Liver damage due to various injuries can be reversed with timely management- reversibility also depends upon the stage of the disease. Treatment and management of liver disease depend on the type of injury and causative factors. Complete abstinence from alcohol – can reverse, stop or delay the progression of liver damage. Timely treatment for Hepatitis B and C again can slow down the progression of liver disease. Fatty liver can be reversed by diet control, exercise, lifestyle modification. When Liver damage becomes irreversible, a liver transplant becomes the only option for treatment.
Liver Transplant
- Every year close to 2.5 lakh death happens in India due to liver failure
- There are estimated to be more than 30,000-40,000 patients who could be saved by a liver transplant
- In India, only 1500 liver transplants are done in a year
- There is a huge unmet need for liver transplantation in India.
Who needs Liver transplantation?
- Acute Liver Failure, Severe Viral Infections (Hepatitis A or B)
– Rat Poisoning ( yellow Phosphorus)
– Excessive ingestion of Paracetamol, some herbal drugs, or Chinese medications
- Chronic Liver disease (cirrhosis). The cause of cirrhosis can be excessive alcohol, viral infection like hepatitis B or C, autoimmune disease like autoimmune hepatitis, Sclerosing cholangitis, Primary biliary cirrhosis
- Cirrhosis per se is not an indication of a transplant. Decompensated cirrhosis( cirrhosis with complications) should be seen by Transplant doctors. There are various objective markers used by the transplant team to assess the risk and benefits of recommending any patient for a liver transplant. The Childs- Turcotte- Pugh (CTP) score of more than 7-8 and MELD ( Model for End-Stage Liver Disease) of more than 15 should be seen by the transplant team
- Hereditary disease leading to chronic liver damage like Wilson’s disease, Hemochromatosis, Alpha -1 antitrypsin deficiency.
- Liver cancer – Not all liver cancer patients are candidates for a liver transplant. There are specific criteria known as UCSF or Milan criteria that determine eligibility for liver transplant
- Pediatric patients have a different indication for a liver transplant. Biliary atresia is the most common cause of liver failure requiring a Pediatric Liver Transplant.
Source of Liver for Liver Transplant
The Liver for transplant can be obtained broadly from two sources:
- Braindead ( cadaver ) – If unfortunately, someone suffers severe brain injury leading to brain death. If that person has already pledged his or her organs or family decide to opt for Organ Donation as a gift of life. Liver from such cadavers can be used for transplantation. Patients should be listed on the waiting list and organs are allocated as per Maharashtra Govt rules by ZTCC( Zonal Transplant Co-ordination Centre)which is not a profit Government organization
- Living Donor – A part of the liver is taken from a healthy, relatively young person ( generally first kin blood relative) who is willing to donate to save the life of his or her dear one. Liver is the only solid organ that has the capacity to grow and regenerate after it is cut and divided. In 3 months Liver grows back to almost 90% of its original volume. Before accepting anyone as a donor a thorough medical check-up with laboratory test along with heart, lungs check-up is done. CT scan is done to make sure the liver has enough volume for both donor and recipient. Only after a thorough check-up which also includes Psychologist and psychiatrist counseling, a person is accepted as a donor candidate
Team Approach
All the liver disease patients are seen by Liver transplant Surgeons, Physicians, Nutritionists, Physiotherapists. A good outcome can be ensured only by optimizing the condition of the patient. Here the role of Nutritionist and physiotherapist becomes crucial. All our patients have individual and group sessions with dieticians and physiotherapists. They get individualized diet plans according to personal taste and preferences.
Liver Transplant workup
- Whether someone opts for a Living donor Liver Transplant( LDLT) or a deceased donor (DDLT), the workup of the recipient is mostly similar. A detailed and comprehensive workup is done which includes testing for the cause of liver disease, complications of chronic liver disease. A detailed cardiopulmonary workup is done to ensure the patient can withstand the stress of surgery. Any immunization which has not been done in past is given to patients while waiting for transplants.
The Operation
- In LDLT, the operation can be planned according to the severity of the disease. In DDLT, patients get called for transplant as an organ becomes available.
- Operation generally lasts 8- 10 hours. It involves two teams of surgeons, anesthetists, Nurses, Technicians. A liver transplant involves the coordination of a large number of departments including pathology, blood bank, microbiology, ICU, Radiology, OT staff
- After transplant Patients stay in an Isolation room in ICU for the next 4- 5 days depending upon condition.
- Patient will be under the strict supervision of doctors, nurses for bleeding, infection, and other complications. To prevent rejection, patients are started on anti-rejection medication (immunosuppressant). These medications need to be continued lifelong. 90% of our patients get discharged within 2 weeks after transplant.
Results of Liver transplant
- Results of liver transplants are measured as 1,5 years of survival. The 1-year survival of liver transplants is close to 90%. 5-year survival is close to 70 %. Survivals are a little higher for LDLT as compared to DDLT( as LDLT can be done in a planned manner and patients does not have to wait to get an organ offer)
- Main complications occur in the first year( more in the first 3 months) after liver transplant which includes bleeding, infections, blockage of one of the blood vessels going to liver, rejections, Bile duct narrowing
Quality of life after Liver transplant
- By the end of three months, most of the patients are on just 2 pills twice a day.
- Change in the quality of life of a patient after transplant is truly amazing. Patients have done Mansrover Yatra after one year of liver transplant treatment. People have gone back to work, participated in sports, trekking, and various other activities. Recipients can expect a life that is normal in all respects including longevity, reproductive function, and physical activity. Most women have a normal pregnancy after a liver transplant. In the case of the children, those with growth failure secondary to liver disease will resume growing, and that there appears to be a general improvement in lifestyle.