Liver Transplant - Procedure, Surgery, Problems and Recovery
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Liver Transplant is a surgical procedure to replace a diseased liver with a healthy liver. A hepatologist and gastrointestinal surgeon along with other professional medical staff performs a liver transplant surgery. It usually takes about 8 to 14 hours to complete.
It has a high success rate. According to the National Institutes of Health, currently, over 1,800 liver transplants are performed in India annually.
|Surgery Name||Liver Transplant / Liver Transplantation|
|Diseases Treated||Acute liver failure, Chronic liver failure, Biliary atresia, Cirrhosis, Alcoholic liver disease, Bile duct cancer, Primary liver cancer|
|Benefits of the Surgery||Better quality of life, Quick recovery, Higher short-term survival rate|
|Treated by||Hepatologist and Gastrointestinal Surgeon|
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What is Liver Transplant?
A liver transplant is a surgical procedure performed to replace a diseased liver with a healthy one from another person. There are several types of liver transplant procedures. However, the most common types vary based on the person who has donated the liver. These include:
- Living donor liver transplantation: The procedure replaces a diseased or damaged liver with a portion of a healthy one from a living donor. Anyone can be a living donor, be it the spouse, parents, siblings, grandparents, children, or friend of the recipient.
- Deceased donor liver transplantation: It is also known as cadaver liver transplantation. It involves removing a healthy liver from a recently deceased person and transplanting it into a patient with a damaged liver.
Anatomy and Physiology of Liver
The liver is the largest organ of the human body and is reddish-brown in appearance. It weighs about 3 pounds (1.4 kg). It is the only organ in our body that can regenerate.
It comprises two lobes, which are further subdivided into 1000 small lobes. These small lobes are associated with small ducts.
Different small ducts connect with a large duct known as the common hepatic duct. The hepatic duct carries the bile synthesised by the liver to the gall bladder and intestine.
The liver performs over 500 vital functions. Some of the essential functions of the liver include:
- Bile synthesis
- Synthesis of plasma proteins and cholesterol
- Storing of glycogen
- Regulating serum amino acid levels
- Helps in blood clotting
Conditions Treated with Liver Transplant
Liver transplant surgery is generally recommended for patients who are at end-stage liver disease. Additionally, it helps treat the following conditions:
Who Needs Liver Transplant?
A doctor generally recommends liver transplants to patients who have significant complications due to end-stage chronic liver disease. A liver transplant procedure is needed in the case of:
- Alcoholic cirrhosis (alcohol-induced liver disease)
- Primary biliary cirrhosis
- Liver cancers, such as hepatocellular carcinoma and hepatoblastoma
- Chronic infections like hepatitis B or C
- Thrombosis (blood clots in veins or arteries)
- Metabolic disorders related to liver failure like Wilson’s disease
- Biliary atresia (a congenital disability that blocks the bile ducts)
How is Liver Transplant Performed?
Liver transplantation is a rigorous procedure that involves the following steps: -
- Registration of the liver donor and the recipient
- Shortlisting of the recipient based on the emergency, health condition and availability of the donor's liver
- Undergoing the liver transplant procedure
The procedure is done under general anaesthesia to keep the patient comfortable. A gastrointestinal surgeon and other professional medical staff perform this procedure. The procedure steps involved in liver transplants in adults and paediatrics liver transplants are different.
However, the following are the general steps involved during liver transplant surgery:
- Firstly, an anaesthesiologist induces general anaesthesia.
- The surgeon will then check the vital measures of the patient, such as the heart rate, oxygen concentration, and blood pressure throughout the procedure.
- A thin tube called a Foley catheter will also be inserted into the urethra. It helps in urine excretion during surgery.
- Once the patient is stable after administering the anaesthesia, the surgeon conducts the liver transplant procedure.
- The surgeon will make a long incision across the stomach to access the liver. The location and the size of the incision will vary according to the surgeon's approach and the anatomy of the recipient.
- The surgeon will then remove the liver and place the donor's liver.
- Then the surgeon will connect the blood vessels and the bile ducts to the donor's liver.
- Once the new liver is in place, the surgeon will then close up the incision through stitches or staples.
What to Expect Before and on the Day of Liver Transplant?
