Liver Transplant

Overview

A liver transplant is a surgical procedure to replace a damaged or diseased liver with a healthy liver or part of the liver from a donor. The Liver is one of the most important organs in the body and performs many critical functions, including filtering toxins from the blood, producing bile to aid in digestion, and regulating glucose and cholesterol levels. When a person's liver is no longer functioning properly, a liver transplant may be necessary to save their life.

Types

Liver transplantation can be classified into two types: deceased donor transplantation and living donor transplantation.

• In a deceased donor transplantation (Cadaver transplant), the liver is obtained from a recently deceased person whose family has agreed to donate their organs. The liver is then transported to the recipient, who undergoes surgery to remove the damaged liver and replace it with the healthy donor liver.
• In a living donor transplantation, a part of a healthy person's liver is removed and transplanted into the recipient. This is possible because the liver is capable of regrowing to its original size in both the donor and the recipient. This type of transplantation is usually performed when there is a shortage of deceased donor livers or when the recipient requires a transplant urgently and a deceased donor liver is not immediately available.

Both types of liver transplantation have their own benefits and risks, and the choice of transplantation method is determined based on several factors, including the availability of a suitable liver, the recipient's medical condition, and the preferences of the recipient and the donor.

Why Is Liver Transplant Done?

This procedure is typically recommended for individuals with liver failure or liver disease that cannot be treated with any other form of therapy. The following are the most common conditions in which a liver transplant is done:

• Cirrhosis: Cirrhosis is a chronic liver disease in which the liver becomes scarred and damaged, leading to liver failure. The most common cause of cirrhosis is chronic alcoholism, but it can also be caused by hepatitis B or C, autoimmune diseases, and non-alcoholic fatty liver disease (NAFLD).
• Hepatic Encephalopathy: This is a condition in which the damaged liver is unable to remove toxic substances from the bloodstream, leading to brain damage and altered mental state.
• Acute Liver Failure: This is a sudden and rapid decline in liver function caused by viral hepatitis, drugs, or other toxins.
• Chronic Hepatitis B and C: Chronic hepatitis B and C infections can lead to cirrhosis and liver failure over time.
• Primary Biliary Cholangitis (PBC): PBC is a chronic autoimmune disease that affects the bile ducts in the liver and can lead to liver failure.
• Primary Sclerosing Cholangitis (PSC): PSC is a chronic autoimmune disease that affects the bile ducts in the liver and can lead to liver failure.
• Wilson's Disease: This is a rare genetic disorder that causes copper to accumulate in the liver and other organs, leading to liver damage and cirrhosis.
• Liver Cancer: In some cases, liver cancer may be treated with a liver transplant, especially if the cancer is confined to the liver and has not spread to other parts of the body.

In addition to these conditions, a liver transplant may also be recommended for individuals with liver tumors, metabolic liver diseases, and inherited liver diseases.

Diagnosis

The diagnosis for a liver transplant typically involves a comprehensive evaluation to determine if the patient has end-stage liver disease and if a transplant is necessary. This evaluation includes the following steps:

1. Medical history and physical examination: The patient's medical history is reviewed, including any previous liver problems or other medical conditions. A physical examination is performed to assess the patient's overall health and to check for signs of liver disease, such as jaundice or swelling in the legs.
2. Blood tests: Blood tests are performed to measure liver function and to assess the presence of liver diseases such as hepatitis B or C. The patient's blood type and immunological status are also determined.
3. Imaging tests: Imaging tests such as a CT scan or MRI may be performed to get a better understanding of the patient's liver and to check for any signs of tumours or other abnormalities.
4. Liver biopsy: In some cases, a liver biopsy may be performed to obtain a small piece of liver tissue for examination under a microscope. This helps to determine the extent and type of liver disease, and to guide treatment decisions.
5. Psychological and social evaluation: A psychological and social evaluation may be performed to assess the patient's ability to comply with the medical regimen and to adjust to life after the transplant.

Once the evaluation is complete, the transplant team will determine if the patient is eligible for a liver transplant and if a transplant is necessary. If a transplant is deemed necessary, the patient will be placed on a waiting list to receive a donor liver.

Pre-Procedure

Preparation for a liver transplant involves a number of steps to ensure the patient is in optimal health for the procedure and to reduce the risk of complications. Some of the most important pre-procedure steps for a liver transplant include:

1. Medical evaluation: A comprehensive medical evaluation is performed to assess the patient's overall health and to determine if they are a good candidate for a liver transplant.
2. Lifestyle changes: The patient may be advised to make certain lifestyle changes, such as quitting smoking, losing weight, and reducing alcohol consumption, to improve their overall health and reduce the risk of complications.
3. Testing: The patient will undergo a series of tests, including blood tests, imaging tests, and a liver biopsy, to assess the extent and type of liver disease and to guide treatment decisions.
4. Psychological evaluation: A psychological evaluation may be performed to assess the patient's ability to comply with the medical regimen and to adjust to life after the transplant.
5. Medications: The patient may be advised to take certain medications before the transplant procedure, such as antibiotics or immunosuppressants, to reduce the risk of complications.
6. Donor liver selection: The transplant team will carefully select a donor liver that is a good match for the patient and that has the best chance of success.
7. Financial planning: The patient may be advised to make financial arrangements for the transplant procedure, as well as for follow-up care and treatment.

