takes place during a liver transplant is:

General Anesthesia

The patient is put under general anesthesia and is put to sleep completely.

Incision

Incision is made to open up the abdominal area to access, normal an inverted L shaped incision or a Mercedes Benz shaped incision is made.

 

Evaluation of the abdomen

Evaluation of the abdomen for abnormalities to prevent liver transplant complications

Mobilization of the native liver

Mobilization of the native liver and isolation of important structures such as veins and arteries

Transection

Transection of the structures attached and removal of the native, diseased liver

Sewing

New liver is attached, all blood vessels and bile ducts are connected before closing the incision

Adequate Control

Ensuring adequate control of bleeding and closure of the incision

 

Complications of Liver Transplant

The following are some of the major issues with liver transplants: 

  • Rejection of the new liver by the body 
  • Bleeding (haemorrhage) 
  • Bile Leakage
  • The need for a new transplant as soon as possible due to the new liver’s initial failure to function (primary non-function).
  • A higher risk of contracting infections;
  • Kidney function decline;
  • Issues with blood flow to and from the liver;
  • A higher risk of certain cancers, particularly skin cancer;

 

Post-Liver Transplant Procedure

Patients are taken to the recovery area following surgery, where they stay for a few hours before being transferred to the intensive care unit (ICU). For several days, they are monitored closely in the ICU while having their vital signs recorded.

To check the new liver, blood samples will be taken frequently. The functioning of the kidneys, lungs, and circulatory systems will also be examined by the medical professionals. Anti-rejection medications will be given and closely monitored to make sure the patients are receiving the correct dose and medication combination.

The patient will be transferred from the ICU to a regular ward once the medical staff determines they are ready. Slowly, patients will be able to move more and walk for longer periods of time.

Life After Liver Transplant

A liver transplant is a procedure that has significantly extended the lives of people with end-stage liver disease and saved countless lives throughout the world. Patients need to be aware of a few safety measures after surgery.

Regular Follow-up:

It is adviced that  patients regularly follow up with their doctor to monitor the progress of the liver transplant. These  may be frequent at first, but will gradually decline.

Immunosuppressants:

The body may regard the new liver as foreign and attack it. Immunosuppressants prevent this from happening. Other drugs help reduce the risk of other complications after the transplant.

Lifestyle changes:

Patient need to alter their lifestyle drastically after the surgery. Patients cannot consume alcohol and need to watch the food they eat as well.