Liver Transplant: Purpose, Procedure, Benefits and Side Effects

Liver transplant, also known as hepatic transplantation, is a surgical procedure in which a diseased or damaged liver is replaced with a healthy one from another person or from an artificial or animal source. The liver plays an essential role in many metabolic processes, and transplantation of the organ is the only possibility for some forms of severe and otherwise untreatable liver disorders.

• Living Donor Liver Transplantation: Living donor liver transplant is the transplantation of a portion of donated liver from a living donor to a recipient with end-stage liver disease. The living donor may be related or unrelated to the recipient, but should ideally have a similar blood type.
• Deceased Donor Liver Transplant: Deceased donation is an important medical option for patients with end-stage organ disease or failure who have no other options for survival without an organ transplant. In this process, doctors and medical teams harvest organs such as livers, kidneys and hearts from donors who have died and then transfer them into recipients waiting for a suitable organ match.
• Split Liver Transplant: Split liver transplant is a procedure wherein a donor's liver is divided into two parts, with one part going to the recipient, and the other being transplanted into a second recipient.

• Improved life expectancy: A Liver transplant leads to an immediate improvement in life expectancy. This is because it replaces an organ that may have been severely damaged with a healthy liver from a donor.
• Improved health: The new liver will begin to take over the functions within a few days and as the patient recovers, there will be gradual improvement in health.
• Quality of life: With improved health comes improved quality of life for the individual following a successful transplantation. They can enjoy activities that may have been restricted due to their illnesses, such as exercising, swimming or eating out with their friends and family members which greatly improves their overall quality of living following the procedure.
• Reduced medication and treatment dependence: Patients who undergo liver transplants often find they reduce their reliance on medications as the new liver begins functioning optimally over time, removing any previous treatment or maintenance needed before the procedure.

• Liver transplant surgery is typically performed as a last resort to treat advanced and life-threatening forms of liver disease.
• Transplanted livers can help patients improve their quality of life by restoring normal metabolism, providing protection against hepatitis C, preventing hepatic encephalopathy, balancing electrolytes, and allowing for normal growth and development in children.

The main risks associated with a liver transplant include the following:-

• Infection: Infections can occur in the transplanted organ, or in the other organs like the kidneys or pancreas, due to bacteria and viruses.
• Bleeding: Bleeding can occur during major surgery, and can be life threatening.
• Rejection: There is a risk that the body’s immune system will attack and reject the new liver, and this could threaten the success of the transplant.
• Complications from anaesthesia: Anesthesia and pain medications used during surgery can also lead to complications such as nausea, vomiting, and headaches.
• Long-term side effects: The long-term side effects of ongoing immunosuppressant medications used after surgery may include an increased risk for developing infections or cancerous cells in other organs of your body such as the lungs or lymph nodes, an increased risk for kidney damage or failure, stomach upset, weight gain, high blood pressure or increased cholesterol levels which put you at higher risk for stroke or heart disease

• Seek out medical help from a qualified transplant team. Your doctor will coordinate your care and help you find a qualified transplant team and hospital which offers liver transplants.
• Undergo evaluation for suitability for the transplant, including physical, mental and family status assessments.
• Have necessary tests done to confirm eligibility for the transplant, such as x-rays, liver biopsies and blood work-ups.
• Discuss risks of complications associated with the surgical procedure with your doctor in order to be fully aware of possible outcomes.
• Get into good health by eating well, exercising regularly, managing any pre-existing conditions, and eliminating unhealthy habits (e.g., smoking). This will help ensure that you are physically ready for the surgery and improve your likelihood for successful recovery post-transplantation.

The procedure is performed under general anaesthesia. Once the patient is connected to all necessary tubes and machines, the surgeons begin by making an incision in their abdomen to access the existing liver.

The old organ is then disconnected and replaced with the healthy donor liver, which is tied into place using specialised stitches and blood vessels. After connecting bile ducts to allow for drainage of bile, any remaining internal bleeding is stopped, and all incisions are closed up with stitches or staples. The entire process typically takes from six to twelve hours.

• An evaluation is done to determine if the patient is a good candidate for the procedure and to ensure they understand the risks.
• The patient may need to be evaluated for drug use and other habits that can affect the success of surgery or increase infection risk during or after surgery.
• Nutrition assessment by dietitian is done.
• Informed consent is obtained from the donor's family in case of deceased donor transplant afterwards the patient will be admitted in hospital on the day before transplantation.
• On the day before transplant he/she will require some laboratory tests like haemoglobin, chest x-ray, urine tests etc.

