Frequently Asked Questions

Replacing one’s own diseased liver with a new donor healthy liver is called liver transplantation. Such surgeries have been done for over 38 years. Several people who have had liver transplants go on to lead perfectly normal lives.

When the liver function deteriorates to such an extent that it can no longer fulfil the requirements of the body, i.e. when the liver function decompensates, and the likelihood of liver function to recover is remote, then a liver transplant is recommended.

Liver disease severe enough to require a liver transplant can come from many causes. In adults, the most common reason for liver transplantation is cirrhosis. Cirrhosis is a condition in which the liver slowly deteriorates and malfunctions due to chronic injury. Scar tissue replaces healthy liver tissue, partially blocking the flow of blood through the liver. Cirrhosis can be caused by viruses such as hepatitis B and C, alcohol, autoimmune liver diseases, buildup of fat in the liver, and hereditary liver diseases. Many people who develop cirrhosis of the liver due to excessive use of alcohol also need a liver transplant.

Alcohol, HCV, HBV and fatty liver disease are the commonest causes of liver cirrhosis. Autoimmune liver disease and metabolic disorders are other common causes.

Abstinence from alcohol and treatment of complications for 6 months will usually allow some of them to improve significantly and these patients may survive for prolonged periods without a transplant. For patients with advanced liver disease, where prolonged abstinence and medical treatment fails to restore health, liver transplantation is the treatment.

In children, the most common reason for liver transplantation is biliary atresia, a rare condition in newborn infants in which the common bile duct between the liver and the small intestine is blocked or absent. The cause of the condition is unknown. The only effective treatments are certain surgeries, or liver transplantation.

Other reasons for transplantation are liver cancer, benign liver tumors, and hereditary diseases. Primary liver cancers develop at a significantly higher rate in cirrhotic livers as compared to normal livers, particularly in patients having liver disease secondary to Hepatitis B. Liver Transplantation at an early stage of liver cancer may result in long-term survival for select patients.

Evaluations by specialists from a variety of fields are needed to determine if a liver transplant is appropriate. The evaluation includes a review of your medical history and a variety of tests. The transplant team will arrange blood tests, X – rays, and other tests to help make the decision about whether you need a transplant and whether a transplant can be carried out safely. Other aspects of your health-like your heart, lungs, kidneys, immune system, and mental health-will also be checked to be sure you’re strong enough for surgery.

 

You cannot have a transplant if you have: cancer in another part of your body, serious heart, lung, or nerve disease, active alcohol or illegal drug abuse, an active, severe infection, inability to follow your doctor’s instructions.

Liver transplants usually take from 4 to 14 hours. However, it may take longer. During the operation, surgeons will remove the entire liver and will replace it with the donor liver. The surgeon will disconnect the diseased liver from the bile ducts and blood vessels before removing it. The surgeon will put the healthy liver in place and reconnect it to the native bile ducts and blood vessels. The blood will then flow into the transplanted new liver. Because a transplant operation is a major procedure, surgeons will need to place several tubes (drains) in the abdomen. These tubes are necessary to help your body carry out certain functions during the operation and for a few days afterward.

Initially in the intensive care unit there is very careful monitoring of all vital signs, including the liver. Once the patient is transferred to the ward, the frequency of blood testing, etc. is decreased, eating is allowed and physiotherapy is prescribed to regain muscle strength. The drug or drugs to prevent rejection are initially given by vein, but later by mouth. During the transplantation, frequent tests are done to monitor liver function and detect any evidence of rejection.

 

Optimism is the need of the hour. Most liver transplant operations go well. About 80 to 90 percent of transplanted livers are still working after 1 year.

There are varying degrees of failure of the liver, however, and even with imperfect function, the patient will remain quite well. If there are complications – say, the new liver fails to function or your body rejects it, your doctor and the transplant team will decide the further course of action. Increasing the immunosuppression may be done to treat rejection. Sometimes, the failing transplanted liver may need to be replaced by a second (or even third) transplant operation. This happens very rarely, but PNF (primary non function) and DGF (delayed graft function) happens sometimes.

