Understanding Liver Transplant Surgery

Liver transplant surgery is a complex but life-saving procedure for patients with severe liver disease. This guide will provide an overview of what to expect during the liver transplant operation, including the time and cost involved.

What is Liver Transplant Surgery?

Liver transplant surgery is a medical procedure in which a diseased liver is replaced with a healthy liver from a donor. This operation is often recommended for patients suffering from liver failure or severe liver disease that cannot be managed with medication or other treatments.

Liver Transplant Operation

The liver transplant operation involves several key steps:

• Pre-Surgery Preparation: This includes comprehensive evaluations, including blood tests, imaging studies, and consultations with various specialists to ensure the patient is ready for surgery.
• Anesthesia and Incision: The patient is placed under general anesthesia. The surgeon makes an incision in the abdomen to access the liver.
• Removal of the Diseased Liver: The surgeon carefully removes the damaged liver, taking great care to preserve surrounding structures.
• Implantation of the Donor Liver: The donor liver is carefully placed into the patient's body and connected to the blood vessels and bile ducts.
• Post-Surgery Care: After the surgery, the patient is moved to an intensive care unit (ICU) for close monitoring and care.

Functions of the Liver

• Your Liver will do plenty of things that keep you healthy. It turns nutrients into chemicals your body desires.
• Filters out Poisons
• It helps food to convert into energy. So if your Liver doesn't work well, it may affect your whole body.

The liver is the largest internal organ and its functions are:

• Producing the Bile and excreting the bile
• Excreting Bilirubin, hormones, and drugs
• Activates the Enzymes
• It acts as storage for vitamins, minerals
• Produces blood proteins for blood plasma
• Regulates clotting of blood
• Produces Cholesterol to assist in carrying fats throughout the body

Types of Liver Diseases

Liver diseases encompass a range of conditions affecting the liver's structure and function. Here are some common types:

1. Hepatitis

• Hepatitis A: Caused by ingesting contaminated food or water. It is usually acute and resolves on its own.
• Hepatitis B: Spread through contact with infectious body fluids. It can be acute or chronic and may lead to serious liver damage.
• Hepatitis C: Typically spread through blood-to-blood contact. It often becomes chronic and can lead to liver cirrhosis or cancer.
• Hepatitis D: Occurs only in those infected with Hepatitis B and can worsen the severity of Hepatitis B.
• Hepatitis E: Similar to Hepatitis A, often spread through contaminated water and typically resolves on its own.

2. Fatty Liver Disease

• Non-Alcoholic Fatty Liver Disease (NAFLD): Accumulation of fat in the liver not related to alcohol consumption. Can lead to inflammation and liver damage.
• Alcoholic Fatty Liver Disease: Caused by excessive alcohol consumption. It can progress to more severe liver conditions like alcoholic hepatitis or cirrhosis.

3. Cirrhosis

• A progressive liver disease characterized by scarring of the liver tissue. It can result from chronic liver diseases such as Hepatitis and chronic alcohol use.

4. Liver Cancer

• Hepatocellular Carcinoma (HCC): The most common type of primary liver cancer, often developing in people with chronic liver disease or cirrhosis.

5. Hemochromatosis

• A genetic condition causing excessive iron accumulation in the liver, which can lead to liver damage.

6. Wilson's Disease

• A genetic disorder where excess copper builds up in the liver and other organs, leading to liver damage and neurological symptoms.

7. Autoimmune Hepatitis

• A condition where the immune system attacks the liver, leading to inflammation and damage. It can be treated with medications to suppress the immune system.

8. Primary Biliary Cholangitis (PBC)

• An autoimmune disorder that causes damage to the bile ducts within the liver, leading to bile accumulation and liver damage.

9. Primary Sclerosing Cholangitis (PSC)

• A chronic disease causing inflammation and scarring of the bile ducts, which can eventually lead to liver cirrhosis.

10. Genetic Liver Diseases

• Includes conditions like Alpha-1 Antitrypsin Deficiency, which affects the liver's ability to produce a protective protein, leading to liver damage.

How Do We Get a Liver?

