All you need to know about liver transplant

Doctors in Chennai have recently done a transplant procedure with the harvested liver of a brain-dead person. Read on to know everything about liver transplant and its implications.

By: Jahnavi Sarma | | Updated: July 4, 2019 9:20 pm

With the novel perfusion technology, livers -- and even injured ones -- can be kept alive outside the human body for a week©Shutterstock

Recently, doctors from Gleneagles Global Health City performed the first successful deceased donor liver transplant (DDLT) at SRM Medical College and Hospital Research Centre in Katankulathur, Chennai, in a 6-hour long surgery. This is a milestone in transplant procedures in India. Surgeons harvested the liver of a brain-dead person for the surgery. Also Read - Rare liver transplant saves two lives

The first DDLT was performed in India in 1995 but it was unsuccessful. The history of DDLT is not very encouraging and there is also a large gap between demand and supply. Most successful liver transplants in India are from living donors. This is why the success of this recent surgery is being lauded in medical circles. Also Read - Liver diseases: All you need to know about them

The importance of the liver for a healthy life can’t be stressed on enough. It is the largest organ in your body, located just below the diaphragm on the right side of the abdomen. This organ makes most of the proteins needed by your body, breaks down nutrients from food to make energy, stores certain vitamins, minerals and sugar and secretes bile. This helps in the digestion of fat and absorption of vitamins A, D, E, and K. It regulates blood clotting and helps the body to fight off infections. Hence, it is absolutely essential that you take care of this organ and keep it functioning smoothly. Also Read - 6 things that may damage your liver

What affects the liver?

Certain medical conditions, however, can affect the proper functioning of your liver. A doctor may recommend a liver transplant if a patient suffers from acute liver failure, which can be the result of serious liver related diseases like viral hepatitis, drug-induced injury or severe infection. Through this procedure, surgeons replace a diseased liver with a whole or partially healthy liver from another person. Here, we guide you through the preparation, process, and outcome of a liver transplant. We also tell you, how to choose the right liver donor.

Who needs a liver transplant?

Our liver has amazing self-healing capabilities. But constant injury and abuse can damage it beyond repair. A transplant is the only option for a person with acute liver failure. It could be due to chronic health conditions like cirrhosis or it can be due to viral and bacterial infections, severe food poisoning and due to a reaction to certain medications. It can also be the result of overdosing on acetaminophen. Symptoms of liver failure are yellow skin, nails and eyes followed by confusion.

Sources of liver for a transplant

Livers can be harvested from brain-dead patients or from living donors. If the person is brain dead, strict guidelines have to be adhered to before a doctor harvests the organ. The consent of the family is needed to harvest the organ. But in countries like France, consent is presumed unless the family objects.In such cases, the donor’s heart is still beating though there is irreversible damage to the brain. He is usually on life support. A person whose heart is not beating cannot be a donor. There are transplant centres that send specialised teams to procure the organ. The procedure takes place in a hospital and the organ is removed and stored for transplant. It is then transported to the hospital of the recipient.

In case the donor is a living person, he or she is checked for medical fitness and other criteria like blood group and age. The donor has to undergo extensive medical and psychological evaluations. Blood group and body size are matched. It is better if a donor is below 60 years of age. If everything is okay, a portion of liver is removed and transplanted in the patient. The procedure takes place in a hospital under anaesthesia. Both the donor’s and patient’s liver grow back to normal within a few weeks.

Who is the right liver donor?

The donor has to be medically fit and healthy. There are strict guidelines that monitor such procedures. There should be no evidence of liver disease, alcohol or drug abuse. A person with any kind of cancer is not a fit donor. Donors are also tested for hepatitis, HIV and all kinds of infections. As a final step, a donor’s blood group and body type are matched with the recipient.

How to prep for a liver transplant

Your surgeon will need all previous doctor records, X-rays, liver biopsy slides and a record of medications prescribed before your liver transplant. You will also have to undergo a full body check. CT scans and chest X-rays will be taken again before the surgery to check your heart and lungs and you will have to undergo a Doppler ultrasound to see if the blood vessels to and from the liver are open.

Your doctor might also insist on an echo-cardiogram to verify heart function. They will conduct blood tests to determine blood type, clotting ability and biochemical status of blood. You will also have to undergo a liver function test. You will also be screened for HIV, hepatitis and other viral infections. If any problems are found, your doctor may order a second round of tests or delay the procedure by a few days till all health issues are taken care of.

The process

In this procedure, the surgeon has to first remove and prepare the donor liver. Then he will have to remove the diseased liver of the patient and then implant the donor organ in the patient’s body by removing all attachments.

The surgeon will then have to perform several other procedures to ensure that the new liver receives the required blood flow and is also able to drain bile from the liver. They have to reattach the inferior vena cava, the portal vein, the hepatic artery and the bile duct to the liver.

Associated complications

Complications are very common in all surgical procedures and this is no different. Some common yet serious complications can arise after his procedure. The most serious one is the inability of the new organ to function properly. This happens when the body rejects the organ. If this condition does not improve fast, another transplant will become necessary. Another complication is hepatic artery thrombosis or clotting of the hepatic artery. This is very common in patients who receive a living donor transplant. Portal vein thrombosis is another problem that can prevent the flow of blood from abdominal organs to the liver. Leaks in the bile duct or a narrowing of said duct can also happen. But this heals with time. Of course, bleeding and risk of infection is always there.

Going home

You may have to be in hospital for around 3 weeks. Sometimes, a patient may be released early. But, discharge from hospital depends on recovery and complications, if any.

Before sending you home, your doctor will give you a set of instructions to follow at home. Nursing staff will instruct you on your new medications and show you how to monitor your blood pressure and pulse. They will also tell you to watch out for signs of rejection and infection.

Follow up

You need to visit your doctor after about 1 to 2 weeks after discharge. After that, you need to go for regular check-ups on the third, sixth and ninth months from the date of the transplant. A visit once a year is fine after this.

Published : July 4, 2019 9:14 pm | Updated:July 4, 2019 9:20 pm

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