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Liver Transplant

A liver transplant is a surgical procedure to remove a diseased liver and replace it with a healthy liver from a donor. Most liver transplant operations use livers from deceased donors, though a liver may also come from a living donor. Such surgeries have been done for over 38 years. Several people who have had liver transplants go on to lead perfectly normal lives.

Liver failure has many causes, that include:

• Liver cirrhosis

• Alcoholic liver disease

• Non-alcoholic fatty liver disease

• Early-stage liver cancer

• Haemochromatosis

• Primary Biliary Cirrhosis

• Primary Sclerosing Cholangitis

• Wilson's disease

• Biliary duct atresia

• Cystic fibrosis, etc

Liver transplant surgery carries a risk of significant complications that include Bile duct complications, including bile duct leaks or shrinking of the bile ducts, bleeding, blood clots, failure of donated liver, infection, memory and thinking problems, the rejection of donated liver  and side effects of anti-rejection medications.

After a liver transplant, you'll take medications for the rest of your life to help prevent your body from rejecting the donated liver which may cause certain side effects, too.  

How are candidates for liver transplant determined?

Evaluations by specialists from a variety of fields are needed to determine if a liver transplant is appropriate. It  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.

Please note : 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

Where does a liver for transplant come from?

There are two types of liver transplant options: living donor transplant and deceased donor transplant.

Living donor liver transplants are an option for some patients with end-stage liver disease. This involves removing a segment of liver from a healthy living donor and implanting it into a recipient. Both the donor and recipient liver segments will grow to normal size in a few weeks.

The donor, who may be a blood relative, spouse, or friend, will have extensive medical and psychological evaluations to ensure the lowest possible risk. Blood type and body size are critical factors in determining who is an appropriate donor. All living donors and donated livers are tested before transplant surgery. The testing makes sure the liver is healthy, matches your blood type, and is the right size so it has the best chance of working in your body.

Recipients for the living donor transplant must be active on the transplant waiting list. Their health must also be stable enough to undergo transplantation with excellent chances of success.

In deceased donor liver transplant, the donor may be a victim of an accident, brain haemorrhage or head injury. The donor's heart is still beating, but the brain has stopped functioning. Such a person is considered legally dead, because his or her brain has permanently and irreversibly stopped working. At this point, the donor is usually in an intensive-care unit. The liver is donated, with the consent of the next of kin, from such individuals. Whole livers come from people who have just died. This type of donor is called a cadaveric donor. The identity of a deceased donor and circumstances surrounding the person's death are kept confidential.

Tests, Procedures and Consultations you may undergo pre liver transplant

•Laboratory tests, including blood and urine tests to assess the health of your organs, including your liver

•Imaging tests, such as an ultrasound of your liver

•Heart tests to determine the health of your cardiovascular system

•A general health exam including routine cancer screening tests, to evaluate your overall health

•Nutrition counseling with dieticians who assess your nutritional status and make recommendations regarding nutritional intake before and after transplant

•Psychological evaluation to determine whether you fully understand the risks of a liver transplant

•Meetings with social workers who assess your support network to determine whether you have friends or family to help care for you after transplant

•Addiction counseling to help people with alcohol, drug or tobacco addictions to quit

•Financial counseling to help you understand the cost of a transplant and post-transplant care and to determine what costs are covered by insurance

After your liver transplant, you might:

•Possibly stay in the Intensive Care Unit for a few days. Doctors and nurses will monitor your condition to watch for signs of complications. They'll also test your liver function frequently for signs that your new liver is working.

•Spend 5-10 days in the hospital. Once you're stable, you're taken to a transplant recovery area to continue recuperating.

•Have frequent check-ups as you continue recovering at home. Your transplant team designs a check-up schedule for you. You may undergo blood tests a few times each week at first and then less often over time.

•Take medications for the rest of your life. You'll take a number of medications after your liver transplant, many for the rest of your life. Drugs called immunosuppressants help keep your immune system from attacking your new liver. Other drugs help reduce the risk of other complications after your transplant.

How long does it take to get a new liver?

If you become an active liver transplant candidate, your name will be placed on a waiting list. Patients are listed according to blood type, body size, and medical condition (how ill they are). Each patient is given a priority score based on three simple blood tests (creatinine, bilirubin, and INR). The score is known as the MELD (model of end stage liver disease) score in adults and PELD (pediatric end stage liver disease) in children.

How long would surgery take?

Liver transplants usually take from 4 to 14 hours. During the operation, surgeons will remove your liver and will replace it with the donor liver. The surgeon will disconnect your diseased liver from your bile ducts and blood vessels before removing it. The blood that flows into your liver will be blocked or sent through a machine to return to the rest of your body. The surgeon will put the healthy liver in place and reconnect it to your bile ducts and blood vessels. Your blood will then flow into your new liver. Because a transplant operation is a major procedure, surgeons will need to place several tubes in your body. These tubes are necessary to help your body carry out certain functions during the operation and for a few days afterward.

What happens during recovery period?

Initially in the Intensive Care Unit there is very careful monitoring of all body functions, 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.

When will I be able to go home?

The average hospital stay after liver transplant is two weeks to three weeks. Some patients may be discharged in less time, while others may be in the hospital much longer, depending on how the new liver is working and on complications that may arise.

Is liver donation safe?

Liver donation is very safe. This is because the liver has great reserve and regenerates to its original size quickly (within 2-3 months) after a part of it is removed. The donor suffers from no long-term effects, does not have to take any medication beyond 2-3 weeks, and is back to normalcy in a month. He/she can resume strenuous physical activity (weight lifting etc) in 3 months

Health Insurance

You will need to check your health insurance policy to be sure it covers liver transplantation and prescription medicines. This is because you will require many prescription medicines after the surgery and for the rest of your life.

What are the signs and symptoms of rejection?

Here is a list of signs and symptoms that may indicate liver graft rejection:

Fever greater than 100°Fatigue or excess sleepiness"Crankiness"Headache Abdominal swelling, tenderness, or pain,Decreased appetite,Jaundice (yellow skin or eyes)Dark (brown) urine,Itching,Nausea.

None of these symptoms are specific for rejection; but they are important enough that when they occur, they should prompt a call to your doctor who will decide whether the situation warrants further investigation or should be observed for the time being.

Since rejection may have no symptoms at all, the standard strategy for post-transplant care is to regularly run blood tests that may be early indicators of liver graft rejection. Doctors will check your blood for liver enzymes, the first sign of rejection. In the beginning, these tests are run daily. For the first month or so after a liver transplant the tests are run at least weekly. Gradually the interval between measurement is increased as the months and years pass. When rejection is suspected it can be confirmed by a liver biopsy.

What if the transplant doesn't work?

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. Sometimes the liver takes a long time to work. 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 whether to replace the failing transplanted liver by a second (or even third) transplant operation.

Paediatric Liver Transplant

In children, the most common reason for liver transplantation is biliary atresia which is a rare condition in newborn infants in which the common bile duct between the liver and the small intestine is blocked or absent. Bile ducts, which are tubes that carry bile out of the liver, are missing or damaged in this disease, and obstructed bile causes cirrhosis. As the bile helps digest food, if unrecognised, the condition leads to liver failure. The cause of the condition is unknown. The only effective treatments are certain surgeries, or liver transplantation.

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