Liver Transplant

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Highlights

  • Improve quality of life
  • Reduce the risk of liver disease from getting worse
  • Big boost to patient’s health

  • 20

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    Hospital
  • 90

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  • 110

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    in India
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    Overview

    Details of Liver Transplant

    The liver is a large organ that, synthesizesproteins, blood clotting factors, triglycerides, cholesterol, glycogen synthesis and bile production. The gallbladder stores bile produced by the liver which later transported to the small intestine for complete digestion. The liver is located under the rib cage on the right side of the abdomen. Liver diseases may be genetic or can be caused by various factors damaging liver like alcohol, obesity etc. the damage caused can persists for long leading to scarring also known as cirrhosis of the liver which can lead to liver failure. Livertransplantation is the choice of treatment for complete liverfailure.

    Livertransplantation or hepatictransplantation is the removal of a liver that is unhealthy followed by an exchange with a healthy liver from someone else (allograft). The most common technique is orthotopic transplantation, in which the native liver is removed and replaced by the donor. It requires a complex and meticulous surgical procedure to carefully harvest the donor organ and implant it into the recipient. Liver transplantation is highly regulated, and can only be performed at certain medical centres by a designated appropriate medical team.The duration of the surgery ranges from 4 to 18 hours depending on the outcome. 

    Science

    In patients with liver failure whose condition seems to be worsening with other treatments and for those with liver cancer. Liver failure can develop suddenly or gradually over a long time. Liver failure that occurs quickly, in a matter of weeks, is called acute liver failure. Acute liver failure may result due to the complications from certain medications or infections.

    Chronic liver failure develops gradually over months and years and may occur due to a variety of conditions. The most common cause of chronic liver failure is scarring of the liver (cirrhosis). This scar tissue replaces normal liver tissue disrupting its functioning. Cirrhosis is the most frequent reason for a liver transplant.

    Major causes of cirrhosis include:

    • Hepatitis B and C
    • Consumption of excess alcohol damaging the liver
    • Nonalcoholic fatty liver disease, a condition in which fat builds up in the liver, causing inflammation or liver cell damage.
    • Genetic diseases including hemochromatosis that is an excessive iron buildup in the liver, and Wilson's disease, which is an excessive copper buildup in the liver.
    • Diseases that affect the bile ducts such as primary biliary cirrhosis, primary sclerosing cholangitis and biliary atresia. 
    • Liver cancers such as hepatocellular carcinoma


    CONTRAINDICATIONS: 

    The absolute contraindication for liver transplant are-

    • severe irreversible medical illness
    • severe pulmonary hypertension
    • metastatic cancer
    • infection that may be systemic or uncontrollable
    • alcohol or drug abuse
    • inability to adhere to a strict medical regimen
    • psychiatric disease 

    Graft Rejection

     Immune-mediated rejection post-transplant may occur that is the immune system identifies attacks and injures the transplanted organ. Blood work may depict abnormal liver function values. Physical findings may include encephalopathy, jaundice, bruising and bleeding tendency. The patient may also present with malaise, anorexia, muscle ache, low fever, a slight increase in white blood count and graft-site tenderness.

    Three types of graft rejection may occur: hyperacute rejection, acute rejection, and chronic rejection-

    • Hyperacute rejection may result due to preformed anti-donor antibodies. These antibodies bind to antigens on vascular endothelial cells. Complementactivation is involved and the effect is usually profound. Hyperacute rejection can occur within minutes to hours after the transplant procedure.
    • Acute rejection is mediated by T cells involving direct cytotoxicity and cytokine-mediated pathways. It is the very common and the primary target of immunosuppressive agents and is seen within days or weeks of the transplant.
    • Chronic rejection is the presence of any sign and symptom of rejection after a year. The cause of chronic rejection is still unknown, but an acute rejection is a strong predictor of chronic rejections. It occurs in less than 5%.

    Before transplantation, liver-support therapy might be indicated (bridging-to-transplantation) The transplant operation consists of three phases –

    • Hepatectomy- recipient liver removal phase
    • the anhepatic (no liver) phase
    • The postimplantation phase. 


    1. The operation is done through a large incision in the upper abdomen.

    2. The donor liver can be harvested using the standard or the rapid technique.

    3. All ligamentous attachments are divided, also the common bile duct, hepatic artery, hepatic vein and portal vein. 

    4. Once the primary dissection is completed cannulae are inserted into the distal abdominal aorta and splenic vein for selective infusions of chilled fluids so that the organ can be core cooled.

    5. After it is cooled the arterial and venous supply is detached the liver is removed with a piece of diaphragm containing suprahepatic vena cava.

    6. The liver is flushed at the back table with the UW solution and immediately packaged in a fluid-filled bag that is packed on ice for transport.at this stage anomalies if any are corrected.

    7. The standard technique takes two or more hours for dissection and as such can lead to injury or affect the blood supply to the liver. 

    8. The incision is similar for recipient hepatectomy. After adequate exposure of the diseased liver and the anatomy, the approach is decided. Control of hepatic arterial and portal venous supply are necessary before mobilizing the liver to prevent blood loss.