Liver transplantation generally requires the patient to stay in the hospital for a few days, depending on his or her health condition. To prepare for the day of surgery, the patient must consider the following things:
Before Liver Transplant
The doctor will recommend tests. It is for evaluating the suitability and getting clearance for a liver transplant. Some of the tests that include the transplant evaluation process are:
- Blood tests
- Imaging studies (X-rays, ultrasound, MRI)
- Pulmonary fitness test
- Cardiac test
- Multidisciplinary clearance
- Social and psychological evaluation to determine if the patient is fit for surgery and can take the stress of surgery.
- Dental exams, comprehensive heart and lung tests, and liver biopsy.
- Women may undergo mammograms, Pap tests and general gynaecological examinations.
Once the patient is qualified, the doctor will explain the complete liver transplant procedure in detail to the patient and the donor. The doctor will ask the patient and the donor not to eat or drink anything after midnight before the surgery.
On the Day of the Liver Transplant
The patient may expect the following on the day of surgery:
- The patient must reach the hospital before the scheduled time for surgery.
- The doctor will ask the patient to sign the consent form that allows the doctor to perform the liver transplant surgery.
- Once done, the patient must change into the hospital gown.
- The doctor or nurse will administer anaesthesia and sedatives to keep the patient calm and sleep during the surgery.
- Then, the patient will be shifted to the operation theatre, where doctors will perform the surgery.
What to Expect After Liver Transplant?
The following things can be expected after the liver transplant procedure:
The Recovery Process at the Hospital
- Post-surgery, both the donor and the recipient will spend the first night in intensive care under close observation and then be moved to the hospital ward so that they can recover.
- Various tubes will be installed in the body after the surgery, which will be removed over time:
- IV lines (a soft, flexible tube placed inside a vein) in the arm or the neck to give the fluids and medications.
- Tubes in the stomach and the abdominal cavity drain fluids.
- A catheter in the bladder to drain urine.
- The patient is prescribed anti-rejection medicine just after the surgery.
- Antibiotics, painkillers and other medications are also prescribed during the recovery at the hospital.
- The patient would have to stay in the intensive care unit for a few days to check for the recovery and functioning of the new liver.
- The patient is usually discharged 7 to 10 days after the procedure depending on the patient's stability.
Recovery Process/Expectation After Hospital Discharge
- All the instructions provided by the surgeon at the time of discharge need to be followed by the patient strictly.
- The doctor prescribes antibiotics, painkillers, and immunosuppressants (to prevent the immune system from attacking the new liver) for the patient.
- The doctor reduces the dose and frequency of medications once the patient starts recovering.
- The patient is advised to take a healthy diet and practice a healthy lifestyle.
- Avoid intake of alcohol to reduce the risk of liver disease recurrence.
- The patient will be able to join work three months after the surgery.
- Several patients experience a lack of sexual desire before the transplant. Such patients may require time to get their libido (desire for sex), returned after the surgery.
- The patient should start exercising a few days a week during recovery.
- The patient should visit the doctor for regular checkups.
First Follow-up Appointment
The follow-up appointments may be as follows:
- The patient will have his/her first follow-up with the doctor after a day of discharge.
- The liver transplant team will design a regular check-up schedule for the patient with the doctor.
- The patient will have his/her second follow-up after a week of discharge. The doctor may perform blood tests to assess the recovery on a follow-up visit.
- The patient can return to the normal routine and work after a few months of liver transplant surgery. However, the recovery duration will vary from person to person and depends on how ill the patient was before the surgery for a liver transplant.
Benefits of Liver Transplant
A liver transplant is a life-saving procedure that saves the lives of several people around the world. The success rate of the liver transplant is high and offers positive hope to patients with liver disease. Below mentioned are some of the benefits of liver transplantation.
- Most liver transplant patients live longer
- Better quality of life
- Less chance of dying from liver disease
- Development of extra energy
- More likely to return to normal activities such as work and travel
Risks and Complications of Liver Transplant
Like any other surgery, a liver transplant is not free of risks. The common risks and complications of liver transplant are mentioned below:
- Bleeding from the surgical area
- Blocked bile ducts or leakage of bile
- Blocked blood vessels to the new liver
- Non-functioning of the new liver for a short time immediately after the surgery
- Breathing difficulty
- Side effects of immunity – suppressing medicines
- Stroke or heart attack
- Liver transplant rejection
When is Consultation with the Doctor Needed?
