Liver Transplant
Dr. A. S. SOIN
November 19, 2024
All About Liver Transplant and Surgery
A few facts about liver transplantation
- Only cure for advanced stages of cirrhosis
- Can be done by donation by a brain dead person or by a close relative with matching blood group
- Done in time, it carries 80% success rate
- Close follow up is essential after transplant
- Life can be completely normal after transplant
Who needs a Liver Transplant?
According to international guidelines, any patient suffering from liver cirrhosis who is assessed to have a life expectancy of less than a year should be considered for a transplant. Severity of liver disease is graded from A to C. Usually all Grade C and most grade B patients are candidates for transplant. Any patient with any of the liver failure symptoms listed below should seek specialist opinion so that liver experts can assess whether a transplant or drug treatment is more suitable for them. In any case, the better the condition of the patient at the time of transplant, the better are the results of surgery. In patients who are critically ill in ICU, malnourished, have active infection, or other organ damage such as kidney impairment at the time of the operation, the results of transplantation are dismal. Therefore, timely transplant is of essence in obtaining good results. A timely transplant done on a patient who is in a reasonable condition, with a good donor liver has around 80% chance of success.
In most instances, the above causes initially result in Hepatitis which can usually be treated. However, if the offending factor is not removed or treated on time, cirrhosis develops and then it is usually too late to change the course of the disease.
Symptoms of liver failure due to cirrhosis
- Black stool
- Blood vomiting
- Water in the abdomen (ascites)
- Drowsiness and mental confusion
- Excessive bleeding from minor wounds
- Jaundice
- Kidney dysfunction
- Excessive tiredness
- Low hemoglobin and other blood counts
Pre-transplant evaluation (Liver Transplant Assessment)
- The liver specialist usually suggests this evaluation once he has diagnosed end-stage liver disease. Recipient evaluation is done in three phases and normally takes 5-7 days in hospital.
- To establish definite diagnosis, determine the severity of liver disease and the urgency of the transplant.
- To determine the fitness of the patient for a transplant. The other systems such as heart, lungs, kidneys, blood counts are tested and the presence of any infection is ruled out. The liver specialist then decides how successful the surgery is likely to be depending on the status of the patient and the cause and severity of liver disease.
- The final phase entails the psychological and mental preparation of the patient. The patient and the family are counseled about the procedure, hospital stay, the likely course after surgery, follow up and aftercare.
- After evaluation, the patient is either placed on the waiting list for cadaveric donation, or , if there is a willing and blood group matched family donor available, he/she is evaluated for donation and a transplant is scheduled.
- While on the cadaver waiting list, the patient follows up with the Transplant Team until a suitable liver becomes available. If the patient's condition shows signs of deteriorating, we normally suggest the family to consider living liver donation.
Liver Transplant
In this a healthy liver is substituted for an unhealthy or failing one during liver transplant surgery, a potentially life-saving treatment. The list of patients waiting for replacement livers is long. Liver transplant recipients are extremely sick and have no alternative course of therapy available to them. They may be suffering from liver cancer, acute liver failure, or end-stage liver disease.
Dr. A.S. Soin, the best liver doctor in the field of liver transplant surgery, has more than 25 years of expertise. Dr. Soin is well known for his proficiency in handling complicated liver situations. He has a stellar reputation and a history of successfully completing procedures. His state-of-the-art methods combined with patient-centered care guarantee the best possible results for each patient. You can rely on Dr. Soin to provide you with compassionate care and unmatched liver transplant care under one roof.
Liver Transplant Surgery
A liver transplant is a form of surgery used to replace an ailing liver from one person’s body with a healthy one from another (the donor). You have the option of receiving a portion of a liver from a living donor or the entire liver from a donor who was just declared deceased. In the presence of adequate volume deseased liver can also be split to save the life of two recipients (usually one and adult and one child) split liver can regrow to its near normal size in both the recipients.
