All you need to know about Liver Transplantation

Liver transplantation is a surgical procedure to replace diseased liver with a whole or partial healthy liver. Healthy liver can be obtained from three kinds of donors – Brain dead donor (Cadaver), and living donor.

Liver is considered as the power house of the human body. It is the largest internal organ of the body located above the stomach, and below the diaphragm. Liver produces bile, stores vitamins, filters toxins, promotes metabolism, fights infections and produces proteins that help in blood-clotting. Hepatic artery brings oxygenated blood and nutrients to the liver. Hepatic vein drains the blood from the liver to the heart.

Who needs liver transplant?

Acute or chronic liver failure, there is no substitute to liver transplant. Acute liver failure or fulminant hepatic failure is a condition in which the liver suffers from massive injury, and the efficiency of liver decreases. Acute liver failure may occur due to drug overdose or reaction, viral infections, toxin ingestion due to poisonous mushrooms.

The visible symptoms of acute liver failure include confusion (encephalopathy), and yellow skin (jaundice). Acute liver failure patients need to wait for weeks or months for liver transplant. If the liver transplant is not done in time, it may lead to deterioration in the health and death of the patient.

Chronic liver failure is also described as decompensated liver disease. This condition is marked by repeated injury and repair. In the final stage, called cirrhosis, the liver shows inadequate functioning. Medication help to certain extent, however transplant serves as the only permanent cure.

What are the symptoms of liver failure?

The four major symptoms of liver failure are gastrointestinal bleeding, fluid retention, encephalopathy and jaundice. When the liver is scarred, the blood cannot flow through the usual portal venous system, and puts pressure on the smaller veins called varices. These varices get enlarged due to excess flow of blood leading to their rupture and bleeding.

An incapacitated liver cannot synthesize the proteins circulating in the blood stream. These substances (albumin etc.) accumulate as fluid in the abdominal cavity and legs. When ammonia and other toxins in the blood are not cleared by the liver, it leads to their accumulation in the body. This condition leads to sleeplessness, mild confusion and coma. When the liver fails to clear bilirubin from the blood, its accumulation spreads to skin and other tissues of the body, making the body to take yellow colour.

What causes chronic liver injury?

Viral Hepatitis (Hepatitis B and C) constitutes the common indication for liver transplantation.

• Excess of alcohol consumption
• Accumulation of fat within the liver cells leads to inflammation, injuries and scars
• Autoimmune, genetic and vascular liver diseases
• Hepatocellular Carcinoma or liver cancer

Who are not eligible for liver transplant?

Under certain conditions, liver transplantation is completely avoided viz. severe medical illness and pulmonary hypertension, cancer and systemic infection, drugs & alcohol abuse, and uncontrolled psychiatric disease.

Who can donate liver for organ transplant?

The liver can be obtained from brain dead (cadaver) and live donors. There is an established criterion for obtaining organs from a brain dead person. Importantly, the family of the brain dead should provide consent or organ/tissue donation. A team of specialized doctors and surgeons are sent to procure the organ for transplant.

Organ procurement from the brain dead or living takes place in the operation room at the donor’s hospital. After procuring the liver, it should be transported in a specialized container. As the liver can live for only 12 hours outside the body, the liver transplant should take place within the limited time.

Living donors can donate a part of their liver for transplantation. So, depending on the recipient’s liver tissue requirements, the surgeons obtain only a portion of the liver. The partial liver transplant will help in the growth of liver tissues. The partial liver transplant is considered as safe for both donor as well as the recipient.

What are the steps involved and safeguards taken during Liver Transplant?

Liver transplant is a complex process, which demands the expertise of specialist doctors, and adherence to safeguards. There are several connections that need to be established to allow for proper blood flow to the liver, and drain bile from the liver. Vena cava, the portal vein, hepatic artery and bile duct have to be reconnected. The steps and safeguards for liver transplant include,

Evaluation of abdominal abnormalities

• Dissection of liver attachments: connecting vena cava, the portal vein, the common bile duct, the hepatic artery
• Removing the native or diseased liver
• Controlling bleeding
• Achieving complete closure of the incision

What are the surgical complications of Liver Transplantation?

Patients who have undergone liver transplant may face the following complications:

Non-function or poor function of the newly transplanted liver

• Hepatic artery thrombosis, or clotting of the hepatic artery
• Portal vein thrombosis
• Biliary leak and stricture complications
• Excessive bleeding in the post-transplant phase
• Infections during the healing of the wound
• Rejection of the transplanted organ by the body’s immune system
• Hepatitis C virus in the blood in the pre and post-transplant stages

There are different rejection treatments viz. high dose of corticosteroids, strong anti-body preparations, and others. Liver biopsy is advised when a liver rejection is suspected. The liver tissue is inspected to understand the injury and analyzed for the presence of immune cells. A large selection of immunosuppressive drugs ensures that rejection is effectively reversed.

Yashoda Hospitals‰’ Institute of Liver Transplant & Hepatobiliary Diseases

Yashoda Hospitals Hyderabad Institute of Liver Transplant & Hepatobiliary Diseases provides comprehensive and highest quality Live Donor and Deceased (cadaveric) Donor Liver Transplantations. The Institute of Liver Transplant & Hepatobiliary Diseases includes Multi- disciplinary Liver Transplant Team, and Dedicated Liver Intensive Care Units (LICU) that help to accomplish Complex Hepatobiliary Surgeries.

The integrated liver care team at Yashoda Institute of Liver Transplant & Hepatobiliary Diseases will evaluate the recipient as well as donor thoroughly before performing the transplant. A battery of investigations are done to ensure the fitness of the recipient and the donor. The vital organs- Heart, Lungs, Kidney and all others should be in good shape prior to the transplant.

Yashoda Hospitals’ Institute of Liver Transplant & Hepatobiliary Diseases features,

Comprehensive care for Liver and Hepatobiliary diseases including terminal liver disease, liver cancer and liver transplantation

• Surgeons with vast experience from leading institutes across the globe
• Completely in-house Liver Transplant Team
• Multi- disciplinary Liver Transplant Team has performed more than 2000 Liver Transplants
• Live Donor and Deceased (cadaveric) Donor Liver Transplantation for Adult and Paediatric Patients
• Dedicated Interventional Radiologists and Liver Pathologists
• Highly advanced and dedicated operating rooms for Liver Transplantation
• Dedicated Liver Intensive Care Units (LICU)