What is Liver Transplant?

A liver transplant is a procedure for removing a damaged or diseased liver and replacing it with a healthy liver.

Usually, the doctors recommend this procedure when the liver becomes damaged and cannot perform normal functions. This stage of the liver is known as end-stage liver disease or liver failure.

Gradually it becomes damaged as a result of infection, alcohol, or illness. This causes the liver to become scarred, which is called Cirrhosis. Liver failure can also develop very rapidly as a result of death and inflammation of liver tissue, known as necrosis.

The main causes of liver cirrhosis and liver damage in India are:

ARLD (alcohol-related liver disease)– is when the liver becomes scarred because of persistent misuse of alcohol.

hepatitis – blood-borne viruses can cause severe liver damage, including hepatitis B and hepatitis C. 

primary biliary cirrhosis – is a poorly understood condition that can cause progressive liver damage

PSC or primary sclerosing cholangitis – causes prolonged inflammation of the liver

Sometimes a liver transplant may also be recommended as a liver cancer treatment.

No device like dialysis for the kidney, lungs, or heart can replicate the liver functions permanently. So, a liver transplant is the only hope for the long-term survival of a person with liver damage or failure.

Liver transplantation in Delhi is a surgery where the diseased liver is removed and replaced with a new liver at the same anatomical position.

There are two kinds of conditions where the transplant is needed:

• Liver Cirrhosis
• Acute Liver Failure

Some uncommon metabolic diseases can be cured by transplant.

Liver cirrhosis is the most common condition for which a transplant is done. The most common causes of cirrhosis are Alcohol intake, Hepatitis A, B and C, and Non-Alcoholic Fatty Liver Disease (NAFLD).

Symptoms of cirrhosis are:

• Jaundice.
• Ascites (accumulation of fluid in the abdomen).
• Hematemesis (Blood in vomitus).
• Hepatic Encephalopathy (Loss of consciousness).
• Development of liver cancer.

All  These conditions can be treated by medicines and various interventions like endoscopic banding to a certain extent. Primary causative factors are critical, like stopping alcohol, treating hepatitis B and C, reducing weight in NAFLD-related cirrhosis. But beyond a specific limit, patients with liver cirrhosis can’t have complication-free survival without replacing the non-functioning liver. There are various parameters like Child’s score (CTP), Mayo Clinic End Liver Disease (MELD) score, which serve as selection criteria for a liver transplant in delhi. These are well-validated robust guidelines for patient selection.

Who requires a Liver Transplant?

Usually, you are only considered a suitable candidate if you meet 2 conditions:

Without a liver transplant, the quality of life is likely so poor as to be intolerable or the expected lifespan would be shorter than normal.

Expected minimum 50% chance of surviving for at least 5 years after the transplant with good quality of life.

People who come in these above criteria will be eligible for a liver transplant, except few conditions that maybe some considered unsuitable for liver transplant

For example, if you have liver cancer or are unable to stop misusing alcohol, you may not be able for a liver transplant.

The doctor also recommends some tests that will show whether the patient is suitable for a liver transplant.

What are the different types of Liver Transplants?

There are main three types of a liver transplant that can be carried out:

deceased organ donation – involves a liver transplantation procedure that has been removed from a recently dead person

living donor liver transplant – a section of the liver is removed from a living donor; because both the remaining section and transplanted section of the liver can regenerate itself, or able to regrow into a normal-sized

split donation – removal of the liver is done and split into two pieces from a recently dead person and each piece of liver is transplanted into a different person, where the liver will grow to normal size.

Liver transplant is of two types depending on the source of a donor’s liver

• Deceased donor liver transplant (DDLT)
• Live donor liver transplant.

In DDLT, the organ (Liver) is retrieved from brain-dead donors, and the entire organ is used, or it can be split in two in the case of pediatric recipients. In the western world, the rate of organ donation is high, and there is a well-geared system in place to list patients for transplant and allocate organs according to availability. Unfortunately, in our country, the rate of organ donation is very dismal. However, there has been increasing community participation and availability of organs in many parts of our country.

In case of non-availability of DDLT organ, LDLT remains the only option. The most common question which comes to mind is that there is only one liver in the body, so how can a person who donates it survive after surgery. Only a portion of the liver is taken (depending on recipient’s weight), and a healthy liver has a unique capacity to regenerate. The donor is usually back to work within a fortnight, and his liver grows to standard size in 3 months’ time. There are stringent selection criteria for the selection of liver donors for the safety of both donor and recipient. There are a host of legal formalities according to the law. Thankfully for liver-only ABO, blood group matching is required, Whereas, in cirrhosis, liver specialists can undertake liver transplants in a planned way. There is a condition called acute liver failure (ALF), where a transplant may have to be performed as an emergency. ALF is a condition in which a previously healthy person develops severe liver dysfunction and characterized by jaundice and hepatic encephalopathy. The most common cause in our country is viral hepatitis A and E; in western countries, it is Paracetamol overdose. Liver transplant in ALF is an emergency and requires many criteria of patient fitness to undergo transplant. These surgeries carry out best at specialized centers.