A healthy liver is essential to survival. A liver transplant surgery is a life saving procedure if the liver is failing or if you have unresectable liver cancer. Your liver can malfunction for a variety of reasons, including acute (short-term) liver disorders and toxic poisoning or chronic (over long term). There is a far greater need for liver transplants than there are available donor livers.
Some patients with liver cancer and those with liver damage whose condition cannot be treated with current therapies may benefit from liver transplantation.
Liver failure can occur suddenly or gradually. Acute liver failure is defined as liver failure that develops rapidly, usually within a few weeks. Acute liver failure is a rare illness that is typically brought on by side effects from specific drugs.
Liver transplant is the most promising treatment for the cure of end stage liver disease which can happen due to a variety of reasons.
Numerous illnesses can result in chronic liver failure. Liver scarring, often known as cirrhosis, is the most frequent reason for chronic liver failure. The liver malfunctions due to the replacement of normal liver tissue with scar tissue that results from cirrhosis. The most common cause of liver transplants is cirrhosis.
The following are major causes of cirrhosis that result in liver failure and liver transplantation:
- Hepatitis C and B.
- Alcoholic liver disease is a condition where drinking too much alcohol damages the liver.
- Fat accumulates in the liver and damaged or inflamed liver cells in nonalcoholic fatty liver disease.
- Liver-related genetic illnesses. These include Wilson’s disease, which results in an excessive accumulation of copper in the liver, and hemochromatosis, which causes an excessive accumulation of iron in the liver.
- Illnesses that impact the bile ducts, which are tubes that remove bile from the liver. These consist of biliary atresia, primary sclerosing cholangitis, and primary biliary cirrhosis. The most frequent cause of liver transplantation in children is biliary atresia.
- Certain malignancies that start in the liver may potentially be treated with a liver transplant.
Liver Transplant Criteria
Liver transplants are in great demand, thus not every candidate will be granted one. Those that do will need extensive surgery followed by convalescence. Dr. Soin and his team of medical professionals strive to make sure that their transplants are as effective as possible. For this reason, to be eligible for a liver transplant, you must fulfill some liver transplant criteria.
The following are the minimal prerequisites for liver transplant eligibility:
- If you are exhibiting symptoms of primary liver cancer or liver failure.
- That you are fit enough to undergo the procedure and heal well.
- There is no reason to believe you may misuse drugs or alcohol in the future.
The process of figuring these things out is somewhat complicated. Your physical, mental, and any history of substance dependency will all be thoroughly assessed by Dr. Soin and his transplant team. You must take care of any compromising situations before treating others. After fulfilling the liver transplant criteria, your name will be added to the nationwide waiting list.
Liver Transplant Process
A large procedure like a liver transplant will take six to twelve hours to complete. During the liver transplant process, general anesthesia will keep you unconscious. Surgeons insert several tubes into your body during this type of treatment so that they may do certain tasks while you’re unconscious. After your operation, the tubes will stay in place for a couple of days. You will possess:
An IV (intravenous catheter) to provide medication and fluids in a vein in your hand or arm.
an IV is placed in a vein in your thigh or neck to collect blood samples and monitor your various physiological/metabolic parameters
A tube (endotracheal tube) connected to a mechanical ventilator is inserted via your mouth and into your windpipe. During operation, the ventilator will mechanically inflate your lungs to ensure that you continue to breathe, While the anaesthetist actively and closely observes you all throughout the various stages of surgery.
Abdomen-mounted tubes that remove fluid and blood from the area surrounding your liver.
To empty your stomach of secretions, a nasogastric tube is put through your nose and into your stomach. It will stay in place until your bowel movements become regular, which should take a few days.
A urinary drain catheter in your bladder.
To reach your liver, your surgeon will first create a single incision (reverse L or upper midline) on your belly. Your liver will be gently removed, and the blood vessels and bile ducts that were attached to it will be clamped. After that, surgeons will place the new liver and connect it to your bile ducts and blood vessels. An abdominal drain will be put to drain an excess fluid accumulating in your belly after surgery. You’ll be sent to intensive care after incision closure.
