Liver Transplant: Indications, Procedure, and Recovery

A liver transplant is a surgery in which a failed liver is removed and replaced with a healthy one. It's a life-saving procedure when the liver is not able to perform its functions. The liver is an important visceral organ that purifies the blood and helps discharge the waste out of your body. So, when it fails, seeking treatment becomes essential.

Liver failure commonly occurs due to some underlying disease or alcohol abuse. While it is true that the liver can regenerate itself, it does become toxic after constant abuse and requires replacement.

There are two types of donors: a deceased donor or a living person who donates a portion of his or her liver, usually a close relative. The liver is special in how it regenerates itself, i.e., it grows back to the normal size in both the donor and recipient of the liver.

Causes of liver damage

Several reasons can cause liver damage. Some of the most common ones include:

• Inflammation of the liver: Typically, liver inflammation is caused by hepatitis infections (hepatitis A, B and C) and other infections such as herpesvirus and listeria monocytogenes. Other causes of liver inflammation include poisoning, alcohol abuse, chemicals, medicines, and supplements.
• Autoimmune diseases: Autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis can lead to scarring and chronic inflammation in the liver and bile ducts.
• Genetic liver diseases: Certain liver problems are inherited from parents. Hemochromatosis, Wilson's disease, and Alpha-1 antitrypsin deficiency are examples.
• Long-term alcohol abuse: The liver suffers greatly when excessive alcohol consumption is sustained over time.
• Certain medicines: Popular over-the-counter medications can also trigger liver malfunction like anti-tubercular drugs (ATT), antibiotics, non-allopathic medicines, etc.

What are the indications of a liver transplant?

A liver transplant is most often the last resort of treatment. It is indicated in cases of acute liver failure or when the liver is chronically damaged and cannot function.

Specific indications can include:

• Cirrhosis-Chronic Liver Disease: Cirrhosis is one of the most common conditions for liver transplantation. It is a consequence of chronic conditions like Hepatitis C or B, alcoholic liver disease, NAFLD, and autoimmune disorders such as Primary Biliary Cirrhosis (PBC) and PSC. Such chronic diseases cause prolonged damage to and impairment of the liver, leading to end-stage liver disease.
• Acute Liver Failure: Acute liver failure is the condition of an abrupt and severe loss of liver function that might have been caused by a toxic overdose of drugs such as acetaminophen, viral hepatitis, or exposure to toxins. Autoimmune reactions can also cause it. Survival would only be possible through a transplant in the event of a patient's liver failure occurring rapidly.
• Genetic or Metabolic Liver Diseases: These include disorders such as Wilson's disease, hemochromatosis, or alpha-1 antitrypsin deficiency. These are hereditary conditions resulting in progressive liver damage. They cause damage to the metabolic function of the liver and require transplanting in most cases before they worsen.
• Biliary Atresia: Biliary Atresia is a congenital disease that mainly affects children. It is described as malformed or blocked bile ducts, leading to liver damage. A liver transplant would be the only hope to restore normal liver function in such infants.

What is the procedure for a liver transplant?

Liver transplant surgery is indeed an intricate procedure and is performed by proficient surgeons with the help of advanced equipment. It involves the implantation of a fully functioning liver in place of a failed one. The entire transplant process can be divided into three phases, i.e., pre-surgery, during surgery, and post-surgery periods.

Pre-surgery

In this phase, you will be thoroughly examined by doctors to evaluate if you are the right candidate for a liver transplant. This includes reviewing the medical history, physical examination and conducting a few liver function tests. Second, if you already have a donor, they will be evaluated to ensure they are your right match. They will undergo legal proceedings to ensure no malpractice is taking place. In case you do not have a donor, you will be placed on a waiting list that decides who gets the liver first from deceased donors or system availability.

During the surgery

The surgery lasts for about 12 hours. Your doctor will give you anaesthesia and you'll be unconscious throughout the surgery.

First, a long incision is made between your stomach and the liver. Then they separate the damaged liver and replace it with the donated liver. After that, your bile ducts and blood vessels are joined with the implanted liver. Once the transplant is accomplished, they seal the incision with stitches and staples.

In case the donor is a living person, two surgeries take place. First, a portion of a healthy liver is taken out from the living donor through surgery. Then, this portion of the donated liver is administered in place of the damaged liver of the patient. The operation ends by reconnecting bile ducts and blood vessels to the liver.

After the surgery

After the transplant is completed, you'll be immediately moved to the ICU. Your doctors will carefully examine if the new liver is working fine and the chances for complications. You'll remain under observation for a few more days. You'll get discharged from the hospital once your doctor is satisfied with your medical condition.

Recovering after the liver transplant

The success rate for liver transplant surgery ranges between 85% to 95%.

Taking a healthy and balanced diet and a little exercise regularly will help with quick recovery. Usually, you will be able to get back to normal life within a few months of your surgery. Donors typically recover within one month but need to take care of themselves for about a year. Some of the recovery tips to follow include:

• Take constant follow-ups with your doctor to ensure you're on the right track for recovery.
• Take all the medicines and tests on time. If you miss a dose, consult your doctor immediately.
• For every extra medicine or supplement you intend to consume, talk to your doctor first.
• Stay away from alcohol and substance abuse.
• Additionally, prevent yourself from getting common colds, flu, and infections.

Conclusion

The liver transplant is highly life-saving for patients with severe liver failure and even acute conditions due to chronic diseases. The failure of the liver is catastrophic since it is an organ crucial for detoxifying harmful substances and providing mechanisms necessary for digestion and nutrient absorption, not to mention its control over vital body functions; hence, failure to carry out these activities causes disaster to the patient. Though many medical treatments can be used to control diseases of the liver, in many cases, transplantation will be the only acceptable intervention when the organ fails to carry out its essential function.

Modern surgical techniques and post-operative care have immensely improved transplant success. With proper care, including a healthy lifestyle, regular follow-ups, and medication adherence, a transplant recipient and liver donor can lead a healthy and effective life after surgery. Early detection, timely medical interventions, and access to liver transplantation cannot be underrated in giving someone a second chance in life.