Liver transplant in Delhi is done regularly in many centers; Sir Ganga Ram Hospital has been a pioneer in this field. After being evaluated by a Hepatologist, the patient needs a transplant if he/she meets the required criteria for transplant. A donor needs to be identified and worked up for fitness. Work-up takes 7-10 days, and the recipient can discharge after 15 days.

A multidisciplinary team carries out post-operative care for early recognition of complications and prompt treatment. Patients require lifelong immunosuppressive therapy. But most patients can return to an active lifestyle within a month. The results at our hospital are at par with the best centers across the globe.

Who can donate?

• The donor could be either a spouse, relative, or friend.
• The type of the blood of the donor must be compatible with the recipients.
• The donor’s physical and mental health should be in good condition.
• The age of the donor should be between 19-60 years.
• The decision of making a donor should be after a thorough understanding of all the complications and risks involved during and after surgery and all the procedures during transplant surgery.
• Don’t have a history of hepatitis B or C
• No HIV infection
• Not frequently heavy alcohol use
• No recent Psychiatric illness under treatment
• No history of cancer
• No presence of any significant medical condition

What are the positive aspects of living donation?

Many common benefits of living-liver donation are mentioned below:

Living donation helps save the lives of people with liver cirrhosis. This increased the number of liver transplant waiting list people.

Living donors can also feel blessed that they’ve had a huge impact or given one more life to a needy person.

Transplant recipients and living donors can schedule surgery time that is suitable for both people.

Flexible scheduling allows the liver transplant to be done soon. It saves valuable time for the liver transplant waitlist and also reduces the risk factors of liver damage getting worse.

As they are receiving a healthy portion of the donor’s liver, recipients have quicker recovery times and improved long-term outcomes.

How soon does a donor recover after a Liver donation?

Mostly Liver donors do not experience any major or serious long-term complications in portion because the liver has the unique ability to regenerate among all the body’s organs. After giving the portion of the liver, eventually, it will return to its original size. 

After surgery, during the first six weeks, the most rapid regeneration occurs—during this time, typically the liver returns to almost 80 percent of its original size. The remaining growth of the liver will continue for up to a year to reach 90 percent of its original size.

The recovery process after liver donation surgery usually follows these steps.

• -The week after surgery
• -The first twelve weeks after surgery
• -The first year after surgery
• -For five years after surgery

What precautions should I take after my Liver Transplant?

Alcohol and Other Toxins

The liver recipients avoid the overuse of alcoholic beverages after liver transplantation because the transplanted liver may be more sensitive to damage by chemicals, including alcohol.

Toxic Chemical Exposures

Many household chemicals like pesticides, drain cleaners, paint, gasoline, paint removers, and insecticide can be toxic. For liver transplant recipients, the fumes of these substances can be harmful

Drinking Water

Liver transplant recipients may drink chlorinated or treated municipal tap water.

Medical Alert Identification

In an emergency, the simple precaution for liver transplant recipients is to wear medical alert identification like a bracelet or pendant under the brand name Medic Alert. can be life-saving.

Liver transplant patients should always keep a list of prescribed medications in their wallets, in case of emergency treatment.

Reducing the Risk of Infection

Pets

Liver transplant recipients try not to come in contact with animal feces, urine, or vomit (emesis).  Some birds, especially pigeon droppings, generally carry a fungus that is dangerous to immunosuppressed patients. 

Pregnancy

 Some doctors do not recommend becoming pregnant for 1 or 2 years after transplantation. Because at this time medication doses are highest and most complications occur 

Travel

Try to avoid travel but it’s impossible for a long period so you will need to take extra precautions while traveling and follow all instructions given by your doctors. 

How long will my Transplanted Liver last?

It is almost impossible to predict the exact survival rate for an individual due to a variety of complicated factors 

So, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) lists the following average survival rates.

 People who have had a liver transplant from a deceased donor:

• 86 % are still alive 1 year after transplant surgery
• 78 % still alive 3 years after transplant  surgery
• 72 % still alive 5 years after transplant surgery
• 53 % still alive 20 years after transplant surgery
• High success and survival rates of liver transplants also depend upon some critical factors including:
• Cause of liver failure
• age
• How healthy a person before transplant surgery
• major fluctuations in weight and body mass index (BMI) 
• The severity of their liver failure and involvement of several other organs, especially the kidneys
• Health condition
• Medical history

Some facts about Liver Transplant

After a liver transplant surgery, the doctor may recommend a healthy diet, and lifestyle changes, including regular exercise. These things at any stage boost the overall health and strength. Because being physically healthy may reduce the chances of transplant rejection.

You can try to avoid the risk factors that cause liver disease. The most common are:

• Smoking
• Alcohol abuse
• Obesity
• Acetaminophen overdose
• High cholesterol