Liver Transplant - Procedure, Surgery, Problems and Recovery

A liver transplant is a surgical procedure wherein a damaged liver is replaced with a healthy one from a donor. It offers a life-saving option for individuals with cirrhosis and end-stage liver disease (ESLD).

The liver can be donated by two types of donors:

1. Living Donor Liver Transplantation: This procedure involves replacing a diseased or damaged liver with a portion of a healthy liver from a living donor. Living donors can be spouses, parents, siblings, grandparents, children, or friends of the recipient. A healthy donor can donate 60% of the organ.

2. Deceased Donor Liver Transplantation: Also known as cadaver liver transplantation, this method removes a healthy liver from a recently deceased individual. It is then transplanted into a patient with liver damage.

Anatomy and Physiology of a Liver

The liver is situated in the upper right of the abdomen, beneath the diaphragm, and above the right kidney and small intestine. 

It has a reddish-brown appearance and weighs approximately 1.3 to 1.5 kilograms. The liver comprises two main lobes: the right and left lobes, each housing thousands of smaller lobules. These lobules are connected by specialised tubes called bile ducts, which transport bile produced by the liver to the small intestine, facilitating digestion.

Over 500 vital functions are performed by the organ, such as regulating metabolism, synthesising proteins, and producing bile for digestion. Additionally, it stores nutrients and releases them as required to maintain proper bodily function.

A transplant becomes necessary when the liver fails to function properly, whether suddenly (acute) or over time (chronic). Despite medical treatments, some liver issues cannot be fully resolved.

Potential candidates for liver transplants undergo a detailed evaluation process. Approximately 80% of liver transplants are due to severe liver damage, known as decompensated cirrhosis.

Various conditions necessitate a transplant. It includes:

1. Viral Hepatitis: Chronic infections like hepatitis B or C can severely damage the liver. This, in turn, leads to the need for a transplant when the liver can no longer function adequately.

2. Non-alcoholic Fatty Liver Disease (NAFLD): This condition involves fat buildup in the liver without alcohol consumption. If it progresses to advanced stages, causing inflammation and scarring, a transplant may be needed.

3. Alcoholic Fatty Liver: Long-term, excessive alcohol consumption can cause liver disease, progressing from fatty liver to inflammation and cirrhosis. Currently, alcohol-related liver disease is the leading cause of liver transplants. If the liver damage is irreversible, a transplant is often recommended.

4. Acute Liver Failure: This sudden, severe liver dysfunction can result from drug toxicity or viral infections, making up about 5-6% of liver transplants. In these cases, a liver transplant is urgently needed to save the patient's life, as without it, the mortality risk is 100% due to liver failure or complications like infections and multiple organ failure.

5. Liver Cancer: In India, many liver cancer cases occur in people with existing liver conditions. A liver transplant is considered when the cancer is advanced or unresponsive to other treatments.

The liver transplant success rate is over 90%. The survival rate after a year of transplant is 93%, and 83% after five years. The chances of a successful transplant and long-term survival depend on the personal health condition.

For patients who are healthy for the surgery, this procedure is often the most effective treatment for liver failure. The main advantages of a successful liver transplant include:

1. Extended Lifespan: Most liver transplant recipients experience a significant increase in life expectancy. The new liver restores essential bodily functions that were compromised by liver failure.

2. Improved Quality of Life: Patients enjoy a much higher quality of life after the transplant. Symptoms like chronic fatigue, jaundice, and abdominal pain often diminish, allowing for a more comfortable and active life.

3. Reduced Risk of Mortality from Liver Disease: The likelihood of passing from liver disease decreases substantially post-transplant, as the new liver can effectively perform the necessary metabolic and detoxifying functions.

4. Increased Energy Levels: Many recipients report having more energy after the transplant. This boost in vitality enables them to engage in activities they previously found exhausting or impossible.

5. Return to Normal Activities: Patients are more likely to resume regular activities, including work, travel, and hobbies. The ability to partake in everyday tasks and enjoy leisure activities contributes to a sense of normalcy and well-being.

The liver transplant process comprises three primary stages. These are:

1. Evaluation: Patients undergo a thorough assessment to determine their eligibility for the transplant procedure.

2. Waiting List Placement: If deemed suitable, individuals must wait for a suitable donor liver to become available, which can take several months.

3. Transplant Surgery: Upon the availability of a donor's liver, patients are admitted to a transplant centre for the surgical procedure.

Before Liver Transplant

Before proceeding with a liver transplant, patients undergo a comprehensive diagnosis and consultation with a transplant surgeon to determine the necessity of the procedure.

After diagnosis, the surgeon carefully evaluates the patient's condition and advises a liver transplant if it is deemed essential. For individuals with alcohol-related issues, it's crucial to seek psychological and psychiatric support beforehand.

This precaution ensures a minimum of six months of alcohol abstinence, aiming to prevent relapses that could result in removal from the liver transplant waiting list.

After Liver Transplant

On the day of the surgery, the patient can expect to go through the following required preparations:

The surgery lasts 8 to 12 hours while the patient is under general anesthesia. In the case of a living donor, the transplant is simultaneous. 

The procedure involves several steps:

1. Anesthesia Administration: In the operating room, the patient is given general anaesthesia to ensure they are unconscious and pain-free during the surgery.

2. Incision and Access: Surgeons make an incision in the abdomen to access the liver. It is carefully done to reduce the trauma and ensure a smoother transplant.

