What is a Liver Transplant?
The liver is the body's largest internal organ, weighing about 3 pounds in adults. It is located below the diaphragm on the right side of the abdomen. It performs various complex functions ranging from metabolism to production of hormones, as a storage house to removal to potentially toxic by products of certain medications that we ingest.
Liver Transplant is considered when the liver no longer functions adequately (liver failure). Liver failure can occur suddenly (acute liver failure) as a result of infection or complications from certain medications or it can be the end result of a long-term problem. The following conditions may result in liver failure
When the liver is so diseased that it is not able to maintain the normal body functions makinng the survival of the patient questionable, Liver Transplant will be required. There are various certain conditions that can lead to a liver failure, they are as follows:
• Chronic hepatitis with cirrhosis.
• Primary biliary cirrhosis (a rare condition where the immune system inappropriately attacks and destroys the bile ducts causing liver failure).
• Sclerosing cholangitis (scarring and narrowing of the bile ducts inside and outside of the liver causing the backup of bile in the liver which can lead to liver failure).
• Biliary atresia (malformation of the bile ducts)
• Wilson's disease (a rare inherited disease with abnormal deposition of copper throughout the body, including the liver, causing it to fail).
• Hemochromatosis (a common inherited disease where the body is overwhelmed with iron).
• Alpha-1 antitrypsin deficiency (an abnormal accumulation of alpha-1 antitrypsin protein in the liver, resulting in cirrhosis).
• Liver Cancer
Living-Donor: Living donor liver transplants are an option for some patients with end-stage liver disease. This involves removing a segment of liver from a healthy living donor and implanting it into a recipient. Both the donor and recipient liver segments will grow to normal size in a few weeks.
The donor must be a blood relative or spouse and will have extensive medical and psychological evaluations to ensure the lowest possible risk. Blood type and body size are critical factors in determining who is an appropriate donor.
A Cadaveric Transplant the donor may be a victim of an accident or head injury. The donor's heart is still beating, but the brain has stopped functioning. Such a person is considered legally dead, because his or her brain has permanently and irreversibly stopped working. At this point, the donor is usually in an intensive-care unit.
The preliminary evaluation, called a Phase I Evaluation, is the first step in helping you and the transplant team determines if transplantation is an appropriate treatment option Every patient is evaluated by a liver specialist, called a hepatologist, and a surgeon. The appointment will take a full day, and can be very tiring. The following tips will help you prepare for this first appointment:
• Because you will undergo many tests, do not eat or drink anything after midnight of the day before your appointment.
• Plan to bring a snack. Please bring any medications you are taking.
You will need to bring all of your previous medical records, X-rays, liver biopsy slides, operative reports and a record of medications to your pre-evaluation. To complement and to update previous tests, some or all of the following diagnostic studies are generally performed during your evaluation. If specific problems are identified, additional tests may be ordered.
• Computed tomography, which uses X-rays and a computer to generate pictures of the liver, showing its size and shape
• Doppler ultrasound to determine if the blood vessels to and from your liver are open
• Echocardiogram and stress testing to help evaluate your heart
• Pulmonary function studies to determine your lungs' ability to exchange oxygen and carbon dioxide
• Blood tests to determine blood type, clotting ability, and biochemical status of blood, and to gauge liver function. Serology screening is also included.
There are three types of liver transplantation surgery procedures - Orthotopic transplantation, Heterotopic transplantation surgery and Reduced-size liver transplantation.
• Orthotopic Transplantation The orthotopic approach requires replacing the recipient liver with the donor liver. After the donor liver is removed, preserved and packed for transport, it must be transplanted into the recipient within 12 to 18 hours. The surgery begins by removing the diseased liver from the four main blood vessels and other structures that hold it in place in the abdomen. After the recipient's liver is removed, the new healthy donor liver is then connected and blood flow is restored. The final connection is made to the bile duct, a small tube that carries bile made in the liver to the intestines.
• Heterotopic Transplantation – Heterotopic Transplantation surgery involves the addition of a healthy donor liver at another site, while the diseased liver is left intact. This liver transplant surgery procedure is performed when the doctor is of the opinion that the diseased liver might recover. The healthy liver is attached very near to the original liver. If the liver recovers, the other organ shrivels away. If not, then the original one shrivels and the donor liver performs the body functions.
• Reduced-size Liver Transplantation – Reduced-size Liver Transplantation is most often performed on children and involves the transplanting a part of the healthy donor liver into a patient. This procedure is performed when 15-20% of the original liver is intact. This way, one donor liver can be used for two successful transplants.
Liver transplants usually take from six hours to 12 hours. During the operation, surgeons will remove your liver and will replace it with the donor liver. Because a transplant operation is a major procedure, surgeons will need to place several tubes in your body. These tubes are necessary to help your body carry out certain functions during the operation and for a few days afterward.
You will stay in the hospital about 1 to 2 weeks to be sure your new liver is working. You’ll take medicines to prevent infections and rejection of your new liver. Your doctor will check for bleeding, infections, and liver rejection. During this time, you will learn how to take care of yourself after you go home and about the medicines you’ll need to take to protect your new live
Liver transplantation in India is performed through cutting- edge clinical solutions, research, extraordinary patient care and infrastructure of world-class standards. This has addressed concerns of many patients and has helped them get rid of complex and most end stage liver diseases. Liver Transplant is a complex surgical exercise and need highly skilled consultants, ingenious technical staff and advanced technology working with perfect harmony, enormous dedication and team work. India offers a one stop solution for all those seeking critical procedures such as Liver transplantation.
You may want to ask some questions before your treatment begins: