All About Liver Transplants: Surgery to Recovery

Liver Transplant: What You Need to Know

A liver transplant is a surgical procedure that replaces a non-functioning liver with a healthy liver from a deceased donor or living donor. Living donors share a part of their healthy livers.

The Critical Functions of the Liver

Liver being a largest internal organ in the body does multiple critical functions such as eliminating infection and managing immune response, processing medications, nutrients and hormones, generating bile, which assist in absorbing cholesterol, fats and fat -soluble vitamins, creating proteins that assists the blood clot and preventing infection and regulating immune responses.

When Liver transplant is done?

Generally, a liver transplant is a treatment option for people suffering from serious complications because of the end stage of chronic liver disease. However, a liver transplant is also done for people with sudden failure of the healthy liver, which is a rare condition.

Deceased donor & Living donor

People waiting for liver transplants are always more than the available deceased-donor livers. The other option for deceased-donor livers is getting a part of the liver from a living donor.

Living-donor liver transplant works because the surgery, the human liver regenerates and returns to its original size briefly after the surgical removal of part of the organ.

Why a Liver transplant?

A liver transplant is a treatment option for a few people with liver cancer or people suffering from liver failure, which can't be treated by other conditions.

Acute liver failure

Liver failure can develop quickly or in the long run. Liver failure that develops quickly in a span of weeks is termed acute liver failure. This type of liver failure is a rare condition and usually occurs as a result of particular medications.

Chronic liver failure

A liver transplant is used to treat acute failure; however, it is most frequently used to treat chronic liver failure. Chronic liver failure develops gradually over a span of months and years.

Chronic liver failure is caused by multiple conditions, and the prime among them is scarring of the liver (cirrhosis).

Cirrhosis

Cirrhosis is a condition in which the normal tissue in the liver is replaced by scar tissue, which results in the improper functioning of the liver. Cirrhosis is the most common reason for liver transplant.

Main Causes of Cirrhosis

• Alcoholic liver disease, which harms the liver due to excessive alcohol consumption.
• Hepatitis B and C
• Genetic disease impacting the liver

1. Hemochromotosis makes the body to absorb excessive amount of iron from the food and resulting in harmful level of iron in the liver and other organs.

2. Wilson's disease makes the body to absorb excessive amount of copper,  resulting in harmful level of copper in the liver and other organs.

• Nonalcoholic fatty liver disease is a condition in which fat develops in the liver, creating inflammation or liver cell damage.
• Diseases that impact tubes which transport bile away from the liver (bile ducts). They include primary sclerosing cholangitis, primary biliary cirrhosis and biliary atresia. Biliary atresia is the most frequent reason for liver transplants among children,
  A liver transplant may also treat specific cancers that arise in the liver.

Complications of Liver Transplant

A liver transplant is associated with the risk of serious complications. The procedure itself carries many risks, and also the drugs essential to preventing rejection of the donor's kidney after the transplant.

The possible risks associated with the procedure are:

• Bleeding
• Bile duct complications such as bile duct leaks or shrinking of the bile ducts
• Blood clots
• failure of the donated liver
• rejection of the donated liver
• infection
• Mental confusion

The long-term complications may also include liver disease resulting in a transplanted liver.

Side effects of anti-rejection medication

Post the liver transplant; you have to take anti-rejection medication for the rest of your life to prevent the body from rejecting the donated liver. These ant-rejection medications can cause a variety of side effects, including

• Diabetes
• Bone thinning
• Diarrhea
• Headaches
• High cholesterol
• High blood pressure

The anti-rejection drugs work by subduing the immune system, they also escalate the risk of infection. Your doctor may provide you medications to assist you fight infections.  

Before the Procedure

Waiting List

Doctors will utilise the results of the liver function tests and other factors to analyse the intensity of the illness, how promptly you require a transplant, and your place on the liver transplant waiting list.

Transplant waiting list priority is calculated by a scoring system. Doctors use the Model for End-Stage-Live-Disease (MELD) scores for adults and Pediatric End-Stage-Live-Disease (PELD) scores for children below 12 years.

The doctor will use a particular formula to calculate the MELD score, which can range from 6 to 40. The score determines the risk of death within 90 days without a transplant. A high MELD score indicates the alarming need of a transplant.