After Liver Transplant Surgery
Following the liver transplant, you should anticipate:
- Perhaps spend a few days in the intensive care unit before being shifted to the ward. Nurses and doctors will keep an eye on your condition to look for any indications of problems. Also, they will regularly test the function of your liver to look for indications that your replacement liver is functioning.
- Generally the stay in the hospital is for approx 7 to 14 days.
- As you heal at home, schedule regular checks. Your transplant team schedules regular check-ups for you. Blood tests may be performed on you many times a week initially, and then less frequently as time goes on.
- For the remainder of your life, take medicine. Following your liver transplant, you will be prescribed many medicines. Many of these will require you to take them for the remainder of your life. Immunosuppressive medications help prevent the immune system from rejecting your newly acquired liver. Other medications assist in lowering the possibility of further issues following your transplant.
- You should allow yourself at least six months for a complete liver transplant recovery. After surgery, you might be able to return to your regular activities or your job in a few months. Your level of illness before your liver transplant may have an impact on how long it takes you to heal.
Liver Transplant Recovery
You will see your healthcare team frequently while you continue the liver transplant recovery at home. They will still do routine blood work to monitor the health of your replacement liver. After a few weeks, your incision stitches could be taken out. Following surgery, you will be put on several drugs, some of which you may need to take for the rest of your life.
For a smooth liver transplant recovery, Dr. Soin’s medical team will instruct you in:
- How to take care of your incision sites.
- How to administer your prescription drugs.
- How to take your own pulse and blood pressure.
- How to spot infection symptoms.
- How to spot the symptoms of organ refusal.
- When getting in touch with them is crucial.
Liver Transplant Facts
- India is one of the top nations in the area for liver transplant procedures, doing more than 2,000 liver transplants a year.
- Depending on the availability of organs and the patient’s health, the typical wait period in India for a liver transplant might be anywhere from a few months to more than a year.
- In India, living donor liver transplants are becoming more and more prevalent, providing hope to end-stage liver disease patients who would not have access to deceased donors’ organs.
- Techniques for liver transplant surgery and post-operative care have advanced significantly in Indian medical centers and hospitals, improving transplant patient outcomes and survival rates.
- In India, there is a severe lack of organ donors despite advancements, making it difficult to supply requests for liver transplants and creating lengthy waiting lists for those in need of them.
Take advantage of the experience of the renowned liver transplant surgeon Dr. A.S. Soin. Over 5000 liver transplants with remarkable success rates have been carried out by Dr. Soin, who prioritizes accuracy and patient comfort. He stands out as the best liver doctor for anyone looking for high-quality treatment for liver disorders because of his commitment to developing surgical procedures and providing individualized care. For thorough and considerate liver treatment, one can rest assured and put his faith in Dr. Soin.
FAQ’s
What is a liver transplant?
A liver transplant is a surgical procedure where a failing or diseased liver is replaced with a healthy liver from a donor. Liver transplants are primarily performed when the liver can no longer function adequately due to conditions like cirrhosis, chronic hepatitis (B or C), liver cancer, or genetic diseases. The donor liver may come from a deceased donor (whole liver) or a living donor (partial liver). In living donor transplants, a portion of the liver is transplanted, and both the donor’s and recipient’s liver regenerate to full size over time.
Who qualifies for a liver transplant?
Candidates for liver transplants are those with end-stage liver disease or acute liver failure that cannot be managed with other medical treatments. Common conditions include cirrhosis (due to alcohol, hepatitis B or C, or autoimmune diseases), non-alcoholic fatty liver disease (NAFLD), and primary liver cancers (hepatocellular carcinoma). Eligibility is determined after a thorough evaluation of the patient’s overall health, including the function of other organs, the presence of any infections or cancer, and their psychosocial readiness for surgery. Patients with active substance abuse, unmanageable infections, or severe heart or lung disease may not qualify.