The patient must contact their surgeon if he/she experiences the following:
- Fever (a sign of infection or rejection)
- Bleeding from the surgical area
- Swelling, redness or drainage from the surgical site
- Drainage from the surgical site
Risks of Delayed Liver Transplant
Delayed liver transplant surgery can worsen the underlying liver disease. It will accelerate the condition, leading to more severe symptoms and complications. If a liver transplant procedure gets delayed, it can lead to the following:
- Damaged to the point where it cannot perform its normal functions properly.
- End-stage liver damage or failure. The stages of liver failure include inflammation, fibrosis, and cirrhosis.
- Cancer in the liver may also spread to other organs, which can eventually lead to death.
Cost of Liver Transplant
The cost of a liver transplant ranges from ₹15,00,000 to ₹35,00,000. The cost varies based on the following factors:
- Age of the patient
- The type of procedure done
- The technique and equipment used
- The medical condition of the patient
- The type of hospital facility availed - individual room or shared
|Procedure Name||Cost Value|
|Liver Transplant||₹15,00,000 to ₹35,00,000|
FAQs for Liver Transplant
What is a liver transplant?
Why is a liver transplant procedure performed?
Is liver transplant surgery safe?
What is the success rate of liver transplant surgery?
What are the different types of liver transplant procedure?
Two main types of liver transplant procedures are:
- Deceased donor transplant: In this type of liver transplant, the donor's liver comes from a person who has recently died.
- Living donor transplant: In this case, the donor's liver comes from a living person, typically a family member or close friend who is a match for the recipient.
What are the indications for liver transplant?
There are several indications for liver transplant surgery. A few indications are:
- End-stage liver disease
- Liver failure
- Certain types of liver cancer
- Biliary atresia
- Alpha-1 antitrypsin deficiency
What are liver transplant side effects?
Some common side effects of liver transplantation include:
- Pain at the transplant site
- Nausea and vomiting
- Blood clots
- Rejection of the transplanted liver
- Changes in mental function
- Difficulty sleeping
- Changes in appetite
What are the advantages of liver transplant?
The advantage of liver transplant surgery are:
- Improved survival: A liver transplant can significantly improve the chances of survival for people with severe liver disease.
- Improved quality of life: A successful liver transplant can lead to an improvement in the patient's overall quality of life by relieving symptoms and improving their ability to engage in everyday activities.
- Treatment of underlying cause: A liver transplant can address the underlying cause of the liver disease, such as hepatitis or cirrhosis, which may not be possible with other treatments.
- Faster recovery: In some cases, a liver transplant can result in a faster recovery compared to other treatments for liver disease.
What are the risks involved in liver transplant surgery?
The risks involved in the liver transplant procedure are:
- Rejection of the transplanted liver
- Problems with the bile ducts
- Complications from anaesthesia
What is the criteria for liver transplant?
Few criteria for a liver transplant procedure are:
- Severity of liver disease: In order to be eligible for a liver transplant, a person must have severe liver disease that is not responding to other treatments.
- Overall health: In order to undergo a liver transplant, a person must be in good general health and free of other serious medical conditions that could complicate the surgery.
- Age: Older patients may be less likely to be considered due to the increased risk of complications.
- Lifestyle: A person must give up alcohol and drugs, in order to be eligible for a liver transplant.
- Availability of a suitable donor liver: A suitable donor liver must be available in order for a person to receive a transplant.
Who are not eligible for liver transplant surgery?
Candidates who are not eligible for liver transplant are:
- Metastatic cancer that has spread to the rest organs
- Severe medical conditions that can't be treated
- Misuse of prescribed drugs
- Mental disorder
- People who do substance abuse
Can you fully recover from a liver transplant?
How painful is a liver transplant?
What is the most common complication of a liver transplant?
The most common complications of liver transplantation are bleeding, infection, and problems with the bile ducts. Other potential complications include rejection of the transplanted liver, complications from anaesthesia, and changes in mental function.
Not all patients will experience complications after a liver transplant, and the severity of the complications can vary from person to person.
What happens if a liver transplant fails?
What percentage of liver transplants are rejected?
What is the cost of a liver transplant procedure in India?
Is the liver transplant procedure covered under insurance?
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Updated on : 1 December 2023
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