After discharge from the hospital, the patient will need to visit your doctor often to be sure your new liver is working well. Regular blood tests to check that the new liver is not being damaged by rejection, infections, or problems with blood vessels or bile ducts. The transplant recipient needs to be careful about avoiding sick people and must immediately report any signs of illnesses to your doctor. Home care involves building up endurance to carry out daily life activities and recovering to the level of health that the patient had before surgery. This can be a long, slow process that includes simple activities. Physiotherapy, breathing exercises, diet management and building up normal strength and function are an important aspect of rehabilitation. The patient should consult the transplant team before any new medication or intervention. Compliance with instruction is important.

Certainly. After a successful liver transplant, most people are able to go back to their normal daily activities. Getting your strength back will take some time, depending on how sick you were before the transplant. Your doctor will be able to tell you how long your recovery period is likely to be.

Work- After recovery, most people are able to resume work.

Diet – Most people can go back to eating as they did before. Some medication may cause weight gain, others may cause diabetes or a rise in your cholesterol. Meal planning and a balanced diet can help you remain healthy. Transplant patients have a tendency to gain weight because of their retention of water. They are advised to lower their intake of salt to reduce or eliminate this water retention.

Exercise – Most people can engage in physical activity after a successful liver transplant.

It is important for women to avoid becoming pregnant in the first year after transplantation.

Liver transplant may be necessary for patients who suffer from liver cirrhosis or acute liver failure.

Liver cirrhosis – progressive slow scarring of the liver results in damaging liver function slowly to a point of decompensation. Such a patient will get jaundice, or ascites (water in the abdomen), edema (swelling of feet), hepatic encephalopathy (affection of brain function) or a liver cancer. Complications like bleeding from the veins in the food pipe, reduction in kidney function, development of infection in the ascites or development of a liver cancer may increase the urgency of getting a liver transplant.

Fulminant liver failure – Sometimes sudden affection of the liver, usually by water borne infection; or by some alternative medicines, or some other cause; may result in severe liver damage necessitating a liver transplant.

Liver transplant may be necessary for patients who suffer from liver cirrhosis or acute liver failure.

Liver cirrhosis – progressive slow scarring of the liver results in damaging liver function slowly to a point of decompensation. Such a patient will get jaundice, or ascites (water in the abdomen), edema (swelling of feet), hepatic encephalopathy (affection of brain function) or a liver cancer. Complications like bleeding from the veins in the food pipe, reduction in kidney function, development of infection in the ascites or development of a liver cancer may increase the urgency of getting a liver transplant.

Fulminant liver failure – Sometimes sudden affection of the liver, usually by water borne infection; or by some alternative medicines, or some other cause; may result in severe liver damage necessitating a liver transplant.

 Liver failure causes many problems, including malnutrition, problems with blood clotting, bleeding from the gastrointestinal tract, and jaundice. Frequently, patients who undergo liver transplantation are quite ill, and require hospitalization in the Intensive Care Unit prior to surgery. A large, upper abdominal specialized incision is used for liver transplant.

Liver transplant may be necessary for patients who suffer from liver cirrhosis or acute liver failure.

Liver cirrhosis – progressive slow scarring of the liver results in damaging liver function slowly to a point of decompensation. Such a patient will get jaundice, or ascites (water in the abdomen), edema (swelling of feet), hepatic encephalopathy (affection of brain function) or a liver cancer. Complications like bleeding from the veins in the food pipe, reduction in kidney function, development of infection in the ascites or development of a liver cancer may increase the urgency of getting a liver transplant.

Fulminant liver failure – Sometimes sudden affection of the liver, usually by water borne infection; or by some alternative medicines, or some other cause; may result in severe liver damage necessitating a liver transplant.

 

 

 

 Liver failure causes many problems, including malnutrition, problems with blood clotting, bleeding from the gastrointestinal tract, and jaundice. Frequently, patients who undergo liver transplantation are quite ill, and require hospitalization in the Intensive Care Unit prior to surgery. A large, upper abdominal specialized incision is used for liver transplant.

Where does the liver come from:-
The healthy liver is obtained either from a living donor or from a donor who has recently died (brain dead) but has not suffered liver injury.

Indian law mandates that a living donor has to someone related to the patient. For a cadaveric liver, the patient needs to be placed on the waiting list, where the liver from a cadaveric donor is usually offered to the sickest patient first.

The diseased liver is removed through an incision made in the upper abdomen. The new liver is put in place and attached to the patient's blood vessels and bile ducts.