How long does a liver transplant surgery take?
Liver transplant surgery typically takes 6 to 12 hours, depending on the complexity and whether it involves a full liver or a partial graft from a living donor. The procedure involves removing the diseased liver and connecting the donor liver’s blood vessels and bile ducts to the recipient’s. Factors such as the patient’s anatomy, surgical complications, and prior abdominal surgeries can extend the duration of the operation. The surgeon must work with precision to minimize complications and ensure proper blood flow to the new liver.
What are the risks associated with a liver transplant?
As with any major surgery, liver transplants come with risks. These include:
- Bleeding and infection: Major blood vessels are involved, so bleeding and postoperative infections are common concerns.
- Bile duct complications: Bile leaks or bile duct narrowing can occur, requiring additional interventions.
- Organ rejection: The body’s immune system may reject the new liver, requiring immunosuppressive drugs. Acute rejection happens in about 15-20% of cases, but chronic rejection is less common.
- Immunosuppressive side effects: Immunosuppressants increase susceptibility to infections, kidney dysfunction, and metabolic issues such as high blood pressure, diabetes, and high cholesterol.
- Other complications: These include blood clots, surgical wound issues, and sometimes liver graft failure.
What is the success rate of liver transplants?
Liver transplantation has a high success rate. Approximately 90% of patients survive the first year after surgery. The five-year survival rate is around 75–85%, though this varies depending on the underlying liver disease and the patient’s overall health. For patients with liver cancer or other complex conditions, survival rates may differ. With advances in surgical techniques and post-transplant care, including better immunosuppressive therapies, outcomes have continued to improve.
How long is the recovery after a liver transplant?
Recovery after a liver transplant typically lasts 3 to 6 months. The patient will initially spend about 1-2 weeks in the hospital, with the first few days in the intensive care unit (ICU) for close monitoring. During this time, doctors watch for signs of complications like rejection or infection. After discharge, patients will require regular follow-up appointments and blood tests to monitor liver function and adjust medications. Light to moderate physical activity can often resume in 1-2 months, but full recovery—returning to work or regular physical activity—might take around 2-3 months or longer, depending on the patient’s condition and recovery progress.
What medications are required after a liver transplant?
Liver transplant recipients must take immunosuppressive medications for life to prevent their immune system from rejecting the new liver. Common drugs include tacrolimus, cyclosporine, and mycophenolate. Initially, these drugs are given at higher doses and gradually reduced over time. Patients also take medications to prevent infections (antibiotics, antivirals, and antifungals), and other drugs to manage side effects such as high blood pressure or cholesterol. The precise regimen depends on the patient’s response to treatment and any underlying conditions.
Can a liver transplant cure liver disease?
A liver transplant can effectively treat end-stage liver diseases like cirrhosis, acute liver failure, and metabolic liver diseases by replacing the damaged liver with a functioning one. However, it does not cure all liver diseases. For instance, conditions like hepatitis B or C can recur in the new liver, requiring antiviral therapy to prevent reinfection. Furthermore, liver transplant patients must adhere to immunosuppressive regimens and make lifestyle changes to prevent complications and ensure long-term success of the transplant.
What lifestyle changes are necessary after a liver transplant?
Post-liver transplant, patients must commit to lifelong lifestyle changes to protect their new liver and overall health. These include:
- Alcohol abstinence: Alcohol can damage the liver, so complete avoidance is necessary.
- Healthy diet: A balanced diet rich in fruits, vegetables, lean protein, and low in processed foods helps maintain liver and overall health.
- Exercise: Regular physical activity improves cardiovascular health, weight control, and overall well-being.
- Infection prevention: Due to immunosuppressive therapy, patients are more prone to infections, so proper hygiene, vaccinations, and avoiding crowded or high-risk areas are crucial.
Routine medical follow-up: Regular visits to the transplant team and monitoring of liver function and drug levels are necessary to prevent complications like organ rejection.
