What is a liver transplant?A liver transplant is defined as a procedure that helps to replace the diseased or nonfunctioning liver of the patient with the complete liver or partial lobe of a healthy liver. The liver is considered the largest abdominal organ weighs about 1.5 grams. The liver’s main function is the production of bile, which helps absorb fat and fat-soluble vitamins. It also helps maintain hormonal balance, stores essential minerals, detoxifies substances, removes bacteria and toxins from the blood, and synthesizes many proteins .
What are the types of liver transplants?Types of Liver Transplants Liver transplantation can be carried out in the following ways: Deceased Organ Donation: This type involves liver transplantation, where the liver is taken from someone who has recently died. Most of the liver transplants come from a deceased person. Adults typically receive an entire liver from a deceased person. In a few instances, the deceased liver is split into two lobes, out of which the larger lobe is transplanted to an adult, whereas the smaller lobe is transplanted to the child or adult . Living Donor: Under this type, a section of the liver is transplanted from a living donor as the liver can regenerate. The transplanted section and the remaining section can grow back into a regular-sized liver. Risks Involved in Liver Transplant Liver transplantation carries a risk of significant complications. There are certain risks linked with the procedure itself and with the drugs essential to preventing the rejection of the donor’s liver after the transplantation process. The risk involved in the procedure includes:
- Bile duct complications, including bile duct leaks or shrinking of the bile ducts
- Blood clots
- Failure of a donated liver
- Rejection of donated liver
- Mental confusion or seizures
Liver Transplant procedurePre-procedure – Choosing a Transplant Center While considering the centers of transplantations, the patient should be aware of the following things:
- Learn about the types of transplants that the center has performed every year.
- Ask the center about the survival rates
- Make the comparison of transplant centers by the database that you can get from scientific transplant recipients.
- Know the cost incurred before the process, during the process, and after the process. It will also include tests, surgery, follow-up appointments, and transportation.
- Is the patient healthy enough to undergo the procedure, and will the patient be able to tolerate the medications prescribed for the rest of the life after the transplantation procedure?
- Does the patient suffer from any medical condition that would intervene in the success probability of the transplantation process?
- Is the patient ready to take medications as guided and follow the guidance of the transplantation team?
Gastrointestinal Bleeding: As per the fact that liver gets scarred, the increase in the portal blood flow resistance takes place that further more leads to increase the pressure of venous system. This results in necessitating the alternative routes for blood to return to the heart (ACG, 2019).
Fluid Retention: One of the main functions of the liver is to synthesize the proteins circulating in the bloodstream that includes albumin. Albumin in the blood retains the fluid in the vascular space by putting forth the pressure which is known as osmotic pressure.
Encephalopathy: This occurs as a result of failure of the liver to clear the ammonia and other toxins from the blood and allows the substances to accumulate. These Toxins culminate in the cognitive dysfunction that ranges from disturbed sleep-wake patterns to mild coma.
Individuals who need the liver transplant usually have one of the following diseases:
• Acute Liver Failure
• Chronic liver failure
• Viral Hepatitis
• Alcoholic Liver Disease
• Metabolic Liver Disease
• Autoimmune Liver Disease
• Genetic Liver Disease
• Vascular Liver Disease
Who can donate liver?
Anyone can donate a liver in two ways.
One either a deceased person (person who died recently) can donate a liver
Another is from a living person. Here are a few of criteria for a person who wants to donate a liver
- Donors could be either a relative, spouse, siblings, or a friend of a recipient.
- The donor’s blood type must be compatible with the recipient’s blood type.
- Donors should abstain from alcohol smoking until complete recovery and have excellent physical and mental health.
- The age of the donor should be between 19-60 years old.
- The donor should not have other severe illnesses such as cardiac or lung disorders or any other cancer .
Who needs a Liver Transplant?
Picture Courtesy: Practo
People with the following conditions usually require liver transplants:
• Acute Liver Failure
• It is also known as hepatic failure, which occurs when the healthy liver suffers from passive injury that culminates in clinical signs and symptoms of liver insufficiency.
• Chronic liver failure
• The liver can repair it back in reaction to the injury. Yet, the repeated injury and repair, typically if the injury has lasted for many years and even decades, lead to failure. The last stage of scarring is known as cirrhosis, where the liver can no longer repair itself.
Who Are Not Candidates for a Liver Transplant?
Below are the conditions that are said to be absolute contraindications to liver transplantation:
• Severe, irreversible medical illness that limits short-term life expectancy
• Severe pulmonary hypertension (mean pulmonary artery pressure greater than 50mm Hg)
• Cancer that has spread outside of the liver
• Systemic or uncontrollable infection
Immunosuppressant drugs – why required and their harmful effects?
In the organ transplant procedure, the patient will be placed on a regimen of immunosuppressant medications to prevent the immune system from rejecting the donor organ. This can be done through medications that might have been prescribed, including corticosteroids, tacrolimus, cyclosporine, mycophenolate, azathioprine, and sirolimus. One of the significant side effects of corticosteroids is osteoporosis which occurs there is a decrease in the density of bones. Hence the risk of fractures increases. This can affect any bone in the body, but fractures are most commonly seen at the hip, spine, or wrist.
Is liver transplant safe for the living donor?
Due to the advancement in technology, the success rate of liver transplantation is increasing. Every surgery has its pros and cons. In the case of a living donor, only a portion of the liver is being transplanted, and the liver starts to regenerate immediately after the surgery. The liver will reach its average size by 6-8weeks after donating the portion of the liver. The cons are bleeding, bile leak, infection, etc. .
Are liver transplant patients immunocompromised?
To avoid organ rejection after the transplant, the patient is advised to take immunosuppressants. These immunosuppressants block the natural defense system of our body to prevent rejection.
Can a liver transplant cure cancer?
Yes, it can cure cancer.
Can liver transplant patients drink alcohol?
After the transplant, the patient is advised to lead a healthy life and avoid alcohol intake and smoking to prevent complications.