Patients require hospital care for one to four weeks after liver transplant, depending on the degree of illness. After liver transplantation, patients must take immunosuppressive medications for the rest of their lives to prevent immune rejection of the transplanted organ.

Liver is obtained from a Deceased donor or Live Related donor.

Deceased Donor (Cadaver) –  Liver is obtained from patients who are brain dead. (They are actually dead for from legal, ethical, spiritual and clinical point of view). Once a braindead patient is identified, and is deemed as a potential donor, the blood supply to his body is maintained artificially. This is the principle of deceased organ donation. Young patients who die of accidents, brain hemorrhage or other causes of sudden death are the donors suitable for organ donation.

Living Donor – Part of liver from living related donor is a certain and timely available option and only hope for cure. Liver surgery can be carried out safely in almost all patients. All patients are listed for deceased donor liver but timely organ availability is uncertain. Liver has the capacity to regenerate if a part of normal healthy liver is removed. Hence, we can divide part of liver from a live donor and implant it into another patient. In a live donor liver transplant, a portion of the liver is surgically removed from a live donor and transplanted into a recipient immediately after the recipient's liver has been entirely removed.

Donor safety is the first objective of whole process. Utmost care is taken while selecting and operating liver donors. The risk of serious morbidities following a living donor liver resection is 10%. The risk of death from a life-threatening complication in the donor is 0.02to 0.05%. Live donor liver transplantation is possible because the liver (unlike any other organ in the body) has the ability to grow back to its original size. The regeneration of liver following surgery is complete by 4 to 8 weeks.

Potential live liver donors are carefully evaluated. The health and safety of the donor is the most important concern during the evaluation. Only donors in good health are considered.

A potential donor should:

1. Be either a relative or spouse,
2. Have a compatible blood type
3. Be in good overall health and physical condition
4. Be older than 18 years of age and younger than 55 years of age
5. Have a near normal body mass index (not obese)

A donor must be free from:

1. History of Hepatitis B or C
2. HIV infection
3. Active alcoholism or frequent heavy alcohol use
4. Any drug addiction.
5. Psychiatric illness currently under treatment
6. A recent history of cancer.

The gift of an organ can save the life of a transplant candidate.

• Donors have reported positive emotional experiences, including feeling good about giving life to dying person.
• Transplants can greatly improve recipients' health and quality of life, allowing them to return to normal activities.
• Transplant candidates generally have better results when they receive organs from living donors as compared to organs from deceased donors.
•  Better genetic matches between living donor and candidates may decrease risk of organ rejection.
• A living donor makes it possible to schedule the transplant at a time that is convenient both for the donor and the transplant candidate.

Please talk to transplant team members to understand what to expect, although the surgery and recovery process can differ among living donors. The donor may stay in the hospital up to 10 days or longer in some cases. The liver typically regenerates in two months. Most liver donor returns to works and normal activities in one to three months, although some may need more time.

Long term medication is not required and long term quality of life of liver donors is not affected.

 

The biggest risks associated with liver transplants are rejection and infection.

Rejection occurs when the body's immune system attacks the new liver as an unwanted foreign substance; just as it would attack a virus. To prevent rejection, transplant patients must take drugs to suppress the immune system. However, because the immune system is weakened, it is harder for liver transplant patients to fight other kinds of infections. Fortunately, most infections can be treated with other medicines.

• Anti rejection drugs
• For the first three months after transplantation you need to take the following medicines.

Antibiotics – to reduce the risk of infections

Antifungal liquid – to reduce the risk of fungal infection

Antacid – to reduce the risk of stomach ulcers and heartburn

Any other medicines that you have to take will be prescribed for you depending on your Symptoms.

One's body doesn't accept other's organ. It is body's defense system to try to attack and destroy other's organ. Anti- rejection drugs makes defense mechanism weak against donor's organ and allow liver graft to sustain and work normally.

Communication, cooperation and coordination between the transplant team and local physician, is essential for well-being of the Liver Transplanted recipient. It is important to follow the instructions that will help prevent or lessen complications.

One of a patient's most important jobs is to ensure that family physician, local pharmacist, and his family members are aware of the transplant, the medications he takes each day, and the precautions he must follow to stay healthy. Each of his family members should have the telephone number of his Liver Transplant Coordinator or Liver Transplant Consultant.

The patient and his family members must be fully aware about the precautions to be taken after a successful Liver Transplant.