LIVER TRANSPLANT : GET TO KNOW ALL ABOUT IT

OVERVIEW

A liver transplant is a surgery in which a diseased or infected liver is replaced by a healthy liver form another person, that is the donor.

Not all liver diseases require a liver transplant, some liver diseases may be cured at the initial stage itself if treated with proper medication.

Liver failure, that is when an individual’s liver stops functioning is one of the main reasons for liver transplant.

 

LIVER STRUCTURE AND FUNCTION

• Liver is the largest and one of the major glands in human body.
• It is located in the upper right quadrant, that is the right hypochondric region and is situated just below the diaphragm.
• The liver is lined by a fibrous connective tissue capsule known as the Glisson’s capsule.
• Cellular composition of liver is simple as it consists of the repetition of a simple structure called lobule.
• Hepatocytes are cells that are organized in the anastomosed layer and form a complex structure and it does the endocrine secretion of a large number of plasma proteins like lipoprotein and albumin.
• The liver is divided into several lobes namely, left lateral lobe, left medial lobe, and right lateral lobe, right medical lobe, and quadrate.
• These lobes are further divided into segments which contain a large number (nearly 1000) lobes.
• Liver performs various major functions in the body:
• Filtration of blood that comes out of the digestive tract
• Liver secreted bile which is a very important aspect of fat metabolism.
• Production of blood proteins that help in blood clotting.
• Glycogenesis, that is the process of storing excess of glucose in the form of glycogen occurs here in liver
• Conversion of poisonous ammonia into urea that can be excreted through urine
• Regulates the blood chemical levels
• Helps in clearance of bile
• The liver produces cholesterol and protein that carry the fat through the body and hence helps in fat metabolism

WHEN DOES ONE REQUIRE A LIVER TRANSPLANT?

One requires a liver transplant when the liver and its functions are damaged beyond the body’s capacity, that is the body cannot regenerate it. There are various reasons for liver transplant in children as well as in adults.

Reason for liver transplant in children

• Amongst children one of the most common reason for liver transplant is biliary atresia.
• Biliary atresia is a condition in which the bile ducts that transport bile from the liver to the gallbladder and also helps in digestion are underdeveloped from birth itself.
• In some cases, this condition solves over a period of time through reconstructive surgery while in some cases the children go on to develop deep jaundice due to the lack of transfer of bile and hence its accumulation and finally liver failure.

Reason for liver transplant in adults

• Chronic infection with hepatitis C virus
• Hepatitis B virus
• Primary biliary cirrhosis
• Non-alcoholic fatty liver disease
• Primary sclerosing cholangitis

Tumors are also one of the major reasons that may lead to liver transplant. Hepatoblastoma (in children) and hepatocellular carcinoma (in adults) are the most common forms of tumor that makes liver transplant a necessity.

 

TYPES OF LIVER TRANSPLANT

There are basically two types of liver transplant in general:

1. Deceased donor transplants

• This is also known as orthotropic transplant
• In deceased type of liver transplant, the donor of a healthy liver is a person who has just died.
• Surgeons remove the diseased or the damaged liver from the patient (that is the receiver) and replace it by the new healthy liver received from the donor.
• Sometimes, the surgeon may split the deceased liver into two parts out of which the larger part goes to the adult receiver and the smaller part goes to the child or smaller adult receiver.

2. Living donor transplants

• Living donor transplants as the name itself suggests that the donor here is a living person.
• A living person donates his or her part of the healthy liver.
• The surgeon then replaces the infected or the damaged liver of the receiver with this healthy part of the liver received from a living donor.
• The part of the liver that the receiver receives and the part of the liver that the donor donates, both grow back to normal size.
• As compared to deceased liver transplants, living donor transplants are less common.

 

LIVER TRANSPLANT SURGERY PROCEDURE

There are basically three procedures that are included in this surgery, all of them are listed and describes below :

PRE-OPERATIVE SURGERY PHASE

• The doctor will view your medical history
• He will check all your previous medical reports of X-ray, liver biopsy, etc.
• He may recommend you to do the following diagnostic tests

1. Computed tomography, that is CT scan of the liver
2. A chest CT scan may also be needed

• Doppler ultrasound to keep a check on the blood vessels that are going to and coming from the liver

1. Echocardiogram, this is done only for adults, and keeps a check on your stress to evaluate your heart
2. Pulmonary function studies to keep a check on lung function activity
3. Blood tests to determine blood type, clotting ability and biochemical status of blood

• Serology screening, this is a blood test that looks for antibodies is also required.

OPERATIVE PHASE

• Liver transplant is a major procedure an it usually takes 6-12 hours for the entire procedure to take place.
• The doctors will need to insert several tubes in the patient’s body which will help in carrying out certain functions during the operation as well as few days after it
• A tube will be placed through the patients mouth into his lungs to help him breath during the operation and few days after. This tube will be attached to a ventilator which will expand the lungs mechanically.
• A nasogastric tube will be inserted through the patients nose to his stomach to drain secretions from his stomach.
• A tube called catheter is placed into the bladder to drain urine.
• Tubes are also placed in the patient’s abdomen to drain blood and fluid from and around the liver.
• After this the patient is given general anesthesia.
• An incision is made at the site of operation .
• The doctor will replace the damaged liver with the healthy one and then the site is closed with the help of stitches.                                  POST-OPERATIVE PHASE
• This is a very sensitive phase and the patient has to be kept under utmost care.
• All necessary precautions must be taken to prevent infection, bleeding and formation of blood clots.

 

RISKS OF LIVER TRANSPLANT SURGERY

• The body might recognize the new liver cells and foreign substance and may attack it
• The transplanted liver might fail to function as expected
• Heart or kidney failure
• Severe extrahepatic infection
• Long term use of immunosuppressants may have certain side effects on the body
• Advanced heart or lung disease

 

RECOVERY TIME AFTER LIVER TRANSPLANT SURGERY

The recovery time after a liver transplant surgery ranges from few weeks to few months.

The healthy liver that is placed in your body might take few weeks to grow back to its normal size and it might take few months to be fully functional.