Liver Transplant

Liver transplant may be necessary for patients who suffer from:

• liver damage due to alcoholism (Alcoholic cirrhosis)
• Malignancies involving liver: Hepatocellular carcinoma, Hepatoblastoma, HilarCholangiocarcinoma, etc
• primary biliary cirrhosis
• long-term (chronic) active infection (hepatitis B or C)
• liver (hepatic) vein clot (thrombosis)
• birth defects of the liver or bile ducts (biliary atresia)
• metabolic disorders associated with liver failure (e.g., Wilson\’s disease)

Patients require hospital care for one to four weeks after liver transplant, depending on the degree of illness. After liver transplantation, patients must take immunosuppressive medications for the rest of their lives-to-prevent-immune-rejection-of-the-transplanted-organ.

Liver transplant means removing a whole or part of liver from a deceasedor living donor, placing and attaching in a patient after removing whole of the diseased liver.

Liver is obtained from a Deceased donor or Live Related donor.

Deceased Donor (Cadaver) – Liver is obtained from patients who are brain dead. (They are actually dead for from legal, ethical, spiritual and clinical point of view). Once a brain dead patient is identified, and is deemed as a potential donor, the blood supply to his body is maintained artificially. This is the principle of deceased organ donation. Patients who die of head trauma, brain hemorrhage or other causes of sudden-death-are-the-donors-suitable-for-organ-donation.

Living Donor – Liver has the capacity to regenerate if a part of normal healthy liver is removed. Hence we can divide part of liver from a live donor and implant it into another patient. In a live donor liver transplant, a portion of the liver is surgically removed from a live donor and transplanted into a recipient immediately after the recipient’s liver has been entirely removed.

Donor safety is the first objective of whole process. Utmost care is taken while selecting and operating live donors. The risk of serious morbidities following a living donor liver resection is 10%.The risk of death in the donor is 0.02to 0.5%. Live donor liver transplantation is possible because the liver (unlike any other organ in the body) has the ability to grow back to its original size. The regeneration of liver following surgery is complete by 4 to 8 weeks.

Selecting the correct donor for a live donor liver transplant requires experience, skill and technical expertise on the part of the many doctors, transplant coordinator and other health care professionals who make up the Live Donor Team.

Potential live liver donors are carefully evaluated. The health and safety of the donor is the most important concern during the evaluation. Only donors in good health are considered.

• Be either a relative or spouse,
• Have a compatible blood type
• Be in good overall health and physical condition
• Be older than 18 years of age and younger than 55 years of age
• Have-a-near-normal-body-mass-index-(not-obese)

• History of Hepatitis B or C
• HIV infection
• Active alcoholism or frequent heavy alcohol use
• Any drug addiction.
• Psychiatric illness currently under treatment
• A-recent-history-of-cancer

The-donor-should-be-having-the-same-or-compatible-blood-group.

Blood group compatibility chart

Note: The Rh factor (+/-) of blood type is not important in compatibility

• The gift of an organ can save the life of a transplant candidate.
• Donors have reported positive emotional experiences, including feeling good about giving life to dying person.
• Transplants can greatly improve recipients’ health and quality of life, allowing them to return to normal activities.
• Transplant candidates generally have better results when they receive organs from living donors as compared to organs from deceased donors.
• Better genetic matches between living donor and candidates may decrease risk of organ rejection.
• A living donor makes it possible to schedule the transplant at a time that is convenient both for the donor and the transplant candidate.

As a liver donor, you may stay in the hospital up to 10 days or longer in some cases. The liver typically regenerates in two months. Most liver donor returns to works and normal activities in one month, although some may need more time. Please talk to transplant team members to understand what to expect, although the surgery and recovery process can differ among living donors. Consider talking with other donors and contacting the organizations. Attend follow-up visits to clinic regularly as advised and do blood or other investigations to make sure that you are recovering well.

The biggest risks associated with liver transplants are rejection and infection..Rejection occurs when the body’s immune system attacks the new liver as an unwanted foreign substance; just as it would attack a virus. To prevent rejection, transplant patients must take drugs to suppress the immune system. However, because the immune system is weakened, it is harder for liver transplant patients to fight other kinds of infections. Fortunately, most infections can be treated with other medicines.

