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Liver Transplantation

What is the process of Liver Transplantation?

What should be known about a Liver Transplant?

How to confirm the need for a liver transplant?

Where will this new liver come from?

What happens in hospital?

How to prevent organ rejection?

Are there any side effects of Immunosuppressive medication?

What are signs of organ rejection?

Is life normal after a transplant?

 

What is the process of Liver Transplantation?

Liver transplantation involves removal of the old diseased liver which is replaced with a new one. This involves the need for a donor. This procedure comes under the purview of the law governed by the Transplant of Human Organ Act, 1994. This is a law mainly for the protection of organ donors so that they are not made victims of coercion in various social circumstances.

What should be known about a Liver Transplant?

In adults, a key reason for a liver transplant is cirrhosis. This can be caused by various diseases that destroy healthy liver cells. Certain causes of cirrhosis are

 long-term infection from hepatitis B and C virus

Overuse of alcohol over time

autoimmune liver diseases

the buildup of fat in the liver

hereditary liver diseases

In children, a common cause for a liver transplant is biliary atresia. This is a condition where bile ducts are missing, damaged, or blocked. These are vital tubes that carry bile from the liver to the gallbladder and small intestine. When bile ducts are blocked, bile flows back to the liver and causes cirrhosis.

Other reasons for needing a liver transplant include

sudden liver failure, called acute liver failure, most often caused by taking too much paracetamol

liver cancers that have not spread outside the liver

 

How to confirm the need for a liver transplant?

The doctor will decide this and refer the patient for evaluation by a liver transplant team. The team includes liver specialists, called hepatologists; liver transplant surgeons; a transplant coordinator and nurses among other health care professionals all working using a multi-disciplinary team approach. The transplant team will begin by running a series of blood tests, an x ray, and other investigations to help decide the benefits from a transplant.

The transplant team will also check to see if

the patient’s heart, lungs, kidneys, and immune system are strong enough for surgery

the patient is mentally and emotionally ready for a transplant

the patient has a support system with family members or friends who can care before and after the transplant

the patient has the finances to cope with the long term care needed post transplantation

 

Where will this new liver come from?

A healthy living near relation will donate part of his or her liver to a patient needing a liver transplant. This donor is usually an immediate family member- related emotionally to the patient.

All living donors are subjected to several tests before transplant surgery. These include

Blood tests

CT Scan

MRCP

Viral tests

Chest X-ray

 

These tests will ascertain the donor’s blood group compatibility with the recipient. These tests will also confirm that the part of the liver to be donated will be adequate for the recipient without risking a donor’s well being. In addition to this, clearances are also needed for the donor from the Cardiologist, Pulmonologist and Gynecologist (if the donor is female). Besides making sure that the donor’s liver will work as it should, it is also important to establish that the donor has no other pre-existing disease.

Transplantation involves a multi-disciplinary team approach wherein each case is put forward before a transplant board and discussed thread bare to ensure the best possible results.

What happens in hospital?

Both the donor and recipient will be admitted to the hospital for a surgical procedure taking place at the same time. The surgery can take anything from 12 to 20 hours. The surgeon will remove the recipient’s old diseased liver and then replace it with the donated liver.

 

After Surgery

 

Post surgery, the stay in the hospital is about 30 days to be sure that the new liver is working. Medicines need to be taken to prevent infections and the body rejecting the new liver. The team of doctors will check for bleeding, infections, and liver rejection. During this time, a patient will learn how to take care of himself/herself as part of preparation for care at home including information about the medicines that are to be taken life long.

 

Possible Complications

 

The new liver may not work

The new liver may be rejected by the recipient’s body

blockage of blood vessels going into or out of the liver is possible

damage to the bile ducts is possible

 

 

About organ rejection

Rejection occurs when the immune system attacks the new liver. After a transplant, it is common for the immune system to try and destroy the new liver.

 

How to prevent organ rejection?

Immunosuppressive medicines are needed to prevent rejection and it is lifelong.

 

 

Are there any side effects of Immunosuppressive medication?

Immunosuppressive medication can have many side effects. Because these medicines weaken the system, one is more infection prone. Other possible side effects include

 

weight gain

high blood pressure

high blood cholesterol

diabetes

brittle bones

kidney damage

The doctor and the transplant team will watch for and treat any of these side effects observed.

 

 

What are signs of organ rejection?

Rejection might make the patient feel tired along with loss of appetite. Other signs might include having

 

fever

pain around the liver

jaundice

dark-colored urine

light-colored stools

But rejection doesn’t always mean feeling ill. The doctors will check through blood tests for signs of rejection. A liver biopsy is usually needed to confirm rejection. This is a procedure that involves taking a small piece of the liver for observation under the microscope

 

Care after discharge from the Hospital

 

Follow-up visits at the hospital will be needed to ensure that the new liver is working well. There will be a need for regular blood tests to check that the new liver is not being damaged by rejection, infections, or problems with blood vessels or bile ducts.

 

Common Tips for those who have had a liver transplant include

 

avoiding people who are ill and report any illness, no matter how small

taking a healthy diet and exercise

not smoking cigarettes or drinking alcohol

taking all prescribed medicines as directed

consulting the doctor before taking any medicines other than those prescribed.

following the doctor’s instructions on how to take care of a new liver

having blood tests and other tests prescribed by the doctor

 

Is life normal after a transplant?

After a successful liver transplant, most people can go back to their normal daily activities, and return to work. Getting strength back may take months, especially if one was very sick before the transplant. The doctor will update you on the recovery period at follow-up.

 

Some activities that may raise questions

 

Work. After recovery, most people are able to return to work.

 

Diet. Most people can eat a normal, regular meal. Some medicines prescribed post transplant may cause weight gain and others may cause diabetes or raise cholesterol. So, eating a balanced, low-fat diet can help maintain a healthy lifestyle.

 

Exercise. Most people can be physically active after a liver transplant.

 

Sex. Most people can have a normal sex life after a liver transplant. For women, avoiding pregnancy in the first year after a transplant is recommended. Checking with the doctor when it is alright to have sex again or getting pregnant is a good idea.

 

Key Points to keep in mind

 

Liver transplantation is surgery to remove a diseased liver and replace it with a healthy one from another person, called a donor.

If the liver stops working as it should, a liver transplant is needed

In adults, common reason for a liver transplant is cirrhosis. Cirrhosis is caused by many different types of diseases that destroy healthy liver cells replacing them with scar tissue. Some causes of cirrhosis are long-term infection with the hepatitis B and C virus, excessive alcohol over time, autoimmune disorders and metabolic diseases.

In children, the most common reason for needing a liver transplant is biliary atresia or any other metabolic cause.

Your doctor will decide whether you need to be evaluated for a liver transplant. The transplant team will examine you by running blood tests, x-rays, and other tests to help decide whether you would benefit from a transplant.

Livers can come from both living and deceased persons. Transplants involving living donors are those who donate part of their liver, to a family member for love and affection.

Liver transplant surgery can take long hours.

Problems after surgery may include bleeding, infections, and rejection of the new liver.

Rejection occurs when the immune system attacks the new liver. After a transplant, it is common for the immune system to try to destroy the new liver.

After a liver transplant, immunosuppressive medication is lifelong to prevent rejection.

Liver transplants are usually successful surgeries. Most people are able to return to work and other normal activities after a transplant

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