Liver Transplant - Types, Indications and Complications

Introduction:

The liver is the largest organ of the human body. The liver performs various essential and life-sustaining functions. You cannot live without a liver; the presence of at least a part of the liver can make survival possible. This organ also can grow back in size in a few months. A liver transplant is recommended in cases of liver failure, and this surgery has a better success rate.

What Is a Liver?

The liver is the largest vital organ of your body and weighs around three pounds. The texture of the liver is rubbery and is protected under the ribcage. The liver is divided into two lobes: the right and the left. The liver's main function is to purify the blood coming from the digestive tract, detoxify chemicals, and metabolize drugs. It also produces certain proteins which help blood in the clotting process.

Many habits and factors can lead to end-stage chronic liver (ESLD) conditions like cirrhosis (a serious disease caused in the liver due to excessive drinking of alcohol), acute liver failure, liver tumor or cancer, and hepatic encephalopathy (nervous system disorder brought on by the liver diseases). The above conditions may lead to huge destruction of cells in the liver, which, in turn, leads to liver dysfunction and many life-threatening conclusions. In such cases, the last mode of treatment suggested to the patient is a liver transplant.

What Are the Signs of Liver Diseases?

Following are the common signs present in a patient with liver disease;

• Jaundice is a condition in which skin, whites of eyes, and mucous membranes turn yellow.

• Nausea, vomiting, and loss of appetite.

• Itching.

• Tendency to bruise and bleed easily.

• Ascites (fluid accumulation in the abdomen).

• Swelling in the legs and feet due to fluid accumulation.

• Fatigue.

• Poor weight gain.

• Decreased energy levels.

What Is Liver Transplant?

The replacement surgery of an unhealthy diseased liver with part or an entire healthy liver from another source is a liver transplant.

When Is It Done?

• Damage to the liver due to excessive alcohol consumption.

• Cirrhosis caused by hepatitis C (late stage of liver scarring).

• Fatty liver diseases (extra fat deposition on the liver).

• Failure of the liver due to an infection or genetic disease.

• Liver failure due to any chronic hepatic condition.

• Biliary atresia is common in children, which indicates a liver transplant.

• Hemochromatosis (increased iron in the body).

What Are the Types of Liver Transplants?

It is mostly based on donor availability:

1. Alive Donor (Living Donor) - Part of an alive, healthy individual's liver is taken and implanted in the site, which will regrow in a few weeks.

2. Deceased Donor - The legally dead donor, i.e., the heart is still beating, but the brain is dead, and whose liver is compatible with the required needs. Such a liver donor comes under this category.

Around 96% of implants are from the deceased donor, and only four percent are from the living donor. Living donor transplants are less common than deceased donors.

Who Is Qualified for a Liver Transplant?

Doctors recommend liver transplants if other treatments for your present condition are not enough. The team refers you to a transplant center; followed by certain test results, you get added up to the waiting list. The priority of the transplant is determined by how bad the condition is. The highest score depends on acute liver failure and complications. This way, the donor's liver is provided to those who need it most. The waiting time of the list is hard to predict as there is always a coordinator to update you on the availability status.

What Disqualifies You for a Liver Transplant?

• Condition with pulmonary hypertension (PH).

• With more alcohol and drug abuse.

• With severe and uncontrollable HIV (human immunodeficiency virus).

• With other organ failures apart from the liver.

• Obesity.

• Above 65 years of age, along with other severe medical conditions.

How Long Does the Procedure Take?

The surgical procedure might require anywhere between six to 12 hours in total, depending upon the complications linked with individual cases. It is a challenging procedure, with an added risk to the donor as well as the recipient.

How Long Does the Hospitalization Last?

Hospitalization usually lasts for two to three weeks post-procedure. There are recorded episodes of hospitalization again due to rejection within a year of the procedure.

Which Tests Are Done Before a Liver Transplant?

• Liver function tests (LFT).

• Doppler ultrasound.

• CT (computerized tomography) scan and X-rays.

• Blood tests and screening for HIV and other viruses.

• Echocardiogram.

What Are the Complications of Liver Transplant?

Mostly the complications of liver transplants show as early as 30 days after surgery. Some of them are:

• Delayed liver function.

• Excessive bleeding.

• The liver does not function at all (primary non-function).

• Bile leakage.

• Rejection of the implant.

• Multiple organ failure.

• Clotting of other major blood vessels.

• Infection.

• Cancer.

• Tiredness.

• Lower immunity due to immunosuppressants.

• Sepsis (extreme response to an infection).

• Death.

How Much Is the Success Rate of the Liver Transplant?

A liver transplant is one of the most successful surgeries; it has a high success rate and survival rate.

The success rate, according to research, is:

• 86% are still alive one year after surgery.

• 78% are still alive three years after surgery.

• 72% are still alive five years after the surgery.

• 53% are still alive twenty years after the surgery.

What Are the Follow-up Care and Self-Care We Need to Follow?

Follow-up care is very important after any major surgery. Mostly, in this case, follow-up is probably in the first two weeks. Regular follow-ups are scheduled by the surgeons in a year, then once a year for the rest of their life.

What Self-Care Do We Need to Take?

Many lifestyle modifications are required for a healthy life and after the liver transplant. They are:

• Quit smoking.

• Avoid alcohol consumption.

• Get regular exercise.

• Eat a healthy balanced diet, and restrict your intake of salt.

• Eat food free of cholesterol, sugars, and fats.

• Limit contact with viruses, germs, rodents, reptiles, and birds.

• Avoid unpasteurized milk and milk products.

• Avoid drinking grape juice.

• Avoid contact with water in lakes and rivers.

Conclusion:

Liver transplants are reasonable and safe procedures with high success and survival rates. Many conditions such as lifestyle habits, additional conditions, overall health, and also the condition which caused the liver failure influences the individual’s success rate of the surgery. Also, success depends on the donor’s liver, and selecting the correct donor is essential for liver transplantation. For every 100 people who receive a transplant for any reason, about 75 people survive for five years or more.