Liver Replacement: Procedure, Recovery, Cost, Risk & Complication

A liver transplant refers to a surgical procedure that involves removing a liver that does not function properly, and replace it with a healthy liver, taken from a living or deceased donor.

The liver, being your largest internal organ, performs several crucial functions such as removing the bacteria and toxins from your blood, processing the nutrients and hormones as well as producing bile, so that the body can absorb fats and cholesterol. Liver transplant is generally kept as a treatment option for patients having significant complications because of an end-stage chronic liver disease, liver cancer or problems that cannot be treated with medications.

A patient may need a liver transplant in the following conditions:

• Cirrhosis, a condition where the scar tissues replaces your normal liver tissues, impairing the function of the liver
• Alcoholic liver disease resulting in liver failure
• Genetic diseases that may affect the liver such as Wilson’s disease (copper poisoning) and hemocromatosis (excess iron in the body)
• Diseases that can affect your bile duct, like biliary atresia (liver disease occurring in infants)
• Treating cancers originating in the liver

Pre Procedure

The following pre-procedure guidelines need to be followed before undergoing a liver transplant:

• You have to meet the eligibility criteria for undergoing the transplant. Your overall health condition, your current condition and whether your body will be able to tolerate the life-long medications after the surgery will be evaluated.
• Finding a donor would be the next important step. In case there is no donor found immediately, you will have to wait till you get a matching donor.
• Laboratory tests, imaging tests like an ultrasound of the liver, and a general health examination will be conducted
• A psychological evaluation is also done for assessing your mental condition, looking for signs like anxiety and depression
• While you are waiting for the transplantation, make sure that you stay healthy with proper diet, exercise and relax your mind

During Procedure

A liver transplant is done by administering general anaesthesia. The surgeon will make a long incision across the abdomen, to get access to your liver. The bile ducts and the blood supply to the liver are then disconnected, after which the diseased liver will be removed. The donor liver will be then placed in your system. The bile ducts and the blood vessels will be then reattached. The surgery can take up to 12 hours, though it depends on your health situation.

Once the new liver is put into place, the surgeon stitches and then staples the incision that was made. There will be drainage tubes attached for draining away the extra fluids, which may remain attached for some days after the surgery.

Post Procedure

Once the surgery has been performed, you will have to stay in the ICU for a few days. The doctors will monitor your health condition, looking for any possible complications. If required, a ventilator can assist you with the breathing, while a tube will be inserted through your nose in the stomach for providing you with the necessary nutrients and fluid. These things are generally removed after a few days.

Your liver function will be tested at regular intervals to analyse if the new liver is working properly or not. You will have to stay in the hospital for around 2 weeks. Once you are discharged, there will be frequent check-ups and blood tests that you have to undergo so that the doctors can understand the rate of your progress.

A liver transplant surgery carries with it some significant complications. It may be related to the surgery itself or to the medications that are required so that the body does not reject the new liver. The common risks include:

• Bleeding or infection in the site of surgery
• Formation of blood clots
• If the donated liver fails to perform properly
• If the body rejects the newly acquired liver
• Seizures or mental confusion
• The medications that you need to take post-surgery for the rest of your life may lead to bone thinning, diarrhea, diabetes, high blood pressure and high cholesterol. They may also increase your risk of getting an infection.
• A long-term complication may include recurrence of a liver disease in the transplanted liver

You will have to take life-long medications after the liver transplant, which will prevent your immune system from attacking the donated liver. Make sure that you have them timely and regularly. It may take you 6 months or more to recover from the surgery. It is advisable to opt for simple exercises like walking in this recuperating period. A normal and healthy diet is also important. Also, always try to maintain a healthy weight. You can consult your dietician for a food chart. Avoid alcohol, especially if your previous liver disease was alcohol-related. Do not self-drive for at least 2 months after the surgery, as the transplant procedure and the medication that you take afterwards may sometimes affect the vision and reaction time.

The cost of a liver transplant could be approximately Rs. 5,00,000 – Rs. 10,00,000.