3. Liver Removal and Transplant: The diseased liver is removed to make space for the healthy donor liver. This step requires great precision to avoid damaging nearby tissues. The donor's liver is connected to the blood vessels and bile ducts, ensuring proper blood flow and bile function.

4. Closure of Incision: After the transplant, the surgical team closes the incision with sutures.

5. Postoperative Monitoring: The patient is moved to a recovery area where they are closely watched for any signs of complications, allowing immediate intervention if necessary.

After a liver transplant, patients usually stay in the hospital for 2-4 weeks, depending on their health before the surgery and how quickly they recover. The following are the recovery expectations:

Recovery in Hospital

For donors, life usually returns to normal without needing long-term medications or special diets. After a liver transplant, recipients can expect the following in the hospital:

1. Vital Signs Monitoring: Healthcare staff will closely monitor vital signs like heart rate, blood pressure, and oxygen levels to ensure a smooth recovery.

2. Pain Management: Effective pain relief methods will keep the patient comfortable and improve their overall well-being during the initial recovery period.

3. Immunosuppressants: The patient will begin taking medications to prevent their body from rejecting the new liver. These doses are adjusted over time, and some may be reduced eventually. 

At-home Recovery

Patients are given a detailed discharge summary that includes instructions for tests, medication schedules and charts for monitoring their health.

Ensure the home is thoroughly cleaned with disinfectants. Stay close to the hospital with easy access to transportation, minimal stairs, and a clean living environment.

Limit visitors for the first few weeks, avoid contact with sick individuals, and report any signs of illness. Patients should wear masks for the first three months and avoid crowded places. 

For a smooth recovery at home after a liver transplant, follow these guidelines:

1. Medication Adherence: Take all prescribed medications, especially immunosuppressants, as directed to ensure a successful recovery. Over time, the need for these medications may decrease, but at least one immunosuppressant is usually required for life.

2. Diet and Nutrition: Follow a high-protein diet to aid wound healing and liver regeneration. Prepare and eat food hygienically, focusing on fresh fruits and vegetables and a balanced, low-fat, high-protein diet.

3. Foods to Avoid: Stay away from fried or greasy foods, leftovers, raw eggs, or undercooked items.

4. Activity and Exercise: Gradually increase walking and routine activities. Regular exercise helps improve energy levels and muscle strength.

5. Rest and Avoiding Heavy Lifting: Ensure you get plenty of rest and sleep. Avoid lifting weights over 5 kg, including babies, and avoid abdominal exercises.

First Follow-up Appointment

Consistent follow-ups and hospital visits are essential for a successful liver transplant. Both donors and recipients to maintain health and address any concerns promptly:

For Donors

1. Donors should have follow-up appointments every 5-7 days during the first month after the transplant.

2. After the first month, donors need follow-up tests and reviews at three months and one-year post-transplant.

For Recipients

1. Frequent Follow-ups Initially: Recipients will have frequent follow-ups initially, according to a schedule provided at discharge.

2. Reduced Frequency Over Time: As the recipient's condition stabilises, follow-up visits will become less frequent, which can be every 3-6 months.

Liver transplant surgery is a complex procedure that carries certain risks and complications. These include:

1. Bleeding: Like any major procedure, there is a risk of bleeding during the surgery.

2. Infections and Bile Duct Complications: After the transplant, infections and complications related to the bile duct are common and require close monitoring and management.

3. Organ Rejection: The risk of rejection is highest during the initial six months following a transplant. After this period, the immune system is less likely to identify the new liver as foreign. Chronic rejection occurs in 2 out of 100 patients. 

4. Possible Liver Dysfunction: There is a risk that the transplanted liver may not function properly, which may necessitate further medical interventions or, in rare cases, re-transplantation.

Delaying a liver transplant surgery can worsen the underlying liver disease, accelerating its progression and causing more severe symptoms and complications. The following can happen if the transplant is not done in time:

1. Impaired Liver Function: The liver may become so damaged that it cannot perform its normal functions effectively.

2. End-stage Liver Damage: It can lead to end-stage liver damage or failure, which progresses through stages of inflammation, fibrosis, and cirrhosis.

3. Spread of Liver Cancer: If cancer is present, it may spread to other organs, potentially leading to fatal consequences.

The liver transplant cost in India depends on various factors like the health condition of the patient. The cost breakdown is as follows:

1. Surgeon's Fees: Pricing is influenced by the expertise and reputation of specialists, particularly transplant surgeons.

2. Hospital Location: Costs may vary based on the facility's geographic location, with urban areas or high-cost regions charging more.

3. Types of Liver Transplant Surgery: Pre-transplant tests play a significant role in pricing and are crucial for evaluating overall health. The final bill includes donor medical exams for living donor transplants. The cost of different types are:

Type of Technique

Surgical methods also influence costs due to aftercare needs, equipment, and expertise required. It includes:

Medications

These also include expenses of immunosuppressive drugs and other prescriptions needed pre-and post-surgery.

Liver transplantation is the most successful treatment option for individuals dealing with severe liver failure. The success rate is over 95%, providing patients with a promising route to restored health and well-being.

HexaHealth is dedicated to providing high-quality and accessible liver transplant surgeries in India. Feel free to contact us for information regarding the procedure, costs, and post-operative recovery. We're here to offer comprehensive assistance and guidance throughout the process.

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