• Anti-rejection-drugs
• For the first-three months after transplantation you need to take the following medicines.
• Antibiotics–to-reduce-the-risk-of infections
• Antifungal-liquid-to-reduce-the-risk-of-fungal-infection
• Antacid–to-reduce-the-risk-of-stomach-ulcers-and-heartburn
• Any other medicines that you have to take will be prescribed for you depending on your Symptoms.

One’s body doesn’t accept other’s organ. It is body’s defense system to try to attack and destroy other’s organ. Anti rejection drugs makes defense mechanism weak against donor’s organ and allow liver graft to sustain and work normally.

Communication, cooperation and coordination between the transplant team, local physician, pharmacist, Liver Transplant Coordinator or Liver Transplant Consultant and the patient is essential for well-being of the Liver Transplanted recipient. It is important to follow the instructions that will help prevent or lessen complications.

One of a patient’s most important jobs is to ensure that family physician, local pharmacist, and his family members are aware of the transplant, the medications he takes each day, and the precautions he must follow to stay healthy. Each of his family members should have the telephone number of his Liver Transplant Coordinator or Liver Transplant Consultant.

The patient and his family members must be fully aware about the precautions to be taken after a successful Liver Transplant. Nothing can be taken for granted after this operation. A rigorous session with Liver Transplant Coordinator or Liver Transplant Consultant is recommended for the patient and his family members to understand the Life after Liver Transplant and precautions to be taken.

Liver transplant has excellent outcomes. Recipients have been known to have a normal life for over 30 years after the operation. The five year survival rate for liver transplant patients is about 75 percent.

Cirrhosis of the liver is a degenerative disease where liver cells are damaged and replaced by scar formation. As scar tissue is accumulated, blood flow through the liver is diminished, which causes more liver cells to die. The healthy liver cells are permanently destroyed and the scarring is irreversible. The liver then becomes nodular in appearance. The scar tissue that forms in cirrhosis harms the function of the liver. The loss of normal liver tissue slows the processing of nutrients, hormones, drugs and toxins by the liver, as well as production of proteins and other substances made by the liver.

• Excessive intake of alcohol
• Chronic viral hepatitis (such has hepatitis B and C)
• Non Alcoholic steatohepatitis(NASH)/ Fatty liver
• Inherited or congenital diseases such as hemochromatosis, Wilson’s disease,
• Alpha-1 antitrypsin disease and autoimmune hepatitis
• Prolonged obstruction of the bile ducts such as primary biliary cirrhosis and
• Primary sclerosing cholangitis
• Prolonged exposure to environmental toxins
• Some forms of heart disease
• Severe reactions to drugs
• Parasitic infections

• Vomiting of blood
• Encephalopathy or mental changes ranging from sleep disturbances and confusion to coma.
• Ascites (abdominal swelling due to an accumulation of fluid caused by the obstruction of blood flow through the liver)
• Jaundice (yellow discoloration of the whites of the eyes and skin because bile pigments can no longer be removed by the liver)
• Kidney function impairment
• Bleeding tendencies
• Increased susceptibility to infection
• Generalized muscle wasting and malnutrition
• Increased sensitivity to drugs, due to the inability of the liver to metabolize them
• Abdominal pain
• Enlargement of the liver (hepatomegaly)
• Enlargement of the spleen (splenomegaly)
• Loss of appetite
• Nausea and vomiting
• Weight loss
• Fatigue
• Dark colored urine
• Gray, yellow, or light colored stools
• Itching (due to the retention of bile products in the skin)
• Abnormal blood sugars
• Loss of sexual drive or performance
• Change in or loss of taste

Not everyone with cirrhosis will have all of the above mentioned signs and symptoms. Many patients may not have any symptoms and are found to have cirrhosis only on physical examination and laboratory tests; this is called compensated liver cirrhosis.

Hepatitis A, B, C, and D are viruses that primarily affect the liver.

Hepatitis A usually causes “acute” hepatitis and is cleared within six months from exposure and does not usually lead to chronic liver failure.

Hepatitis B and C on the other hand can lead to “chronic” hepatitis, lasting many years and can lead to cirrhosis and the development of hepatocellular carcinoma (HCC).

