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Liver Transplant
What is a Liver Transplant?

It means that the entire diseased liver will be removed and will be replaced by a new liver.

What are the types of transplant?

There are two types of transplant Deceased Donor and Living Donor Liver Transplant (DDLT and LDLT).

What are the types of Organ Donors?

Brain dead organ donors

Most livers used for transplantation are obtained from patients who are brain dead. Brain death is usually due to a large stroke or massive trauma to the head from blunt injury.

Living Donors

Although each person has only one liver and would die without it, it is possible to donate a portion of the liver for transplantation into another individual.

What is DDLT? (Deceased Donor Liver Transplant)

This involves receiving a liver from a patient who has been declared brain dead by a team of doctors. This is commonly seen in patients who have been admitted due to a stroke or suffer from head injury secondary to a road traffic accident. After the declaration of brain death, the relatives have consented to give the “gift of life” and donate the organs of their deceased relative. The recipient (Patient suffering from liver disease) will get an entire liver.

How can I register myself for the DDLT?

You need to register with a recognized liver transplant centre. The hospital would then put your name on the Zonal Transplant Co-ordination Committee (ZTCC) waiting list; as per your blood group.

What would be the waiting period?

It is difficult to predict the waiting period as donations are very sporadic.

What is LDLT? (Living Donor Liver Transplant)

A relative donates a part of their liver to the recipient. Liver is the only solid organ to grow. It will regenerate, both in the recipient and the donor. It doubles in size in almost 2 weeks.

Why consider living donor liver transplantation?

This is an important choice to help meet the organ shortage. Adults on the Cadaveric liver transplant list currently wait up to a year or more for a liver transplant. Unfortunately, a vast majority of patients waiting for transplant (on the cadaveric list) will die before a liver becomes available.

Who can be a living donor?

Donors must be:

  • A blood relative or spouse, who share a compatible blood group with the patient
  • Between the ages of 18 and 55 years
  • In good health and an acceptable body mass index
  • Freely willing to donate
What has to be blood group of the donor to be compatible with the recipient?
Recipient / Patient Blood group Donor Blood group
A A / O
B B / O
AB AB / A / B / O

Rh factor (Positive /Negative) does not matter in liver transplant. Thus, “O” group is a universal donor and “AB” groups are universal recipients.

What is the work-up process for living donor?

The live donor assessment is performed by a team of doctors and a transplant coordinator; who will organize the assessment process. This will involve blood tests, X-rays, CT, MRI scans and detailed cardiac test.
There are also important meeting with members of the transplant team including a surgeon, hepatologist, cardiologist, pulmonologist, psychiatrist and gynaecologist. (In female donors)
Once the potential donor is accepted a date for surgery will be chosen. A ethics committee meeting will ensure that all the necessary permissions are in place

What does the donors operation involve?

The donor surgery lasts about 6 hours. The surgeons remove about half (Right or Left side) of the donor’s liver (depending on whether donation is to an adult or child), which is then transplanted into the recipient. Within 6 to 12 weeks the liver in donor and recipient regenerates (grows) to approximately 90% of its original size and function returns to normal.
The hospital stay is on average between 5-7 days.
Donors can usually return to work after 4-6 weeks.
However, he/ she will be unable to lift any heavy weights (More than 1 kg) for at least 3 months.

What are the risks to the donor?

Live liver donation is major intervention and inevitably there are potential risks associated with this kind of surgery.
These include:

  • Problems with aesthetics, wound infections, pneumonia and blood clots in the lungs or legs
  • Bleeding
  • Psychological stress
  • eath (1 in 200 for right lobe) (1 in 500 for left lobe) due to liver failure. It must be noted however that the vast majority of donors do extremely well and recover quickly from their surgery. The risks will be discussed at length when donors meet with the transplant team.
    Living Donor safety is the first priority of all transplant teams and utmost care is taken to ensure a thorough evaluation of the donor.
What does the recipient operation involves and what do we except?

The recipient operation goes on for around 8-12 hours. After the surgery, the patient would be in the ICU for approximately 3-7 days and shifted to the wards after that. The patient will have to stay for another 5-12 days in the wards. (Depending on the clinical condition)
The patient will have 3-5 tubes in his body and will be generally on a ventilator when he is shifted from the OT to the ICU.
Continuous and vigorous monitoring will be done in the ICU. Your doctor will keep a close watch on the patient’s clinical observation, blood test and any abnormal findings. The relatives will be constantly counseled and informed of the patient’s condition.

What are the risks to the recipient?

The risks in general would be the following. A detailed explained and counseling would be done by the transplant team

  • Bleeding (during the surgery or in the postoperative period)
  • Infections and sepsis
  • Reversible kidney damage
  • Bile leaks
  • Rejection
  • Thrombosis or blocks of the connected major vessels
  • Primary non-function: Rarely the transplanted liver does not work at all. The only treatment is re- transplantation.
What are the chances that the patient would not survive a transplant?

