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An ultimate guide on Liver Transplant

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An ultimate guide on Liver Transplant

General Surgery | by CMRI | Published on 01/04/2020

The liver is the largest internal organ in the human body and is placed on the right side of the abdomen, right below the diaphragm. The liver performs various vital functions such as:


  • Detoxifying the body
  • Breaking down food and nutrients to form energy
  • Stores vitamins, minerals, and sugar
  • Produces bile – a compound used to digest fat and absorb vitamins
  • Prevents blood clotting
  • Helps fight infection by filtering bacteria from the blood
  • Regulating immune responses


A healthy functioning liver is very critical for a healthy life because a liver performs various vital functions. When this essential organ of the body becomes diseased or severely compromised, a transplant may be required. A liver transplant is a surgical procedure that aims to replace the diseased liver with a healthy liver from another person – known as a donor. A diseased liver is a liver that does not function properly. In a liver transplant, a part of the liver or the whole liver can be replaced, depending on the condition of the liver of the patient requiring the transplant.


Reasons for a liver transplant


A liver transplant is recommended for patients that have end-stage liver disease or whose liver no longer functions adequately; this condition is also called liver failure. A liver failure may occur suddenly due to viral hepatitis infection, injuries from drugs, or any other infection. In some cases, liver failure can also occur because of a prolonged liver problem. A liver transplant can be used to treat both acute liver failure and chronic liver failure; the main cause of which is scarring of the liver tissue known as cirrhosis. Cirrhosis replaces the healthy tissue with scar tissue, hampering the functioning of the liver. It is the most common reason for a liver transplant in patients.


Some major causes of cirrhosis leading to liver failure and the need for liver transplant include, but are not limited to:


  • Hepatitis B and Hepatitis C
  • Excessive consumption of alcohol
  • Excessive consumption of tobacco products
  • The non-alcoholic fatty liver problem creates masses of fat in the liver leading to damage
  • Wilson’s disease leads to the accumulation of copper in the liver
  • A genetic problem such as hemochromatosis leads to a build-up of iron in the liver
  • Bile duct conditions such as primary biliary cirrhosis, primary sclerosing, and biliary atresia


Also, to assess if a patient qualifies for a liver transplant, the doctor might evaluate:


  • The severity of the problem
  • Overall health
  • Medical history including infections such as HIV and tuberculosis
  • Mental health
  • Provision of support and care post the surgery
  • The willingness of the patient to alter lifestyle patterns and habits


Moreover, before doing the transplant, the doctor will also assess if the donor's liver will benefit the condition of the patient concerned and increase his life span considerably. A patient with chronic health conditions may not qualify for a liver transplant.


Risks involved in a liver transplant


A liver transplant surgery is a significantly risky surgery with risks associated with the procedure, as well as with the medications are given to the patient to prevent rejection of the donor's liver. Some basic risks associated with a liver transplant include:


  • Bleeding
  • Blood clots
  • Rejection of the donor's liver
  • Failure of the donor's heart
  • Infection
  • Leakage from bile ducts
  • Shrinking of bile ducts
  • Seizures
  • Confusion


Moreover, in some cases, liver disease might recur in the transplanted liver. Also, post a liver transplant, the patient would need to continuously take medications to prevent rejection of the liver; these medications are called anti-rejection medications and can cause a host of side effects, such as:


  • Thinning of bones
  • Diabetes
  • Diarrhoea
  • Severe headache
  • High blood pressure
  • High cholesterol level
  • Higher chances of infection
  • Weakened immune system


The procedure of a liver transplant


Before the procedure, the doctor will conduct some tests to assess the overall health of the patient. These include blood and urine test, ultrasound, heart test, cancer tests, etc. Moreover, liver function tests will be performed to know the severity of the problem and the urgency of the transplant. Accordingly, the patient is put on the liver transplant waiting list. The wait for a donor liver to be available can vary greatly from case to case; where some patients might get a matching donor liver within days, while others might not get the donor liver for months or years. In fact, some patients might not receive the donor's liver. During the waiting process, the doctor will make the patient as comfortable as possible by treating symptoms.


An alternative to this could be a living donor liver in which a living person donates a part of the liver to the patient in need of the transplant. The donor’s liver grows back to its size within some weeks. This procedure is done after careful consideration. Foremost, there needs to be a person who is healthy, and willing, and also matches the donor’s criteria such as age, health, blood type, organ size, etc. In most cases, the living donors are close family members or friends of the patient. A living donor transplant is safe and also as successful as a deceased donor transplant, but a lot of evaluations and tests need to be conducted to ensure the donor is a match; also the surgery carries risks for the donor.


No matter whether the patient is waiting for a liver or has the surgery already scheduled, it is critical for the patient to stay healthy and be ready for the transplant surgery. All medications need to be taken regularly, a healthy diet needs to be followed, all medical check-ups and appointments should be taken, and the patient should stay reasonably active.


Once the liver is available for surgery, the patient will be admitted to the hospital and an examination to assess the overall health of the patient will be done. When cleared, the patient is given general anesthesia and sedated before beginning the surgery. Then the surgeon makes a long incision across the abdomen to access the liver and remove the deceased liver while replacing it with a donor liver in the body. Once the donor's liver is placed properly, the surgeon then connects the blood vessels and bile ducts to the new liver. Post this, staples and stitches are used to close the incision and then the patient is transferred to the intensive care unit for follow-up and recovery.  A liver transplant surgery can take up to 12 hours or more depending on the condition of the patient.  In the case of a living donor operation, the surgeon first removes the liver from the donor and then performs the surgery on the patient similar to that of a deceased donor liver transplant surgery.


Post the surgery, the patient is kept under observation for a period of time to check for any complications and the response of the donor's liver. Once, the patient is discharged, the doctor advises on the complete care routine regime, medications, home precautions, etc. that should be followed to ensure a speedy recovery and effective functioning of the liver.


That said, the chances of a liver transplant surgery being successful depend on the patient’s condition and the complexity of the case. Though survival rates are high and hence, surgery is retorted as the ultimate step to treat fatal liver conditions.