Hepatitis D is only seen in patients who are exposed to Hepatitis B. Other viruses like CMV (Cytomegalovirus), EBV (Epstein – Barr virus), and HSV (Herpes Simplex Virus) can also affect the liver and cause hepatitis.

Autoimmune hepatitis is a liver disease characterized by the formation of antibodies made by the individual’s immune system that affect the function of the liver, thereby destroying the cells and leading to cirrhosis.

Primary Biliary Cirrhosis is a chronic, progressive cholestatic liver disease that is indicated by the destruction of the small intrahepatic bile ducts leading to fibrosis and cirrhosis characterized by four stages.

Primary Sclerosing Cholangitis is a chronic progressive cholestatic liver disease that is characterized by ongoing inflammation, destruction, and fibrosis of both the intra- and extra-hepatic bile ducts. There is an increased incidence of Primary Sclerosing Cholangitis in patients with ulcerative colitis. Patients with primary sclerosing cholangitis have a greater risk of developing cholangiocarcinoma.

Alcohol related liver disease is associated with the excess use of alcohol. It can be connected to heavy binge drinking or daily use of alcohol more than 45 grams per day. Women are more susceptible to develop alcoholic liver disease than men.

NASH (non-alcoholic steatohepatitis) is accompanied by the presence of fat deposition within the liver cells that causes inflammation, fibrosis, and cirrhosis, which is not related to alcohol use. Some predisposing conditions linked to NASH are obesity, type 2 diabetes, and high lipid levels in the blood.

Cryptogenic cirrhosis is liver disease with an unknown cause. Basically, every possible cause for impaired liver function must be excluded.

Fulminant Hepatic Failure (FHF) is described as a progressive and rapid onset of liver failure in an otherwise healthy individual who did not have any previous history of liver disease. The overall survival of these individuals is 7-30% without transplantation. Some common causes are acute viral hepatitis, acetaminophen overdose, Wilson’s disease, Budd-Chiari Syndrome, mushroom poisoning, and drug-induced hepatitis (INH toxicity for example).

Budd-Chiari Syndrome is associated with an acute blockage of the hepatic veins. Patients usually develop fluid accumulation in the abdomen (known as ascites), abdominal pain, enlarged liver and spleen, gastrointestinal bleeding, yellowing of the skin (known as jaundice), and changes in their mental status.

Hemochromatosis is an inherited disorder that causes an overload of iron deposited into the cells of an organ that disrupts its function and can eventually lead to failure of that organ. Hemochromatosis primarily affects the liver but can also affect the heart and other organs as well. Diagnosis is usually made by measuring iron levels in the blood and with an MRI to look carefully at the organs.

Wilson’s disease is characterized by a copper storage abnormality associated with an enzyme deficiency that is made in the liver. Copper may be stored in many organs or tissues, but primarily affects the overall function of the liver cells. Diagnosis can be made by measuring Ceruloplasmin levels in the blood and urine, and careful examination of the eyes by an ophthalmologist.

Alpha-1 antitrypsin disease is associated with an inability of the liver cells to get rid of this particular enzyme. This disease can affect the lungs as well.

• Gastrointestinal Bleeding
• Ascites
• Spontaneous Bacterial Peritonitis (SBP)
• Hepatic Encephalopathy (HE)
• Hepatorenal Syndrome(HRS)
• Infection
• Hydrothorax
• Peripheral Edema
• Jaundice
• Muscle Wasting
• Gynecomastia
• Pruritus
• Hepatocellular Carcinoma (HCC)

• Do not drink excessive alcohol.
• Vaccination against hepatitis A and B.
• Do not use multiple medications or illicit drugs. Never mix alcohol with medications. Always talk to your physician about your medications and get your liver enzymes checked to make sure that the liver is functioning fine.
• Do not make it a habit of share personal care products with anyone, even household members.
• If you work with hazardous chemicals, change clothes before you go home. If you work in the garden and use chemicals, wear long sleeve shirts, gloves and a hat.
• Avoid high risk behavior. No to intravenous drugs, do not share needles or syringes. Never have sex without a condom with a stranger and avoid multiple sex partners.
• If you plan to have tattoos or have your body pierced, choose a place authorized to do so.
• Eat healthy, exercise and keep your weight down. Obesity is a well known cause of chronic fatty liver disease.