When the deceased-donor organs become available, they are grouped by blood type and allocated in accordance with the MELD scores. Generally people with higher MELD score will first get the donated livers first. Time spent on the liver transplant waiting list is used to break ties for people with same MELD scores and blood types.

Few liver conditions, like liver cancer, may not result in a person acquiring a high MELD score. The transplant centre may request extra MELD points for people with particular diseases if they meet defined exception criteria.

Furthermore, adults with acute liver failure are exempted from the MELD-based donor organ prioritisation system and can be placed higher on the transplant waiting list in accordance with the severity of the disease.

The wait for a new liver

The wait for a donor's liver differs greatly; few may get a deceased donor's liver in days, while others may wait for months or may end up never getting one.  

During this waiting period, your doctor will treat the complications that arise due to liver failure.  The complications of end-stage liver failure are serious, and you may be often hospitalised. If your liver deteriorates, your MELD score is increased.

Living Liver Donors

Living donors constitute a small percentage of liver transplants happening every year. Here, surgeons transplant a small portion of a liver from a healthy living person.

Initially, living donor transplants were only used for children because the liver for children was scarce from suitable deceased donors. At present, it is also an option for adults who have end-stage liver disease.

The majority of living donors are friends or close family members of the liver transplant candidate. If you have a family member or friend who is willing to donate part of her or his liver to you, talk to your transplant team about this option.

Living donor transplants give good results, just as transplants use livers from deceased donors. However, finding a living donor may be complicated.

Living liver donors go through a substantial evaluation to ensure they are matched with the organ recipient and to evaluate their physical & mental health. The surgery also carries significant risks for the donor.

Domino liver transplant

Another rare type of living donor liver transplant is known as domino liver transplant. In a domino liver transplant, you get a liver from a living donor who has a disease known as familial amyloidosis. Familial amyloidosis is a very uncommon disorder in which an abnormal protein accumulates and gradually damages the body's internal organs.

During the procedure

Upon notification of the availability of a liver from a deceased donor, you will be required to report to the hospital promptly. Upon arrival, your healthcare team will admit you for an examination to ensure you are in suitable health for the surgery.

Liver transplant surgery is done under general anaesthesia, rendering you in a state of deep sleep throughout the procedure.

The transplant surgeon will make a lengthy incision on your abdomen to access your liver. The precise location & size of the incision will depend on the surgeon's technique and your individual anatomy.

Following the removal of your liver and the placement of the donor's liver, the surgeon will connect your blood vessels & bile ducts to the new liver. The duration of the surgery can range up to 12 hours, based on your particular circumstances.

After the successful placement of your new liver, the surgeon will close the incision using stitches and staples. Consequently, you will be transferred to the intensive care unit to start the recovery process.

Living Donor

Living donor liver transplantation involves scheduling the surgery in advance if you are receiving a liver from a living donor.

Initially, the surgeons will perform the operation on the donor to extract the part of the liver intended for transplant. Consequently, your liver will be removed, and the donated liver portion will be implanted into your body. The blood vessels and bile ducts will be connected to your body.

Both the transplanted liver part in your body and the remaining portion in the donors will regenerate quickly, returning to their normal size within a few weeks.

After the Procedure

After a liver transplant, you can anticipate:

Potentially staying in the intensive care unit for a few days. Medical professionals will closely monitor your condition for any signs of complications and regularly check your liver function to ensure your new liver is functioning properly.

Spending five to ten days in the hospital. Once your conditions stabilise, you will be transferred to a transplant recovery area to continue your recovery process.

Attending regular checkups as you recover at home. Your transplant team will create a checkup schedule for you that may include frequent blood tests initially and less frequent tests as time goes on.

Taking medications for the rest of your life. Following your liver transplant, you will need to take several medications, including immunosuppressants, to prevent your immune system from rejecting the new liver and other drugs to reduce the risk of complications.

Allowing for a recovery period of six months or longer before feeling fully healed after the liver transplant surgery. Depending on your pre-transplant health condition, you may be able to resume normal activities or return to work a few months post-surgery. The duration of your recovery process may vary based on your health status prior to the transplant.