Let’s Talk About Liver Transplant!

A liver transplant surgery involves the removal of a failed liver (one that no longer functions properly) and the insertion of a healthy liver from a deceased donor or a part of a healthy liver from a living donor. At Manipal Hospitals, our expert hepatologists offer the largest liver transplant program in the country. In addition, our proficient team of medical specialists, surgeons, and nurses work together in the liver transplant program to consistently deliver clinical excellence.

For example, during the COVID-19 crisis, our veteran specialists successfully performed a liver transplant procedure on a 58-year-old Maldivian citizen diagnosed with hepatitis B and liver cirrhosis, giving him a new lease on life. Read the whole article by clicking on the link below:

https://bangaloremirror.indiatimes.com/bangalore/others/liver-transplant-amid-the-lockdown/articleshow/76470982.cms

Why is a Liver Transplant Performed?

This procedure is generally recommended for people who have been diagnosed with several complications because of end-stage chronic liver disease or liver cancer. It is also recommended by doctors if there is a sudden failure of a previously healthy liver and thus, the surgery is widely considered a liver-saver procedure for patients with liver failure. The procedure is performed for treating both acute liver failure (which usually happens quickly because of complications due to the consumption of certain medications) and chronic liver failure (which happens slowly over a long period of time). Visit Manipal Hospitals Global for Liver transplant treatment in India.

Chronic liver failure is primarily caused by:

• Scarring of the liver or cirrhosis

• Alcoholic liver disease which damages the liver because of excessive alcohol consumption

• Non-alcoholic fatty liver disease which occurs due to liver cell damage or inflammation because of the build-up of fat in the liver According to Dr. Rajiv Lochan, Lead Consultant of HPB and Liver Transplantation Surgery at Manipal Hospital Old Airport Road in Bangalore, fatty liver develops most commonly in people who have diabetes, a high lipid profile, or are overweight)

• Genetic liver disorders, such as Wilson’s disease (which causes the build-up of copper in the liver) and hemochromatosis (that causes the build-up of iron in the liver)

• Diseases (such as primary sclerosing cholangitis, biliary atresia, and primary biliary cirrhosis) that affect the bile ducts which are the tubes that carry bile away from the liver

• Hepatitis B and C as they cause inflammation of the liver

What Can Be Expected Before a Liver Transplant?

Patients are advised to undergo a liver function test before a liver transplant as this test helps doctors assess the severity of the illness, how urgently the patient needs a transplant, and the patient’s place on the liver transplant waiting list which is developed on the basis of certain formulas and parameters that estimate the probability of death without a transplant as well as the availability of a suitable deceased donor. Patients with liver cancer and acute liver failure are generally given priority over those with chronic liver failure. 

In addition, doctors will prescribe medications to treat the complications of liver failure and make the patient as comfortable as possible as they wait for a transplant. However, if the patient’s condition deteriorates and the complications become more severe, they are immediately pushed toward the top of the transplant waiting list. 

In some cases, living donors are generally preferred by doctors for liver transplants. In these cases, doctors transplant a small portion of a liver from a healthy and living person. These transplants allow the recipient to avoid severe complications of waiting for a transplant and are majorly performed in children and adults with end-stage liver disease due to the lack of availability of suitable organs from deceased donors. Although living-donor transplants generally yield positive results, they are not as widely performed as deceased-donor transplants. Consult with liver transplant specialists in India by booking an appointment today.

This is primarily ascribed to the fact that finding the right living donor is incredibly difficult. Moreover, living liver donors are often subjected to extensive evaluation to ensure that they are a right match with the recipient and to also accurately assess their physical and mental health. Additionally, the procedure carries various risks for the donor. 

Besides deceased-donor and living-donor transplants, domino liver transplants are also performed by doctors for treating liver disorders. In a domino liver transplant, the patient is given a liver from a living donor who has himself undergone a liver transplant to treat a rare disorder called familial amyloidosis which occurs due to the accumulation of protein in the internal organs. 

While the liver given by the donor is healthy and functions well, the recipient may eventually experience symptoms of amyloidosis after a few decades. Owing to this reason, doctors generally select recipients aged 55 years and older for a domino liver transplant as people in this age bracket are not expected to experience any symptoms before their deaths. 

While waiting for a transplant, patients are expected to:

• Take their medications as prescribed by the doctor

• Follow their exercise and diet guidelines

• Spend time with friends and family

• Stay in touch with the transplant surgeons and inform them of any changes in health and the overall condition

How is a Liver Transplant Performed?

A liver transplant is performed using general anesthesia. During the procedure, the surgeon makes a long incision across the stomach to access the liver. The size and location of the incision usually vary as per the patient’s anatomy and the surgeon’s approach. This is followed by the removal of the liver and the placement of the donor liver in the body, after which, the surgeon connects the bile ducts and blood vessels to the donor's liver. The procedure can last for 12 hours, depending on the situation. 

After the new liver has been put in place, the surgeon uses staples and stitches to close the incision. The patient is then transferred to the intensive care unit for observation. 

Are There Any Complications Associated with a Liver Transplant?

While a liver transplant procedure is usually considered quite safe, some complications do occur during/after liver surgery, such as:

• Infection

• Bleeding

• Blocked bile ducts or leakage of bile

• Blocked blood vessels (to the new liver)

• Improper functioning of the new liver for a short period of time immediately after the procedure

Furthermore, symptoms, such as dark-colored urine, yellowing of the eyes and the skin (jaundice), sore or swollen belly, itching, fever, upset stomach, persistent feeling of tiredness (fatigue), and headache, may also occur after a transplant. In such instances, the patient is advised to consult a doctor immediately as these symptoms generally indicate the rejection of the new liver by the body’s immune system. 

What to Expect After a Liver Transplant?

After a liver transplant, the patient should expect to:

• Stay in the ICU (intensive care unit) for at least a few days so that doctors and nurses can properly assess their condition and identify signs of complications. Moreover, they will also test the functioning of the new liver to ascertain if it is working properly.

• Undergo frequent check-ups as they continue their recovery at home. In addition, the patient will have to undergo regular blood tests for a few weeks post the transplant.

• Take medications (as prescribed by the doctor) for the rest of their life. The doctor will prescribe immunosuppressants to stop the immune system from attacking the new liver. Besides, the doctor will also prescribe other drugs to mitigate the risk of various complications after the transplant. 

• Be at a higher risk for infections, including herpes, diseases caused due to respiratory viruses and oral yeast infections due to the immunosuppressants. 

While the patient can resume routine activities after a few months following the transplant, they must expect a minimum of six months of recovery time before they can feel fully healed.

Dr. Aravind Kidambi Seshadri

Consultant - HPB & Liver Transplantation Surgery

Manipal Hospitals Global