Liver Transplant

Listed below is the step by step procedure of Liver transplant:

1. What is Liver transplant ?
2. Why is Liver transplant Required?
3. Pre-operative Preparation
4. Day Before Surgery
5. Procedure Day
6. Methods/Techniques of Liver transplant
7. Post-operation Procedure
8. Risks and Complications

What is Liver transplant?

Liver transplant or hepatic transplant is the replacement of diseased liver with a whole or partially healthy liver obtained from a donor. Liver transplant is carried out based on the type of liver donation:

• Deceased organ donation:
  This liver transplant involves replacement of diseased liver with a liver removed from a recently deceased person. There is a very narrow window of time after a patient's death. When liver can still be removed and used to be transplanted.

• Living donor liver transplant:
  Removal of a section of liver from a living donor is carried out for transplant. The transplanted section and the section left in the donor's liver are able to regenerate.

• Split donation:
  During split donation, liver obtained from recently deceased person is split into two parts. Transplant of each part of liver is carried out to benefit two different liver transplant patients.

Eligibility criteria for liver donors

Potential liver donors for liver transplant need to be in the age range of 18 and 55 years. Also they need to be healthy enough with no history of liver disease, hepatitis infections, heart diseases, Cancer, Diabetes and HIV infection.

Why is Liver transplant Required?

When liver functioning gets damaged beyond regeneration capacity of body, liver transplant is essential. People who need liver transplants usually have acute or chronic liver failure. Liver failure can occur at a faster rate for longer period of time. Acute liver failure or fulminant hepatic failure is the one that occurs quickly within few weeks and is caused by the medication-induced liver injury. In most cases, liver transplant is preferred for chronic liver failure than acute liver failure. Chronic liver failure is the one which happens over months and years at the slower rate. Mostly it occurs as a result of liver cirrhosis which is the commonly listed reason of liver transplant. If a major chunk of liver needs to be removed surgically in liver cancer patients, transplant can be one of the treatment options.

Suitability of the patients for liver transplantation

Many people suffer from liver cirrhosis and other severe liver conditions, but not all of them can undergo liver transplantation. Given below are the contra-indications to liver transplantation.

• Spread of cancer outside of the liver
• Uncontrollable infection
• Irreversible medical illness
• Severe pulmonary hypertension
• Drug or alcohol abuse
• Severe psychiatric disease

Pre-Operative Procedure

Once liver transplant is decided to be carried out, waiting for liver from donor is next step. Once suitable liver is obtained from the donor, liver transplant is carried out.

Prior to the process of liver transplant, patients need to undergo evaluation tests listed below:

• X-ray
• Liver biopsy
• CT scan
• Echocardiogram
• Blood tests to check for blood sugar levels, hemoglobin, active infections.
• Pulmonary function tests

Before liver transplant, patients need to stop taking medications which will interfere with the operative process. Blood thinners, such as Warfarin and Clopidogrel need to be taken with the advice of surgeon.

Day Before Liver transplant

All reports of tests need to be kept handy. Surgeons give brief details about the procedure of liver transplant to the patient an close relatives prior to the surgery. It is important to maintain a very light and simple diet on the day before surgery. The patient should try and relax mentally as well as physically. It is important to remember that no food can be consumed since the night prior to surgery.

Procedure Day

On the day of procedure, medicines need to be taken only with the advice of surgeon. Cleanliness needs to be maintained. The patient will be wheeled to the operation theater and asked to dress in a sterilised surgical gown. Instructions regarding anesthesia will be given to the patient. The area over abdomen is shaved and skin is cleaned with an anti-septic solution.

Methods/Techniques of Liver transplant

Method of liver transplant involves collection of liver fromm donor, removal of diseased liver and implantation of new liver in the patient's abdominal cavity. There is need to make connections for new liver to get blood flow. Inferior vena cava, the hepatic artery, the portal vein and bile duct are the structures that need to be reconnected. Given below is the sequence of events in the operation room.

• Incision making
• Abdomen evaluation for abnormalities such as undiagnosed infection or malignant tumors
• Dissection of the liver attachments
• Isolation of the the portal vein, inferior vena cava above, behind, and below the liver
• Isolation of the common bile duct
• Sewing in the liver collected from the donor
• Re-establishment of venous blood flow by connecting portal veins and inferior vena cava of the donor and recipient.
• Re-establishment of arterial flow by sewing hepatic arteries of the donor and recipient.
• Biliary drainage
• Making sure that bleeding is in control
• Incision closure

Post-Operative Procedure

Post - liver transplant, patients need to remain in the ICU (Intensive care unit) for some days. Surgeons will monitor the health of the patients to ensure no complications are there. Functioning of new liver is checked after a regular interval. Patients may need to remain hospitalized for 5 to 10 days. It depends on overall health of the patient. Regular check up after discharge from the hospital required to be done. This include blood tests and recovery check ups. Immunosuppressants are given for helping the immune system of the patients from attacking newly implanted liver. For other complications, medications are given to the patients. Usually six months or more time period is required for recovery of liver transplant patients. After few months of liver transplant process, patients can return to their normal routine based on the advice of surgeon.

• Follow-up appointments

  Regular follow-up is necessary for monitoring progress of liver transplant. Tests to asses liver and kidney function are carried out in follow-up methods. Level of immunosuppressants in the blood is also checked during these appointments.

• Diet and nutrition

  After liver implantation, it is very essential to follow a healthy diet. It helps in recovery process. Advise of nutrition specialist needs to be followed. For prevention of liver damage, the diet needs to be low in cholesterol, fats, salt and sugar. It is recommended to avoid alcohol consumption. This helps in preventing liver damage. Fresh fruits and vegetables as per daily requirements are required to be consumed.

• Exercise

  For improving physical as well as mental health, patients of liver transplant need to exercise on regular basis after liver transplant process. This needs to be with the consultation of surgeon. During hospitalization recovery process, training of necessary exercises can be given by the team of specialists.

Exercise helps in reducing further complications post surgical process. Patients need to walk as much as they can based on their physical condition. Physical activities can be incorporated as per the advice of surgeon. Swimming, low-impact strength training and bicycling can be part of physical activities.

The above article aims are providing a detailed idea about the concept of liver transplant. Patients should follow their doctor's advise completely before and after the procedure. The procedure tends to bring successful results only if all instructions are heeded and followed.

Risks and Complications

The most common complications of liver transplant include liver rejection, graft failure, risk of developing cancer and risk of infection. These complications are described below.

• Liver rejection

  When new liver from the donor is transplanted into the body of the patient, around one in every three patients report improper functioning of new liver. This happens as a result of liver rejection. The immune system of the patient attacks the new liver and hence there are issues with functioning of liver arise. Liver rejection generally occurs in weeks or months after the process of transplant.

• Infections

  As a result of immunosuppressants, immune system of patients gets weakened. This make these patients prone to catch infections. Antiviral medications, antifungals and antibiotics can be given as a precautionary measure to avoid getting infections. Symptoms of infection include headaches, fever, diarrhea and muscle pain.

• Biliary conditions

  Problems associated with biliary tract can be seen in the patients post liver transplant. An endoscopy is used for treatment of obstructions in the bile ducts caused by liver transplant.

• Graft failure

  Graft failure is a serious complication of liver transplant. Formation of blood clots lead to disruption of the blood supply to the liver which is transplanted. Graft failure can be observed suddenly or slowly for a longer period of time. Symptoms of graft failure include jaundice, mental changes, fluid retention (edema) and a swollen tummy. In this case, medications work short term. Only cure in this case is transplantation of a new liver as soon as possible.

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