The liver is the human body’s very own chemical processing plant as it performs the metabolism process. This metabolism process and cells in the liver known as hepatocytes help in keeping the body in its best condition.
In actual fact, liver loves and cares for the human body and keeps it energized. Any interruptions in the regular functioning of the liver can be a reason for trouble in a complete digestive system.
Liver disorders can range from mild to severe. In scenarios where treating the condition with medication is not possible, a liver transplant is carried out. But before understanding liver transplant surgery in depth, first, we will have a quick look at liver anatomy and important functions carried out by the organ.
The liver has a shape like a cone. It is a dark reddish brown organ which is weighing about 3 pounds in an average adult. The liver is situated below the diaphragm on the right side of the abdomen. There are two distinct channels that provide blood to the liver.
Oxygen-rich blood comes from the hepatic artery
Nutrient-rich blood comes from the hepatic portal vein
The liver holds about 13% of the human body’s blood supply at any given moment. The liver is made up of two major lobes. Both lobes consist of eight segments. These 8 segments are further made up of 1,000 small lobes or lobules.
These lobules are linked to small ducts that unite with larger ducts to structure the common hepatic duct. The common hepatic duct transfers the bile prepared by the liver cells to the gallbladder and duodenum through the common bile duct.
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How the Liver Functions?
The liver is undeniably one of the most essential organs in a person. It is the largest organ in the body and carries out many functions of the human body like:
It helps to fight against infections and cleans the blood.
It also helps in digesting food and stores a form of sugar that the body uses for energy.
Production of crucial amino acids is done by the liver.
The liver helps in the production of vital blood clotting supplements.
Production of cholesterol and particular proteins to help out carry fats through the body.
The liver helps in the production of bile, which ultimately assists in carrying away waste and break down fats in the small intestine during the digestion process.
Now, that we have had a look at the anatomy and functions of the liver, let’s move ahead.
We will now explore the basics of liver transplant surgery and when it is needed.
Defining Liver Transplant Surgery
Liver transplantation is a complex surgical procedure to remove a diseased or injured liver and restore it with a healthy one donated by a living or deceased donor. When there is no other option left to treat a liver, then as a final alternative, liver transplant surgery is carried out by a surgeon. This procedure is known to have a tremendous positive impact in the case of end-stage liver disease or liver failure.
When is Liver Transplantation Surgery required?
The liver is a crucial organ in the body. Hence, if it performs poorly due to disease or injury, the patient can experience a wide variety of symptoms. These range from the color of the skin changing to bleeding easily.
If not taken care of on time, the issues can escalate to cause total liver failure. This can compound complications or even result in death. Though the cases of acute liver failure are not widespread, we do find some cases occurring from time to time.
Here are some of the cases where liver transplantation becomes crucial to save a life.
1) Chronic Liver Failure
The liver has a notable capability to repair itself in reaction to injury. However, frequent injury and repair scar the liver enduringly.
The final stage of scarring is known as cirrhosis. It means the liver is at a point where it can no longer repair itself.
Once a person has cirrhosis, he/she experiences signs of poor liver function which is called decompensate liver disease.
Even though prescribed medications can lessen the symptoms caused by liver failure, the surgical procedure of liver transplantation is the only permanent cure.
Chronic liver failure occurs gradually over the course of years, frequently because of disease or excessive alcohol intake.
2) Acute Liver Failure
Acute liver failure occurs unexpectedly. In acute liver failure, a patient mostly doesn’t have any history of the liver disease developing symptoms speedily.
This may happen after a viral infection or toxin or probably an injury.
In acute liver failure, it may happen that a person had a long history of liver disease, but is having a sudden deterioration of that disease. For example, an individual may have a long-standing of hepatitis C but has an unexpected worsening of their liver function.
Causes of Liver Failure
Some of the typical reasons for liver failure are:
Fatty Liver
Viruses
Liver Cancer
Alcohol Abuse
Metabolic Diseases
Bile duct Diseases
Tylenol Overdose
Signs and Symptoms of Liver Problems
Some signs and symptoms of liver problems are:
Jaundice
Weakness
Losing your appetite
Feeling sick to the stomach
Weight loss
Itching
Bleeding easily
Throwing up blood
Passing black stools
Swollen abdomen
Becoming forgetful or confused
If a person experiences any such issue, it is strongly recommended that expert physician advice is sought immediately. Timely intervention by a medical expert can ensure that the problems don’t complicate further into life-threatening conditions.
When to opt for liver transplantation?
One cannot live without a fully functional liver. If a person’s liver stops functioning as intended, he/she may require a liver transplant. In an adult, cirrhosis is the main reason for liver transplantation surgery.
