Liver Transplant

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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.  Read More

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Liver Transplant

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. 
liver transplant
Picture Courtesy: Mayo clinic
  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 [2]. 

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 [1]. 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
  • Bleeding
  • Blood clots
  • Failure of a donated liver
  • Infection
  • Rejection of donated liver
  • Mental confusion or seizures

Liver Transplant procedure

Pre-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.
Evaluation Once the patient decides and chooses the transplant center, the patient will be evaluated to see whether the patient is liable and meet the liver transplant requirements or not. The objectives of the evaluation process lie on the following criteria :
  • 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? 
What are the steps to be followed for a liver transplant? Prior to the Procedure Prior to the procedure, the patient has to undergo a couple of blood tests and scans such as complete blood test, liver function test, scans such as CT or MRI scan of the liver, heart function test, and overall general health check-up will be done in order assess and confirm whether the patient is eligible for transplantation or not. Once the patient is eligible for the procedure, the patient will be placed on the waiting list for the donor. After this, the organs are allocated as per the MELD (Model for End-stage Liver Disease) scores for adults and PELD (Paediatric End-stage Liver Disease) for children younger than 12 years, and they are stratified on the basis of blood type. This score estimates the risk of death of an individual within 90days without transplant [4]. Individuals with higher MELD scores usually are offered the donated livers at first. The time used on the transplantation list is used to break the ties among the people with similar MELD scores and blood types. During the Procedure Deceased donor liver transplant Once the donor is available, the patient will be intimated and advised to admit the hospital immediately. The patient undergoes a few blood tests before the procedure to ensure that the patient is healthy enough for the surgery. At the time of surgery, the patient will be given general anesthesia, where the patient will be unconscious throughout the procedure. An incision is made on the abdomen. • The surgeon then disconnects the blood supply of the recipient’s liver, and then the diseased liver is removed from the body. The donor’s liver is placed in the recipient’s body, and blood vessels and bile ducts are attached again. The average time for this entire process can take up to 12 hours as per the patient’s condition. Once the patient’s liver is transplanted, the surgeon stitches to close the incision opened for the surgery. The patient is then shifted to ICU (Intensive Care Unit) for further follow-up and care. Living Donor Liver Transplant The patient is informed in advance in case of a living donor transplant procedure. Surgeons first operate on the donor, and a portion of the liver is removed. Later the surgeon removes the diseased liver from the recipient and replaces it with the donor’s liver. They then connect the recipient’s blood vessels and bile duct to the new liver. The transplanted liver portion in the recipient’s body and the liver left behind in the donor’s body regenerate rapidly, reaching average volumes in a few weeks. After the Procedure After the liver transplant procedure, the nurse will shift the patient to ICU for close follow-up and care. Then the patient’s liver function test and a few more blood tests will be done to monitor the function of the donor’s liver.  •. Once the patient is stable, the patient is then shifted to the recovery area for further follow-up and care. Patients will be advised to take a few medications such as immunosuppressants to prevent organ rejection and other medications from reducing the risk of complications post-surgery. • The patient will be discharged home once the patient is hemodynamically stable and will be advised to visit the hospital and undergo a few tests regularly to monitor the patient’s condition after transplant. Complete recovering from a liver transplant procedure is a time-consuming process. People can get back to their everyday routine life after a few months. Potential Complications of liver transplant Hepatic artery or clotting of the hepatic artery is one of the complications that might occur under which the blood vessels bring the oxygenated blood from the heart to the liver. This occurs in 2 to 5 percent of the deceased donor transplantation. The second possibility could be Biliary complications. There are two types of biliary problems: biliary Leak or biliary stricture. This complication might occur in 15 percent of the deceased donor transplant and 40 percent of living donor transplants. Survival Rates after the Transplant The chances of a successful liver transplant and long-term survival depend on the specific situation. Generally, an average of 70 percent who went through the transplantation process live for five years or more. People who get a liver from a living donor usually have better short-term survival rates than those who receive a deceased donor liver.  Clinical Trials It is pretty normal to feel anxious and overwhelmed when waiting for the transplant to have fears about rejection, returning to work, or other issues after the transplant. Seek the support of friends and family members that could help to deal at the time of stressful times. The transplant team also assists with other resources and coping strategies at the time of the transplant process that includes: • Joining the support group for the recipients of transplants by talking to the ones who have similar experiences. They can share their experience and comfort the patient’s fears and anxiety • Sharing experience on social media will allow helping the transplant recipients and donors to connect with others through social media and get motivated. • Look for the rehabilitation services: If the patient wants to return to work, the social workers might be able to connect the patient with the rehabilitation service offered by the state department of vocational rehabilitation.  


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 [6].

Who needs a Liver Transplant?

  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. [5].

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.