Liver is a vital organ of the human body that performs several important functions. It aids in digesting food, storing energy and removing toxic waste from the human body. A person cannot live if his/her liver is not working (liver failure). Liver failure can be caused by disease or injury.
A liver transplant can be life-saving surgery for people having significant complications due to end-stage chronic liver disease. In this procedure, the diseased or injured liver is removed and replaced with a partial or complete healthy liver from another person (donor). The donor can be a living person or a deceased person.
In case of a living donor, the liver can regenerate and return to its standard size after removal.
In the present time, a liver transplant is the only cure for liver failure or liver insufficiency, as no machine or device is yet discovered, which can do all liver functions.
A person with liver failure may need a liver transplant surgery. However, a person is unfit for liver transplant surgery if he/she has any of the following condition:
- An irreversible or severe medical illness that can shorten the life span
- Liver cancer that has spread outside the liver
- Severe pulmonary hypertension
- Uncontrolled or systemic infection
- Uncontrolled or severe mental disorder
If a person uses abusive drugs or alcohol in an excessive amount or is unable to follow the medical regimen, he/she cannot undergo liver transplant surgery.
PREPARATION BEFORE PROCEDURE
Before the surgery, you will be evaluated completely to determine whether you are eligible for the liver transplant. The past medical and medication history will be obtained. The information about the habits including smoking, tobacco chewing, or drug use, will also be recorded.
Complete physical examination, several tests, including blood tests, imaging tests, heart tests, kidney tests, lungs tests and cancer screening tests, are done. Nutritional and psychological status is also evaluated.
Once you are declared fit for the liver transplant, your name will be added to the liver transplant waiting list. Model for end-stage liver disease (MELD for children above 12 years and adults) or pediatric end-stage liver disease score (PELD, children below 12 years) is calculated. This score aids in evaluating the condition of the persona and determining the need for a liver transplant. Higher the score, worse is the condition. Once the liver is available, the patients are stratified based on the MELD score and blood type. A person with a higher MELD score gets the first preference.
Before the day of the surgery, you will be examined again to evaluate the health status. Avoid eating or drinking anything at least 8-12 hours before the surgery procedure.
Type of the surgery
Based on the donor, the surgery can be of the following two types:
- Deceased donor liver transplant: In this method, donor is a dead person. Death can be a brain death or cardiac death. In both these cases, the liver can be transplanted with the consent of the family. This type of surgery is the most common type of liver transplant surgery.
- Living donor liver transplant: Sometimes, a part of the liver from a living donor can be transplanted to the recipient. A living donor is mostly a close family member or a friend with the right blood type, who is healthy and fit to undergo a surgical procedure.
The surgery is performed under the effect of general anaesthesia. Once the anaesthesia is effective, a long incision is made across the abdomen to get access to the liver. Once the liver is exposed, the bile ducts and the blood supply to the liver is detached, and the diseased liver is removed. Then the donor's liver is placed in the body, and the bile ducts and blood vessels are attached to the new liver.
After completing the procedure, the incision is closed by stitches or staples.
In case of a live donor transplant, the donor is first operated. The surgeon will remove some portion of the liver, which will be transferred to the recipient by following the same steps.
The liver portion remaining in the donor's body and transplanted portion of the liver in the recipient's body regenerate and reach to the normal volume in a few months.
After completing the procedure, you will be moved to the care unit where you will be closely monitored. Liver function test will be done regularly to evaluate the functioning of the new liver. Once your condition is stable, you will be moved to the recovery room. You will be given immunosuppressants to prevent rejection of the organ, which should be taken for lifetime. Some other medications may also be given to prevent other complications. Before you leave the hospital, you will be informed about your check-up schedule.
Following measures aid in speedy recovery after liver transplant:
- Take the prescribed medications on time
- Get regular check-ups done as per the schedule
- Consume a diet that is low in salt, sugar, fat and cholesterol
- Avoid consuming alcohol
- In a day, eat 5 servings of fruits and vegetables except for grapefruit
- Add plenty of fibre to your diet
- Drink plenty of water
- Indulge in some exercise and physical activity