But before performing the surgery, the liver transplant surgeon examines a patient properly and runs blood tests, x-rays, and other tests to make a decision whether a patient would benefit from a transplant or not.
This is necessary because not all candidates would be suitable to undergo a liver transplantation procedure.
Who are not suitable for the Liver Transplant?
Each liver transplant center has a set of laws about who can have a liver transplant. A person is not capable to have a transplant surgery if he/she has the following conditions.
Cancer that has spread outside the liver
Severe heart or lung disease
An alcohol or drug abuse problem
A severe infection
AIDS
Trouble following the strict medical regimen
Preparations for the Surgery
When there is a need for a liver transplant, doctor or transplant team performs the following tests. This helps assess whether a recipient is qualified for a liver transplant and donor’s liver will get matched or not.
Lung function tests
Blood tests
Cancer work up in case of liver cancers
Kidney function tests
Blood Group matching
Virology work up
Computed tomography, or CT, Doppler ultrasound
Echocardiogram for analyzing the heart-health status
Blood group and the size of the organ of the donor and recipient must match for successful transplantation. A database is maintained to match all these aspects and then align the best possible donor for a liver transplant patient.
A liver transplant committee checks the assessment results and decides whether the person’s name should be incorporated in the national waiting list for a liver transplant or not.
The transplant committee continuously gives information to the patient about the liver transplant criteria for selection and progress at all stages. The team also provides information about the things that need to take care of a patient after surgery.
Surgery Process
The surgery takes place as soon as the suitable donor is identified after performing the final set of tests on a patient. For a living donor, the patient’s and donor’s surgery will happen at the same time. If the patient is getting the liver from a deceased donor, then the surgery will commence when the liver reaches the hospital.
General anesthesia is given to the patient before the surgery. Liver transplantation surgery can take up to 12 hours. The surgeon will remove the unhealthy liver of a patient and then replace it with the donated liver.
The first step is performed by a surgeon is incision.
After that surgeon examine the abdomen for defects that would prevent liver transplantation
Then, mobilization of the native liver is carried out.
A surgeon does separation of imperative structures after mobilization of the native liver.
Removal of the diseased liver.
Sewing in the new liver
A surgeon makes sure that bleeding is in control.
Finally, closure of the incision is performed.
Recovering From Liver Transplant Surgery
During the first few weeks and months, the patient requires help to manage medication, to travel back and forth to doctors’ appointments, and to stay on top of lab tests.
Most people get back to their routine lives within 6 to 12 months of surgery. But a fact is that family and friends play an essential role in accelerating the recovery period. After recovery, the patient can look forward to the future with confidence. As long as there aren’t major rejection issues, the liver works well and can last for a lifetime.
Results
If you are weighing the pros and cons of going for a liver transplantation procedure then this section will shed some light into the immense advantages offered by the procedure
According to research, liver transplanted people have an 89% chance of living after one year. The 5 years continued existence rate is 75%. It sometimes may happen that the transplanted liver can stop working, or the original disease may return.
For a successful result, it’s vital that surgeon keep records of patient’s recovery long after the transplant to become aware of any issues. It is expected to a patient that he/she does regular blood tests and also takes anti-rejection medications for the rest of the life.
With the latest surgical techniques, organ maintenance, operational care, and immunosuppressant, survival will optimistically continue to improve in the future.
In the Western world, it is one of the costliest medical treatments. This is the key trigger for patients to choose a skilled physician from a country like India to undergo this procedure. They have a great chance of successful procedures carried out at the hands of skilled and experienced physicians.
The cost advantage is huge even after considering the fact that the quality of treatment, surgery, and post-operation healthcare offered at both countries is nearly the same.
There are many factors which decide the cost in India for the liver transplantation surgery like :
The fees of the liver transplant surgeons.
The number of experts participating in the treatment.
Total days spent in intensive care and at the hospital.
Cost of medications and other consumables.
Hospital room type allotted to a patient.
Fees of post-surgery consultation.
It is seen that when all these aspects are looked at for India vis-à-vis a developed nation like the US, UK, or Australia, the odds are stacked heavily in favor of India for liver transplantation surgery. For example, liver transplant charges in the US is about $300,000 (Almost Rs. 2.15 crores) for all billing including stay and medicines. In a nation like India or Jordan, it will cost about $55,000 (Almost Rs. 40 lakhs)
Conclusion
The implications from a diseased liver are too severe to ignore. Liver transplantation comes across as a viable treatment option in case of liver failure or acute liver complications.
A person can look at making a smart move and receive international quality patient care at the hands of qualified and highly experienced physicians in India. This way, they receive best in class treatment, at a fraction of the costs incurred in the US, Europe, UK, or Australia.
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20 Feb, 2019
