Liver Transplant

About Liver Transplant

A Liver Transplant is a life-saving surgical procedure in which a diseased or failing liver is replaced with a healthy liver from a donor. It is primarily recommended for patients with end-stage liver disease, liver failure, or certain liver cancers. The donor liver may come from a deceased donor or a living person who donates a part of their liver.

The liver is the only organ in the human body capable of regenerating, which makes living-donor transplants possible. After a successful liver transplant, the new liver resumes normal function and the patient can return to a better quality of life.

Types of Liver Transplant

1. Deceased Donor Liver Transplant (DDLT):
   A liver is obtained from a brain-dead donor whose family has consented to organ donation. This is the most common type.
2. Living Donor Liver Transplant (LDLT):
   A healthy individual donates a portion of their liver (usually the right lobe for adults). Both the donor’s and recipient’s livers regenerate to full size within a few months.
3. Split Liver Transplant:
   A liver from a deceased donor is split into two segments and transplanted into two recipients — usually one adult and one child.
4. Auxiliary Liver Transplant:
   A partial liver from a donor is transplanted without removing the recipient’s own liver. This is usually done in metabolic liver diseases where the original liver may recover.

Symptoms Indicating Need for Liver Transplant

Liver transplant may be required for patients with:

• Cirrhosis (due to hepatitis B/C, alcohol, NASH)
• Acute liver failure
• Liver cancer (Hepatocellular Carcinoma)
• Genetic liver diseases (e.g., Wilson’s disease, hemochromatosis)
• Biliary atresia (in children)
• Repeated ascites or hepatic encephalopathy
• Severe jaundice, fatigue, confusion, or bleeding

Risk Factors

Liver transplant, like any major surgery, carries risks:

• Rejection: The immune system may recognize the new liver as foreign and try to attack it. Lifelong immunosuppressants are required.
• Infection: Immunosuppressants increase the risk of bacterial, viral, and fungal infections.
• Bleeding: The liver is a highly vascular organ; excessive bleeding may occur during surgery.
• Blood Clots: Clotting in the portal vein or hepatic artery may lead to graft failure.
• Bile Duct Complications: Bile leakage or narrowing of bile ducts (strictures) may require intervention.
• Kidney Dysfunction: Caused by immunosuppressants or underlying liver disease.
• Recurrence of Liver Disease: Conditions like hepatitis B or fatty liver may return.
• Cancer: Long-term use of immunosuppressants slightly increases the risk of certain cancers.

Investigations

To assess eligibility and prepare for a liver transplant, doctors perform extensive evaluations:

• Blood Tests: To assess liver function, clotting ability, viral markers (e.g., hepatitis), and kidney function.
• Imaging Studies: Includes ultrasound, CT scan, or MRI to evaluate liver size, structure, and blood flow.
• Endoscopy: To check for varices or internal bleeding.
• Liver Biopsy: May be done to evaluate liver damage.
• Cardiac and Pulmonary Tests: To assess overall fitness for surgery.
• Psychological Evaluation: To ensure the patient is mentally prepared and compliant with post-transplant care.
• Donor Evaluation (in case of living donor): Compatibility tests and imaging to ensure donor safety.

Side Effects

After liver transplantation, patients may experience:

• Fatigue and weakness during early recovery
• Nausea or digestive disturbances
• Swelling or fluid retention
• Side effects of immunosuppressants such as weight gain, high blood pressure, diabetes, or increased infection risk
• Hair thinning, acne, or mood changes (due to steroids)
• Mild rejection episodes, which are treatable with medication

Most side effects can be managed with proper post-operative care and regular follow-ups.

Success Rate

Liver transplants have high success rates, especially with early intervention and expert surgical care:

• 1-year survival rate: 85–90%
• 5-year survival rate: 70–80%
• Living donor transplants often show even higher success due to reduced wait time and better organ condition.
• With lifestyle modifications, regular monitoring, and medication adherence, many patients live 15–20 years or more after transplant.

Recovery time is usually 3 to 6 months, with the patient returning to normal daily activities and improving significantly in energy levels and overall health.