The procedure of removing a part/whole of a diseased liver and replacing it with a new functioning liver is called liver transplantation. A liver transplant requires only blood group matching between donor and recipient.
Once the body is not able to compensate for the failing liver, one requires a liver transplantation. The following are the common indications of liver transplant:-
Based on the type of organ donor, there are primarily two types of liver transplant:
The organ donor in a living donor transplant is a healthy person, preferably from the family. The donor in a deceased donor transplant is a brain-dead person whose family has decided to donate his/her organs. Individuals must be registered on the state organ recipient list to be eligible for a deceased donor transplant.
Liver transplantation is a complex surgery and requires experience and teamwork. The recipient and donor surgeries go on simultaneously in two operation suites. The donor's liver is taken out and prepared for implantation. At the same time, the recipient's liver is also taken out. Once prepared, the donor's liver is placed in the recipient's body. The donor hepatic vein, portal vein, hepatic artery and bile duct are joined with the recipient's blood vessels and bile duct. The whole procedure takes approximately 10-12 hours.
After surgery, the recipient must stay in the ICU for approximately 5-7 days, for a total hospital stay of approximately 2-3 weeks. In a living donor liver transplant, the donor needs to stay in the hospital for approximately 6-8 days. There are generally no long-term effects of donor surgery. The livers of the donor and recipient grow back to standard size in approximately 2-3 months.
Liver transplantation requires only blood group matching between the donor and the recipient. There are situations where a blood group-matched donor is unavailable in the family. It is not the end of the road. There are other alternatives in such situations-
Pre-transplant evaluation of the recipient includes an exhaustive list of investigations, which include;
Some patients may require specific investigations, such as auto-immune markers and tests for Wilson's disease. Other specialists evaluate patients, such as a cardiac, pulmonary, gynaecologist (for female patients), anaesthetist, and psychiatrist. In the case of a living donor transplant, the donor also needs to be evaluated like the recipient.
After the transplant, a patient continues a multi-drug immunosuppression regimen. These medicines are tapered over a period, and generally, only one drug (tacrolimus) is supposed to be taken after one year. In most cases, the patient needs to take medication lifelong.
In most cases, a patient needs to be in the hospital for 2-3 weeks after a liver transplant. It includes an ICU stay of approximately 5-7 days. The patient is generally ambulated by the 2nd- 3rd postoperative day. They are allowed liquids by the 2nd to 3rd postoperative day and solids by the 4th- to 5th postoperative day. The surgical stitches are generally removed in 2-3 weeks.
Post-discharge, a patient needs to come for regular follow-up visits. These visits are initially frequent (weekly). As the patient recovers from the surgery, the follow-up visits become less frequent. After 3-6 months, the visits are scheduled at 3–6 month intervals, which are to be followed life-long. Some blood tests are done during these follow-up visits, and an abdominal ultrasound is generally advised at 6–12-month intervals.
The overall success rate of liver transplants is between 90-95%. The estimated 1-year survival is 85-90%, and 5-year survival is more than 70%. A person can have a normal quality of life after a liver transplant. He/she can resume normal job activities, work out in a gym, and pursue any sports activities. He/she can marry, have a normal sexual life, and have kids.
A transplanted liver has no shelf-life. If a person takes medicines regularly, carries out all tests regularly, and follows medical advice, he/she can have a normal life span with good quality.
After your hospital discharge, the post-transplant team will closely monitor you on an outpatient basis. It will include regular tests on your new heart, including blood tests, ECGs, heart biopsies, and clinic visits with the cardiologist. The transplant team will communicate with your cardiologist and primary care physician to provide seamless, coordinated care.
A common complication after a liver transplant is rejection of the grafted liver by the recipient’s immune system. To prevent this, certain medicines are needed to suppress the recipient's immune system. These medicines are called immunosuppressants.
These medicines are initially given in combination after transplant, usually 2-3 drugs. Over time, they are reduced in number and dose. After 1 year, only one or two drugs are continued for life. Common immunosuppressants are steroids, tacrolimus, cyclosporine, mycophenolate mofetil, everolimus, and sirolimus.
These medicines need to be taken as prescribed by the doctor and cannot be stopped or modified without the doctor’s advice.
EDICM, IDCCM, M.D Anaesthesia, M.B.B.S
MBBS, MS (General Surgery) , DrNB (Gastroenterology and Liver Transplantation )
