Types of Liver Transplant

In adults, cirrhosis is the most common cause of liver failure, resulting in end-stage liver scarring. In cirrhosis, your liver becomes damaged to the point where it cannot repair itself anymore. Other diseases that require a liver transplant include:-

1. Hepatitis B and C 
2. Autoimmune liver diseases (such as autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis)
3. Fatty liver  
4. Biliary atresia (the most common cause of a paediatric liver transplant)
5. Genetic liver diseases
6. Liver cancer
7. Liver failure due to excessive alcohol intake
8. Benign liver tumours

 

The three main types of liver transplant include:-

Deceased/ Cadaver Liver Transplant

This liver transplant involves removing the entire liver from a deceased or brain-dead (cadaver) donor and transplanting it into the patient. For deceased donor liver transplantation (DDLT), the person requiring a liver transplant is added to the nationwide waiting list. The waitlist contains all the information about the patients requiring the transplant. The patients are prioritised for receiving a donor liver based on their Model of End-Stage Liver Diseases (MELD) score, the severity of liver damage, and the chances of survival. The waiting time usually ranges from months to several years. 

In most cases, the deceased donor liver transplantation is done in an emergency setting. Because it is highly unpredictable when a donor becomes available. Several tests are performed to match the recipient’s liver size to the donor’s. Moreover, the complete liver is removed and transplanted in deceased liver transplantation. 

Living Donor Liver Transplantation

In living donor liver transplantation (LDLT), the diseased or damaged liver is removed and replaced with a portion of the healthy living donor liver. The living donor must be a first or second-degree family member of the recipient, such as a daughter, son, sibling, mother, father, or grandparent, aged between 18-55 years. Friends, employees, or neighbours are not eligible donors for living donor liver transplantation. 

The living donor must be healthy to undergo surgery. Since the liver can completely regenerate itself to its original size, both the donor and recipient can have a fully grown liver within two to four months of the surgery. Any person with liver or kidney diseases and mental illnesses is not eligible as a donor. Moreover, a person who has AIDS or HIV is also not eligible. 

Split Liver Transplantation

Split liver transplantation includes transplanting a liver from a deceased donor into two recipients by splitting the liver into two parts - 35-40% of the left lobe and 65-70% of the right lobe. This is possible when the two recipients are an adult and a child. By splitting the donated liver into two parts, it can be used to help two people on the waitlist for a liver transplant. The smaller left lobe of the donated liver is transplanted into a child, and the larger right lobe is transplanted into an adult. 

Like living donor transplantation, the transplanted parts regenerate themselves, and the liver grows back to its original size. Split liver transplantation is an efficient way of utilising the donated liver. 

 

The other types of liver transplants include:-

1. Domino Liver Transplantation: It is a less common type of liver transplant where a patient with a disease called familial amyloidosis who receives a liver transplant donates their liver to a recipient. Familial amyloidosis is a rare inherited disease in which an abnormal protein made by the liver accumulates and damages organs, such as the heart, kidneys, and nerves. In domino liver transplantation, the donor donates their liver because it still functions well. The recipient may develop the symptoms of amyloidosis. However, it usually takes decades. 
2. Auxiliary Liver Transplantation: It is a type of liver transplantation where the recipient’s liver is not removed completely. In auxiliary liver transplantation, only a portion of the native liver is removed, and the rest is left in its place. The transplantation provides temporary support while the native liver recovers. 
3. Orthotopic Liver Transplant (OLT): In this procedure, the diseased liver is completely removed and replaced with a normal liver taken from a deceased or living donor. The liver is transplanted with normal or near-normal anatomic reconstruction. 
4. Heterotopic Liver Transplant (HLT): In this procedure, the surgeon leaves the patient’s diseased liver in its place and grafts an auxiliary liver in an ectopic site. A heterotopic liver transplant is performed for patients with acute fulminant hepatic failure or who had surgery in the right upper quadrant, ruling out the possibility of an orthotopic liver transplant. 
5. Piggyback Liver Transplant: It is a surgical procedure used in both living and deceased donor liver transplantation. The piggyback method simplifies the liver transplant procedure by preserving the recipient’s retrohepatic inferior vena cava (a vein that is relatively fixed to the liver, making it difficult to access and control the vein). 
6. Swap Liver Transplant: A patient requiring a healthy liver but unable to find a compatible one with a living donor can opt for a swap liver transplant. Under this method, a swapping of donors between two pairs of people takes place. Each pair comprises a donor and a recipient. Each recipient gets a healthy liver compatible with the donor of the other pair.  
7. ABO-Incompatible Liver Transplantation: The number of living donor liver transplantations is increasing. However, the number of organs remains lower than required. When ABO- compatible donors aren’t available, crossing the blood-typing barrier and receiving living liver donations from ABO-incompatible donors becomes the only chance to save lives from liver diseases.

A common misconception - only adults can get liver diseases. The truth - even children can get liver diseases and require a liver transplant 

The most common cause of a liver transplant in children is a liver disease called biliary atresia. As opposed to an adult liver transplant, a paediatric liver transplant is a surgery used to replace a child’s damaged liver with a healthy liver from another person. The child may receive a liver from a deceased donor or a family member.

When your liver becomes severely damaged, a liver transplant is the only treatment to improve the chances of survival. Since the availability of organs is less than its demand, the waiting time can range from some months to several years. It is critical to get a prompt diagnosis so an early treatment approach can be decided. Of the 2,00,000 patients dying yearly due to liver failure in India, about 10-15% can be saved with a well-timed liver transplant. 

HexaHealth is a one-stop solution for your healthcare needs to help you throughout your surgical journey, from finding the right hospital to post-surgical recovery. The expert team of 1500+ doctors and surgeons at HexaHealth can help start an early donor search to ensure a successful liver transplant. In the meantime, they will begin your treatment plan to manage your condition and decide which type of liver transplant suits you the best. So without any delay, consult an HexaHealth expert TODAY!