• The diseased liver is removed from the patient, using careful technique to preserve veins and arteries that will be used later in the transplantation.
• The donor liver is prepared for transplant by ensuring it matches the size and blood type of the patient.
• Blood vessels in the donor liver are connected with those of the patient’s, allowing blood to flow in and out of the new organ.
• Venous drainage tubes are attached so that bile can be diverted away from both livers before they are reconnected.
• Common bile ducts and gallbladders are connected between both livers to restore continuity of function.
• The transplanted liver is scanned to ensure it is correctly connected and producing functional output.
• Sutures are placed on vascular anastomoses connecting donor and recipient vessels.
• The abdomen is closed after ensuring that there is no evidence of bleeding post-reconnection.

• The patient will be placed in an intensive care unit so they can be monitored closely following surgery and over the next few days.
• During this time, they may receive medications to help reduce the risk of complications such as blood clots or infection.
• Over time, the patient’s body will begin to accept and work with their new liver and corresponding medications may need to be adjusted as needed.
• Once out of ICU, the patient will likely stay for several more days, depending on their response to treatment and continued recovery process.

The average cost of a liver transplant in India can range from Rs. 8-15 lakhs ($12,000 to $21,000 USD). This cost may vary depending on the hospital, patient’s medical condition and donor availability. Additionally, post-transplant medical expenses should also be included while calculating the total cost.

• Eating a healthy, well-balanced diet plays an important role in the recovery and overall health of someone who has received a liver transplant. Some nutrient-rich foods to consider include:
• Lean proteins such as fish, chicken, turkey or beans.
• Plenty of fruits and vegetables such as spinach, kale, apples, oranges and bananas.
• Whole grains such as quinoa, brown rice and oats.
• Low-fat dairy products like yoghurt or skim milk.
• Healthy fats from sources like nuts and olive oil.
• It is recommended that someone who has had a transplant avoid processed or fried foods whenever possible to help reduce their risk for complications. Additionally high sodium foods should also be avoided since they can increase blood pressure levels.

Yes, liver transplant is typically a safe procedure when performed by a skilled surgical team. The direct mortality rate of the transplant procedure is low, typically between 2 and 6 percent.

Generally, the majority of liver transplant patients do not feel pain during surgery.

A local anaesthetic is generally used to numb the area at the incision site, and most patients are kept sedated throughout the procedure. Some minor discomfort may be felt after the anaesthesia wears off, but this is typically mild and controllable with pain medication.

The time it takes to recover from a liver transplant varies significantly between individuals and depends on the level of damage to the original organ, the patient's overall health, and the quality of post-surgery care.In general, most people can expect to return to their normal activities within 1-3 months after their procedure.

• The most common side effects of liver transplant may include:-
  • Infection: Symptoms may include fever, chills, nausea, sore throat and other flu-like symptoms.
  • Side effects from immunosuppressant medication: Many people must take medication to prevent rejection of the new organ. These medications can cause a wide range of side effects such as shaking, vomiting and high blood pressure.
  • Bleeding or clotting problems: The recipient’s blood may not clot as quickly due to the suppression of the immune system and corticosteroids. This can lead to serious bleeding, bruising or internal clots.

• Here are some guidelines for aftercare following liver transplant:
• Take all prescribed medications as directed. Many people take up to 9 medications following a liver transplant in order to prevent organ rejection and maintain optimal functioning with their new organ. Make sure that you take these as directed.
• Pay attention to dietary considerations that your doctor has recommended for you in order to ensure proper nutrition while taking immunosuppressants, which weaken your immune system in order to prevent rejection of the new organ.
• Exercise regularly in order to help maintain strength and muscle tone, reduce stress, increase respiratory function, improve heart rate variability, boost immunity, and more. Speak with your doctor before beginning an exercise program however as they will understand best what level of physical activity is appropriate for you.
• Monitor yourself daily for signs that might indicate an infection such as unexplained fatigue, fever or chills, sore throat or coughs that worsen quickly over time despite proper rest and other home remedies. If such symptoms persist despite treatment then reach out to your medical team immediately for further evaluation if needed.
• Connect with other people who have gone through a similar experience; having someone who understands first-hand what you’re going through can be extremely helpful during this challenging time while adapting both mentally and physically.

Liver transplant is an effective treatment option for those who suffer from liver failure. The success rate of the procedure is high and most patients experience significant improvements to their health post-surgery. However, there are potential risks associated with surgery in general and potential for complications due to organ rejection or infection. Therefore, careful consideration must be taken on whether or not to proceed with a transplant and if so, close monitoring is important for long-term success.