Way I: Relatives Donating

• Eligibility: 1st-degree relatives can donate part of their liver. Typically, the liver portion removed is around 60%, with a variation of +- 5-10%.
• Procedure: The donated liver portion is given to the patient in need. For survival, a minimum of 30% of the liver is necessary for a healthy person; hence, 70% can be donated.
• Pre-Donation Testing:
  • Blood Tests: Initial tests check for health issues such as thyroid disorders, blood sugar levels, and lipid profiles. Donors with detected problems are not accepted.
  • Imaging: CT scans and MRIs assess liver volume and suitability for donation, ensuring that the remaining liver in the donor and the transplanted liver in the recipient will function optimally.
  • Counseling: Rigorous counseling is conducted to understand the donor's willingness and to check for any medical complications like medication use, thyroid conditions, diabetes, hypertension, or past major surgeries. Donors with these conditions are not accepted.

Way II: Cadaveric Liver Transplant

• Process: If a patient is declared brain dead, a social worker approaches the family to discuss liver donation. With their consent, and after completing formalities, the liver can be used for transplantation.

Who Needs a Liver Transplant?

• Conditions: Liver transplants are necessary for patients with liver cirrhosis due to causes like alcohol use, Hepatitis B or C, Wilson disease, Nash-related cirrhosis, or hepatocellular carcinoma.
• Complications: Transplantation is required for those with complications such as:
  • Ascites (fluid accumulation in the abdomen)
  • Hepatic encephalopathy (brain dysfunction)
  • Bleeding leading to decompensation, jaundice, or brain effects
  • Infections inside ascites or kidney effects

What are the Types of Liver Transplants?

Cadaveric Liver Transplant Surgery

Orthotopic Liver Transplant means, taking a liver from the deceased or dead patient. Here the Person's Liver will be taken and placed to the patient who needs a Liver Transplant. This kind of transplant is also called Cadaveric Liver Transplant.

Living Donor Liver Transplant Surgery

Living Donor Transplantation means taking a part of the Liver. For instance, either the left lobe or right lobe and place it to the person who needs Organ. Living donors come under the first degree of family members like Mother, Father, Brother, Sister, Grandmother, Grandfather, and wife. Any of these persons are eligible to give their part of the liver to the affected person.

Split Type of Liver Transplant Surgery

Split means dividing. The name itself indicates that we have to Split the Liver into 2 parts. As a result, the split live is placed to 2 Liver Transplant needed persons. We can get the split liver from a deceased or dead person.

Cardiac Dead Liver Transplant Surgery

Many Liver Transplantation needed people are waiting on the UNOS Liver transplant waiting List. These patients are waiting to acquire liver from Brain Dead patients. However, it will take more time to get a Cadaveric Liver or Brain Dead patient's liver. However, there is another way to get Liver Transplantation that is Cardiac Dead Liver Transplantation. In this case, patients who are dead due to cardiac arrest can donate their Liver to the recipients who need Liver transplants. Therefore, waiting will be decreased and there is more chance for Liver Transplant recipients to get Liver.

When to Prefer a Liver Transplant?

Firstly, Liver Transplant Surgery is needed, when there is Liver Failure. Liver Failure can occur all of a sudden which leads to Viral Hepatitis, Drug-induced infection. Here is the list of the problems which may cause serious Liver Failure

• Chronic hepatitis with cirrhosis
• Primary biliary cholangitis
• Sclerosing cholangitis
• Biliary atresia
• Alcoholism
• Wilson's disease
• Hemochromatosis
• Alpha-1 antitrypsin deficiency

Who is Eligible for Liver Donation?

• The donor whose age is between 18 to 20 years
• A person who is physically and mentally prepared for surgery and has undergone doctor counseling
• The candidate whose health condition is good
• A donor who is weighing correctly
• The person who does not take alcohol or drugs
• A candidate whose Blood Group matches the recipient
• A person whose Liver, Kidney, Lungs, and Heart are functioning normally.

Who is Not Eligible to Donate Liver?

Here are some conditions in which the person is not eligible to donate their part of the liver:

• A donor whose age is under 18 years
• A person who is suffering from Lungs disease and heart-related disease
• A candidate whose Blood group does not match
• A donor who is having HIV or Hepatitis
• A person who takes alcohol/drugs
• A candidate who is psychiatrically ill
• The person who is overweight

Tests Required Before Opting for Liver Transplant

Given below are the Clinical Tests that are involved before the Liver Transplant.