If you experience severe complications (mentioned above), the stay in ICU and ventilator may be prolonged.
This is a critical period. Unfortunately, a proportion of these patients do not survive this period. The worldwide acceptable mortality rates are in the range of 5-10%.

When can I resume my normal work life?

Generally, after 3 months. Depending on your clinical condition and liver function test, the doctors will deem you fit to resume your duties and lead a normal life again.

How many medicines do I have to take after discharge?

Around 10-12 medication in the first month. These gradually reduce to 2-3 after 3 months and only one single tablet after 9-12 months. The most important medicine would be the immune-suppressive medications that need to be taken life long and cannot be changed or dose-adjusted without your doctor’s permission.

What are the benefits of liver transplantation?

The main aim of a liver transplant is to replace the unhealthy liver with a healthier one, thus leading to the restoration of regular health of the patient. A number of critical liver diseases can be cured by going for liver transplant.

Local Legal Requirements?

It's important that the donor and recipient understand the risks and benefits involved in liver transplant. Our transplant coordinators advice them on the right procedures that are to be followed during the entire liver transplant process.

What is rejection?

When the liver is transplanted from one person (the donor) into another (the recipient), the immune system of the recipient triggers the same response against the new organ that it would have against any foreign material, setting off a chain of events that can damage the transplanted organ. This process is called rejection. It can occur rapidly (acute rejection), or over a long period of time (chronic rejection). Rejection can occur despite close matching of the donated organ and the transplant patient.

How is rejection prevented?

After the liver transplant, you will receive medications called immunosuppressant. Immunosuppressant weaken your immune system's ability to reject your new liver. These medications slow or suppress your immune system to prevent it from rejecting your new liver. Immunosuppressant drugs greatly decrease the risks of rejection, protecting the new organ and preserving its function. These drugs act by blocking the recipient's immune system so that it is less likely to react against the transplanted organ. A wide variety of drugs are available to achieve this aim but work in different ways to reduce the risk of rejection. They may include steroids, cyclosporine, tacrolimus, sirolimus, and mycophenolate mofetil. You must take these drugs exactly as prescribed for the rest of your life.

Do immunosuppressant have any side effects?

Immunosuppressant drugs lower a person's resistance to infection and can make infections harder to treat. Although these medications are meant to prevent rejection of the liver, they also decrease the ability of the body to fight off certain viruses, bacteria, and fungi. The organisms that most commonly affect patients are covered with preventive medications. However, avoiding contact with people who have infections is very important.

What are the signs and symptoms of rejection?

Here is a list of signs and symptoms that may indicate liver graft rejection:

  • Fever greater than 100°
  • Fatigue or excess sleepiness
  • "Crankiness"
  • Headache
  • Abdominal swelling, tenderness, or pain
  • Decreased appetite
  • Jaundice (yellow skin or eyes)
  • Dark (brown) urine
  • Itching
  • Nausea

None of these symptoms are specific for rejection; but they are important enough that when they occur, they should prompt a call to your doctor who will decide whether the situation warrants further investigation or should be observed for the time being.
It is very important to realize that rejection of transplanted liver is quite variable. Some patients will feel perfectly well, only to discover that their liver is being attacked by their immune system. In fact, it is more likely than not that there will be minimal or no symptoms of rejection.

What if the transplant doesn't work?

Optimism is the need of the hour. Most liver transplant operations go well. About 90 percent of transplanted livers are still working after 1 year. Sometimes the liver takes a long time to work. There are varying degrees of failure of the liver, however, and even with imperfect function, the patient will remain quite well. If there are complications – say, the new liver fails to function or your body rejects it, your doctor and the transplant team will decide whether to replace the failing transplanted liver by a second (or even third) transplant operation. Unfortunately, there is no dialysis treatment for livers as is possible with kidneys. Researchers are experimenting with devices to keep patients with failing livers alive while waiting for a new liver.

Can I go back to my daily activities?

Certainly. After a successful liver transplant, most people are able to go back to their normal daily activities. Getting your strength back will take some time, depending on how sick you were before the transplant. Your doctor will be able to tell you how long your recovery period is likely to be.

How safe is it for women to become pregnant after transplantation?

Studies have shown that women who undergo liver transplantation can conceive and give birth normally, although they have to be monitored carefully because of a higher incidence of premature births. Mothers are advised against nursing babies because of the possibility of immunosuppressive drugs being transmitted to the infants through breast milk.

How the organs are selected and checked for matching?

When an organ becomes available for donation, it's checked to make sure it's healthy. The blood and tissue type of both donor and recipient are also checked to ensure they're compatible. The better the match, the greater the chance of a successful outcome.
People from the same ethnic group are more likely to be a close match. Those with rare tissue types may only be able to accept an organ from someone of the same ethnic origin.
Better matching of the donor organ to the recipient will improve transplant outcomes and benefit the overall waiting list by minimizing graft failure and need for re-transplantation.