Liver transplantation is the replacement of a diseased liver with the healthy liver . It is essential when damage to liver is severe leading to liver failure .The liver is the second most commonly transplanted major organ after Kidney .
The liver is located on the right side in the abdomen , performs many vital functions like
- Producing Glucose, Proteins, Blood-clotting factors, Bile,
- The liver also acts as a storehouse of vitamins and minerals.
- It also acts as a filter, removing impurities and metabolizes and detoxifies substances ingested by the body.
Types of Liver Transplants
1. Deceased donor transplants
Most livers for transplants come from people who have just died, called deceased donors. Adults typically receive the entire liver from a deceased donor. Sometimes a donated liver may be used for two different recipients. The larger part may go to an adult, and the smaller part may go to a child.
2. Living donor transplants
When a healthy living person donates part of his or her liver, most often to a family member it is called a living donor. During a living donor transplant, surgeons remove a part of the living donor’s healthy liver.
Signs of liver disease
- Yellowing of the skin or eyes known as Jaundice,
- Itching of skin
- Dark colored urine clay-colored bowel movements
- Ascites i.e collection of fluid in abdomen
- Bleeding tendency
- Mental confusion, forgetfulness
Diagnosis for Liver Transplant
Liver failure is the reason for liver transplant , however it could be acute onset i.e acute or chronic liver failure
Acute liver failure– sudden onset liver failure could be due to
- viral hepatitis,
- drug-induced due to some reaction to pain killers , or prescription medication , herbal medicines
- injury / clots in vessel supplying blood to liver
Chronic Liver failure– can also be the end result of a long-term problem
- Alcoholic liver disease
- Cirrhosis , fatty liver disease
- Biliary atresia common reason in children
- Auto immune , genetic disorders
Tests for liver transplant
- CT scan of the abdomen: to determine the liver size and to identify any abnormalities, including liver tumors.
- Ultrasound of the liver: study of liver and the surrounding organs. Doppler ultrasound determines how well the blood vessels that carry blood to and from the liver are working
- Blood tests: These include liver function tests , clotting factors , routine blood tests and culture.
Procedure of liver transplant
Presurgical studies, including blood tests, urine tests, chest X-rays ultrasound ,CT abdomen , ECG etc, are performed, these tests are done to evaluate the severity of the liver disease ,Once this is complete patient is accepted as candidate for liver transplant and put on Wait list for transplant
Pre transplant tests are performed , The testing makes sure the donor liver has good chance of working in body
- Liver is healthy,
- Matches your blood type
- Right size
Donor livers function best if they are transplanted within 8 hours, although they can be used for up to 24 hours. Before surgery the patient also receives a dose of steroids to prevent rejection of the new liver-and a dose of antibiotics to prevent infection.
Transplant process takes approximately 6-8 hours & is performed under a general anaesthesia.
- Incision is made in the upper part of the abdomen.
- Segregation of important structures (the inferior vena cava above, behind, and below the liver, the portal vein, the common bile duct, the hepatic artery)
- Removal of the natural, diseased liver.
- Placement of the new & healthy liver, which is then reconnected to the bile ducts and blood vessels. Blood will now flow into this new liver.
- Adequate control of bleeding is established.
- Finally closure of the incision
- The liver begins to regenerate itself almost immediately.
After the procedure:
After the transplant is complete patient is moved to an intensive care unit (ICU).
A machine called a ventilator assists the patients breathing, and a tube is inserted through the nose and into the stomach to provide the patient with fluid and nutrients.
Antibiotics are prescribed after procedure to protect against infections.
Transplant patient with a new liver must take medications for the rest of his life to avoid Rejection syndrome .
Regular follow ups are important for successful transplantation initially weekly and gradually reducing the frequency of testing to ascertain how well the Liver is functioning and early detection of rejection episode .
Complications of Liver Transplant
- Rejection syndrome , the body’s immune system attempts to destroy the newly transplanted liver. Immunosuppressive medications are used to prevent rejection of the transplanted liver but these medications have a general weakening effect on the immune system. This is why transplant patients are more likely to get certain infections.
- Bleeding after surgery, formation of clots
- Infection – fever
- Jaundice indicating that bile is backing up and not draining from the liver properly.
- Side effects of immunosuppressant medicines like bone thinning osteoporosis and bone damage (osteonecrosis ),increased risk of infections esp skin cancer , oedema and weight gain .
Factors Affecting Cost Of liver Transplant
The cost to the patient depends on a variety of factors like
- The hospital, the patient chooses.
- Room –Standard single room, deluxe room, super deluxe room for the number of nights specified (including nursing fee, meals, room rate, and room service).
- Fee for the team of doctors and OT charges
- cost of medications
- Standard tests and diagnostic procedures.
- Cost of the follow –up care and immunosuppressive medications required after the procedure