Liver Transplant Guide by Dr. Harshal Rajekar

Liver is the largest abdominal organ. Liver weighs about 1200 – 1500 grams in an average roughly 2% of body weight. Liver, though a single organ, broadly it can be divided into two parts – right and left liver and 8 independent segments (each having its own blood supply and biliary drainage) functioning as a single organ. Liver as a whole has a hepatic artery supplying oxygenated blood, a portal vein carrying blood from intestines to liver and bile ducts draining bile formed in the liver to intestines. Blood from liver is delivered to heart via three hepatic veins.

Liver produces bile which is drained by biliary tree. Bile is essentially a waste product for excretion, a result of hemoglobin breakdown, but it also helps in digestion. Gall bladder is a reservoir for the bile lies on the liver bed, and is attached to bile duct. It regulates delivery of bile into intestines. Liver is endowed with remarkable capacity to regenerate after division into parts. This is the basis of Live Related Liver Transplants (LDLT), and the reason why live related liver transplant is possible.

 

The liver is in the right upper abdomen. The liver has more than 700 known functions. The liver serves many functions, including the detoxification of substances delivered to it from the intestines, and the synthesis of many proteins.

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:

---

How long would I take to recover after liver donation?

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.

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.

---

What precautions should I take after my liver transplant?

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. 

 

---