    9. A veno-venous bypass may be used may help in physiological stability resulting in longer anhepatic phase which also provides time for dissection.

    10. Preparation of venal cuffs including suprahepatic and infrahepatic cuff.

    11. The new or donor's liver is brought and suprahepatic and infrahepatic anastomosis is achieved, biliary tract reconstruction portal vein anastomosis 

    12. After blood flow is restored to the liver the biliary drainage achieved by sewing it to the recipient's bile duct or the small intestine.

    13. Hemostasis achieved and the incision closed.

    The surgery may take five or more hours.

    The donor's liver is obtained from a deceased person in most cases, particularly for adult recipients. In case of pediatric liver transplantation, a portion of an adult liver is used for an infant or small child. Living donor liver transplantation, in which a portion of a healthy person's liver is removed and used as the allograft. Living donor liver transplantation for pediatric recipients involves removal of approximately 20% of the liver. This speeds up the recovery and the patient stays in the hospital shortens to within 5–7 days.

    Radiofrequencyablation that is a minimally invasive technique which involves introducing a thin probe into the tumour and a high-frequency current is passed which heats the tumour cells to destroy them. This technique acts as a bridge while awaiting liver transplantation. 

    Living donor liver transplantation (LDLT):

     For patients with end-stage liver disease, such as cirrhosis and/or hepatocellularcarcinoma this may be a solution The LDLT is an alternative considering factors like the living donor livers regenerating capability and the shortage of deceased people livers for patients awaiting transplant. In LDLT, part of a healthy liver is surgically removed from a living person and transplanted into a recipient, as soon as the diseased liver has been removed. 

    55 to 70% of the liver (the right lobe) is removed from a healthy living donor. The donor's liver will regenerate approaching 100% function within 4–6 weeks. The transplanted portion will reach full function and the appropriate size in the recipient as well, although it will take longer than for the donor. 

    Complications post-surgery for donors are blood clots and biliary problems that can be treated easily. The LDLT donor's immune system may diminish due to the regenerating liver, so certain foods which would normally cause an upset stomach may cause serious illness.

    Donor requirements

    Any member of the family can donate their liver. The criteria for a liver donation include:

    • Fitness
    • Compatible blood type with the recipient's
    • Donating without financial motivation
    • Between the ages of 20 and 60 years 
    • Donor-related to the recipient

    Similar or larger body size than the recipient

    The donor undergoes extensive psychological and medical testing. 

    Complications:

    • blood transfusion
    • death 
    • bleeding
    • infection
    • blood clots
    • prolonged recovery

    The donors usually enjoy full recovery within 2–3 months.

    Paediatric Transplantation

     Children have a smaller abdominalcavity, hence space for a partial segment of the liver only, usually the left lobe of the donor's liver. This is also known as a "split" liver transplant. There are four anastomoses required for a "split" liver transplant: hepaticojejunostomy (biliary drainage connecting to a roux limb of thejejunum), portalvenous anastomosis, hepaticarterial anastomosis, and inferior vena cava anastomosis.

     Benefits

    The advantages of living liver donor transplantation include:

    • donor is easily available
    • surgery can be scheduled anytime
    • fewer complications

    Screening for donors

    All living liver donors undergo a medical evaluation. Donor confidentiality is maintained. Also, the medical team ensures the donor understand the implication complication and risk associated and is not deciding on any pressure. The donor and the family members are counselled thoroughly. A complete physical examination done to ensure compatibility.

    Post-Transplant Immunosuppression:

    The risk of chronic rejection decreases over time, but most patients need to continue with immunosuppressive medication for the rest of their lives 

    The outcomes are very good but depending on the reasons for a liver transplant. The overall patient survival one year after the surgery is 85% and after 5 years 70%

    Hospitals

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    FAQ

    What is Liver transplantation?

    Liver transplantation is the transplantation of an infected liver with healthful liver from another person. Liver transplantation may be a treatment probability for end-stage illness and severe liver failure, though the terms of donor organs may be a major limitation.

    How long do an individual stay in hospital after liver transplant?

    Most patients are hospitalized for seven to ten days when liver transplant. Later, they recuperate at home and typically respond to school or work after about 3 months

    How long does a liver transplant take?

    The liver transplant can last up to seven to eight hours But, it can take up to six-twelve hours looking at complications.

    How long does it take to get a new liver?

    If the transplant team recommends that a person want a transplant, their name is going to be placed on a roll with their consent. Their blood group, body size, and the way sick they're plays a job choose their place on the list. While a person waits for a new liver, then their doctor ought to mention what they will do to remain strong for the surgery. They are going to conjointly begin learning concerning taking care of a replacement liver.

    Who is a candidate for liver transplantation?

    Individuals that suffer from end-stage disease from variable causes are also thought of for liver transplantation. If it is determined that an individual simply would like a liver transplant, their eligibility are going to be determined by their medical and social analysis.  

    What if the transplant does not work?

    Liver transplants sometimes work. Quite ninety percent of transplanted livers are still operating after one year and regarding seventy-fifth, percent are engaging at five years once transplant. If the newly transplanted liver does not operate or if an individual body rejects it, the doctor and also the transplant team can decide whether or not another transplant is feasible.

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