• Imaging scans
• Blood Tests
• Radiology
• Diagnostic tests
• Consults and exams

Liver Transplant Tests include:

• Magnetic resonance imaging (MRI) of abdomen/pelvis OR
• Computed tomography (CT) scan of abdomen/pelvis
• A dopamine stress echocardiogram (DSE)
• Ultrasound of abdomen/pelvis
• Electrocardiogram/chest X-ray
• Colonoscopy
• Mammogram or Pap smear for women
• Other testing and blood work

What are the Requirements of Donor for a Liver Transplant?

Below is the list of requirements:

• A donor must be in Good Health Condition
• Blood Group of the Donor who is ready to donate their part of the Liver must be matched with the recipients.
• The age of the donor must be in between 18 years to 60 years
• A donor should not have any health complications
• The physical size of the donor must be the same or larger than the recipient

Liver Transplant Procedure for Living Donors

In Case of a Living Donor

• Donor Procedure:
  • The donor's procedure begins first, with the surgeon making an incision under the rib cage.
  • The healthy liver is carefully divided. Typically, the right lobe is selected for donation.
  • The gallbladder, connected to the liver by two lobes, is removed along with the lobe to be donated.
  • The donor's incision is then closed.
• Recipient Procedure:
  • The recipient's unhealthy liver, including the gallbladder, is completely removed.
  • The donor's liver is placed in the recipient's empty cavity.
  • Attaching the new liver to the recipient's blood vessels and bile ducts takes an additional 4 to 8 hours.
• Post-Transplant Regeneration:
  • Both the donor's and recipient's lobes begin to regenerate immediately after transplantation.
  • The donor's liver will grow back to its original size (with only one lobe) in about 2 months.
  • The recipient's new liver will also grow as a single lobe to become a complete liver.
• Surgical Timeline:
  • If receiving a Living Donor Liver from family, friends, or a matched donor, the surgery typically occurs within 3 to 4 days.
  • Tests and scans are conducted to ensure the donor's suitability. If the donor qualifies, they will undergo surgery.
  • During the surgery, approximately 60% (+-5-10%) of the donor's liver will be removed and transplanted into the recipient.

Outcomes after Liver Transplant

Apart from all, according to the survey, on average Outcomes of Liver Transplant is excellent. After 1 year of a liver transplant, the survival rate of the recipient is 88%. And after 5 years, recipients survival is 74%

Liver Transplant Success Rate

As we know it is a very major surgery and the possibility of developing problems during and after surgery is high. Chances if the success rate in the best of the best hand is around 90-92%. So now the question comes, suppose if you overcome this problem of life, the risk of around 8-10% what is the life after this once we are under over Liver Transplant

Liver Transplant Recovery

• The patient will be shifted to the Intensive Care Unit (ICU) after successful liver transplantation for 2 days.
• To assist the patient in breathing, a breathing pipe is inserted. When the patient is stable, then they will be discharged from the hospital.
• After discharge, the patient must visit the hospital once a week for the 1st month. Slowly the visiting time will be decreased. Later you will be visiting the hospital once a year.
• The patient needs to undergo regular medical tests. As a result, you can check your liver is not getting damaged by rejections, infections, etc.
• The patient must be careful while going outside. Meanwhile, every time he/she should wear a mask while going into a crowd to avoid infections.
• While moving with sick people, you must be very careful. Because liver transplant patients are at high risk of catching infections. In case you find any illness, immediately contact the doctor.
• However, recovery is time taking and it's a long process in Liver Transplantation patients. You should follow simple exercises like walking, deep breathing, etc.
• Diet plays a major part in Liver transplant people. Firstly you should go with ice chips, after that liquids, and finally, you are eligible to take hard foods and solids.
• Meanwhile, 3 to 6 months of rest is compulsory. After this, the patient can go back to normal work if they feel comfortable and ready to do it. Above all, doctors' consult is also important before going back to work.
• Liver Transplant people should avoid Alcohol.
• Liver Transplant people should not take any medicine without a doctor's prescription.

Diet After Liver Transplant

• Avoid street foods
• Don't take raw food items like beef, fish, seafood, etc.
• Shouldn't eat undercooked food items
• Always eat the hot served food
• Eat well-cooked food
• Avoid food that is not covered
• Eat proteins and mineral containing foods
• Take fresh fruits and vegetables
• Take cereals and food grains
• Don't take alcohol
• Avoid Grapefruit
• Make sure you are having fiber in your diet
• Avoid taking too much salt and fat-containing food items
• Avoid sugar contained foods and drinks

Frequently Asked Questions