What are SYMPTOMS OF LIVER FAILURE?
The liver starts to fail only when more than half of it is damaged. Thus, once a person demonstrates symptoms of liver failure, there is not much liver function left. Signs and symptoms of liver failure include:
- Black Stool
- Blood Vomiting
- Muscle Wasting (loss of muscle)
- Forgetfulness, Confusion, or Coma
- Low Hemoglobin and Other Blood Counts
- Poor Blood Clotting
- Build-up of Fluid in the Stomach (ascites)
- Bleeding in the Stomach
What are TYPES OF LIVER TRANSPLANTATION?
There are two types of liver transplantation
- Living Donor - This is an option for some patients with end-stage liver disease. This involves removing a segment of liver from a healthy living donor and implanting into a recipient. Both the donor and recipient liver segments will grow to normal size in a few weeks. The donor may be a blood relative, spouse or friend. They will have to undergo extensive medical and psychological evaluations before the transplant procedure.
- Cadaver in cadaveric liver transplantation - The donor may be a victim of an accident or head injury. The donor’s heart will still be beating, but the brain would have stopped functioning. Such a person is considered legally dead, his or her brain has permanently and irreversibly stopped working. The heart continues to beat because the donor is attached to a respirator. The respirator delivers an adequate supply of oxygen to all vital organs. T this point, the donor is in an intensive - care unit. The identity of a cadaveric donor and circumstances surrounding the person are kept confidential.
What are LIVER DONOR REQUIREMENTS?
Any member of the family, parent, sibling, child, spouse or a volunteer can donate their liver. The criteria for a liver donation include:
- Being in good health
- Having blood type that matches or is compatible with the recipient's
- Having a charitable desire of donation without financial motivation
- Being between 18 and 60 years old
- Being of similar or bigger size than the recipient
- Before one becomes a living donor, the donor must undergo testing to ensure that the individual is physically fit.
What is the process of PRE - TRANSPLANT EVALUATION?
The liver specialist usually suggests this evaluation once he has diagnosed end-stage liver disease. Recipient evaluation is done in three phases and normally takes 5-7 days in hospital.
- To establish definite diagnosis, determine the severity of liver disease and the urgency of the transplant.
- To determine the fitness of the patient for a transplant. The other systems such as heart, lungs, kidneys, blood counts are tested and the presence of any infection is ruled out. The liver specialist then decides how successful the surgery is likely to be depending on the status of the patient and the cause and severity of liver disease.
- The final phase entails the psychological and mental preparation of the patient. The patient and the family are counseled about the procedure, hospital stay, the likely course after surgery, follow up and aftercare.
After evaluation, the patient is either placed on the waiting list for cadaveric donation, or, if there is a willing and blood group matched family donor available, he/she is evaluated for donation and a transplant is scheduled.
While on the cadaver waiting list, the patient follows up with the Transplant Team until a suitable liver becomes available. If the patient's condition shows signs of deteriorating, we normally suggest the family to consider living liver donation
What is IMMUNOLOGY OF LIVER TRANSPLANTATION?
Only blood group cross-matching i.e. ABO compatibility is sufficient.
Who may not be eligible for LIVER TRANSPLANTATION?
A person who needs a liver transplant may not qualify for one because of the following reasons:
- Active alcohol or substance abuse: Persons with active alcohol or substance abuse problems may continue living the unhealthy lifestyle that contributed to their liver damage. Transplantation would only result in failure of the newly transplanted liver.
- Cancer: Cancers in locations other than just the liver weigh against a transplant.
- Advanced heart and lung disease: These conditions prevent a transplanted liver from surviving.
- Severe infection: Such infections are a threat to a successful procedure.
- Massive liver failure: This type of liver failure accompanied by associated brain injury from increased fluid in brain tissue rules against a liver transplant.
- HIV infection
Explain LIVER TRANSPLANT PROCEDURE
- The patient will be evaluated by a Hepatologist( Liver specialist), to determine the need for liver transplantation and listed for transplantation.
- When the liver is available, the patient will be instructed to report to the hospital immediately.
- Admission and initial evaluation will be done.
- On the day of surgery, the patient will be taken to the pre-operative area and started on IV.
- After shifting to operation theatre, appropriate form of anesthesia will be administered.
- The surgeon will make an incision between the rib cage and extend down to the right and left of the rib cage.
- The diseased liver will be removed and replaced with the healthy liver.
- Patient will be shifted to post – operative unit.
- Body functions will be monitored closely and blood tests performed regularly.
- Patient will be in hospital for atleast 1 week.
Explain AFTERCARE OF LIVER TRANSPLANT PATIENTS?
The first three months after transplant are the most risky for getting such infections as the flu, so patients should follow these precautions:
- Avoid people who are ill.
- Wash hands frequently.
- Tell the doctor if you are exposed to any disease.
- Tell the doctor if a cold sore, rash, or water blister appears on the body or spots appear in the throat or on the tongue.
- Stay out of crowds and rooms with poor circulation.
- Do not swim in lakes or community pools during the three months following transplant.
- Eat meats that are well-cooked.
- Stay away from soil, including those in which house-plants are grown, and gardens, during the three months following transplant.
- Take all medications as directed.
- Learn to report the early symptoms of infection.
Can I know HISTORY OF LIVER TRANSPLANTATION?
- The 1st liver transplantation was done in 1963 in US.
- Since 1985, there has been a rapid increase in the number of centres performing liver transplants.
- Liver transplant was introduced in India about 15 years ago.
- Annual number of liver transplants performed throughout India are less than 1000 as compared to requirement of more than 20,000.
- The Transplantation of Human Organs (Amendment) Bill, approved by the Lok Sabha in August 2010, brought stringent measures to check illegal trade of human organs and stop exploitation of the poor.
Who needs a Liver Transplantation?
Anyone with a long-standing (Chronic) or sudden onset (Acute) severe liver disease leading to liver failure needs to be considered for Liver Transplantation.
Can a donor Liver be got ONLY from a brain dead person?
No, there is Living donor Transplantation, wherein a segment of liver from a healthy living donor is removed and implanted into a recipient. Both donor and recipient liver segment will grow to normal size in few weeks.
Who can be a living liver donor?
The person must be a close relative, aged between 18-55 years, have a matching blood group, and weigh between 50 - 90 kg ( But not fat).
Is liver donation safe?
Yes, It is very safe, since the liver has great reserve and regenerates to its original size quickly ( within 2 - 3 months) after a part of it is removed.
Can the donor lead a normal life?
The donor suffers from no long-term effects, does not have to take any medication beyond 2-3 weeks and is back to normalcy in a month.
What is the success rate of Liver Transplantation?
It depends on the patient level of illness and the expertise available at the Centre. It is successful in more than 90% patients.
Is it necessary to take medications even after Transplant?
Yes, but the number of medicines and the doses decrease with passage of time. Most patients are down to a single medicine in 2 - 4 years which needs to be taken life long.
After the Liver Transplantation, does a person have a high infection rates and have to lead a restricted life?
Not True, by 3 - 6 months, the susceptibility to infection diminishes.
Are there any diet restrictions for Liver transplant patients?
There are typically very few dietary restrictions, depending on the patients basic health condition, after the Livet Transplantation