During Procedure

The liver transplant procedure is a complex surgical procedure that typically involves the following steps in detail:

• Anesthesia: Before the procedure begins, the patient is given general anesthesia to put them into a deep sleep. This will prevent them from feeling any pain or discomfort during the procedure.
• Incision: The surgeon makes an incision in the patient's abdomen to access the liver. The incision is usually made in the midline of the abdomen or on the right side, depending on the patient's anatomy and the type of liver transplant being performed.
• Removing the diseased liver: The surgeon removes the diseased liver by carefully separating it from the surrounding organs and blood vessels. This includes disconnecting the liver from the hepatic artery, which carries oxygen-rich blood to the liver, and the portal vein, which carries blood from the intestines to the liver. The surgeon also disconnects the bile ducts, which carry bile from the liver to the small intestine.
• Implanting the new liver: The surgeon carefully implants the new liver in the same location as the original liver. The new liver is connected to the patient's blood vessels and bile ducts, and the blood flow to the liver is restored. The surgeon takes care to ensure that the blood vessels and bile ducts are securely attached to prevent any bleeding or bile leaks.
• Closing the incision: The surgeon closes the incision in the patient's abdomen with sutures or staples. The incision is typically closed in multiple layers to provide strength and to prevent any leaks.
• Monitoring: After the procedure, the patient is closely monitored for signs of bleeding, infection, or other complications. The patient's vital signs, such as blood pressure and heart rate, are regularly monitored, and the patient may receive medications to manage pain or to prevent infection.

Post Procedure Care

The post-procedure care for liver transplant patients is critical for a successful recovery and to prevent any complications. The following are the steps involved in post-procedure care and recovery:

• Monitoring: After the procedure, the patient is closely monitored in the hospital for signs of bleeding, infection, or other complications. The patient's vital signs, such as blood pressure and heart rate, are regularly monitored, and the patient may receive medications to manage pain or to prevent infection.
• Pain management: Pain is a common side effect of liver transplant surgery. The patient may receive pain medications, such as opioids or non-steroidal anti-inflammatory drugs (NSAIDs), to manage their pain.
• Incision care: The patient should follow the instructions provided by the surgeon for incision care. This may involve keeping the incision clean and dry, avoiding strenuous activity, and taking any prescribed medications.
• Diet and nutrition: After a liver transplant, the patient will need to follow a healthy, balanced diet to promote healing and support their overall health. The patient may need to avoid certain foods, such as high-fat or high-protein foods, for a period of time.
• Physical activity: Physical activity is important for recovery after a liver transplant, but it is important to avoid strenuous activity until the surgeon gives the green light. The patient should gradually increase their level of physical activity as they recover, starting with light exercise and gradually increasing the intensity.
• Medications: The patient will need to take immunosuppressant medications to prevent rejection of the new liver. These medications suppress the immune system to prevent it from attacking the new liver. The patient will need to take these medications for the rest of their life to prevent rejection.
• Follow-up appointments: The patient will need to attend regular follow-up appointments online or offline as per patient requirement with their surgeon and transplant team to monitor their progress and check for any signs of complications.

Risks and Potential Complications

While Liver transplant can be life-saving for individuals with end-stage liver disease, it also carries certain risks and potential complications. Some of the most common risks and complications of a liver transplant include:

• Bleeding: Bleeding can occur during or after the transplant procedure, and may require additional surgery or blood transfusions.
• Infection: The patient is at risk of developing an infection after the transplant procedure, which may require treatment with antibiotics or other medications.
• Rejection: The patient's immune system may reject the new liver, which can cause a variety of symptoms and may require additional treatment.
• Liver failure: The new liver may not function properly after the transplant, which can lead to liver failure and the need for additional treatment.
• Complications with medications: The patient will need to take immunosuppressant medications to prevent rejection of the new liver, and these medications can cause side effects such as increased risk of infection, high blood pressure, and kidney damage.
• Return of liver disease: The patient's liver disease may return after the transplant, which may require additional treatment.

It is important to note that these risks and complications vary from person to person and are not necessarily indicative of what will happen to every patient who undergoes a liver transplant. With proper care and monitoring, the majority of individuals who undergo a liver transplant experience a successful outcome and return to a more active and healthier lifestyle. 

Cost of Liver Transplant in India

The cost of a liver transplant in India can vary greatly depending on various factors such as the type of transplant, the hospital, and the location. On average, a liver transplant in India can start from $30,000.

The cost of the liver transplant also depends on the type of transplant, whether it is a cadaveric transplant (using a deceased donor) or a living donor transplant. Living donor transplants are typically more expensive. 

The success rate of liver transplant in India is generally considered to be good. According to data from the National Organ and Tissue Transplant Organization (NOTTO), the overall success rate for liver transplant in India is around 80-85%, which is comparable to the success rates seen in other countries.

Overall, the cost of a liver transplant in India is significantly lower compared to developed countries such as the United States, where the cost of a liver transplant can range from $300,000 to $600,000. Despite the lower costs, the quality of medical care and the success rate of liver transplants in India is at par with developed countries.