The liver is the largest internal organ of the body. It is located below the diaphragm on the right side of the abdomen. It performs many complex functions that includes, producing proteins required by the body, breaking down the nutrients from food to produce energy, preventing shortage of vitamins, minerals and other nutrients by storing them, produces bile to digest fat and absorb vitamins, helps body in fighting infection by removing bacteria from the blood, removes toxins byproducts of some medications.
When liver is no longer functions properly (liver failure) due to infection, complications from certain medications, any disorder or defect of the liver, patient needs to undergo liver transplant surgery in which doctors replaces a diseased or defected liver with a healthy liver from another person. A whole liver may be transplanted, or just part of one (called lobe). In many cases, the patient will receive the healthy liver from organ donor who has just died. Healthy living person may be a family member or may be someone not related to the patient but whose blood type is a good match can also donate a part of their liver. People can lead a healthy life with the liver that is left after donating a part of their liver. The liver is the only organ of the body that can regenerate the lost or injured tissue. The donor liver grows back in to normal size after the surgery in some time.
There are some most common reasons of liver failure that need the transplantation such as:
• Chronic hepatitis
• Primary biliary cirrhosis which is a rare condition in which the immune system attacks and destroys the bile duct causing liver failure.
• Scarring and narrowing of the bile ducts inside and outside of the liver which is known as sclerosing cholangitis. This causes backup of bile in the liver and liver failure.
• Malformation of the bile ducts known as Biliary atresia which is the most common reason for liver transplant in children.
• Wilson’s disease that is a very uncommon inherited disease in which copper is deposited abnormally throughout the body, including the liver.
• Hemochromatosis (a common inherited disease in which body is overloaded with iron)
• Amyloidosis (abnormal deposit of the protein called amyloid in the liver that disrupts normal liver function)
• Liver cancers like Cholangiocarcinoma, primary hepatocellular carcinoma, primary hepatocellular malignancies and hepatic adenomas
Patient suffering from AIDS, existing cancer in any other organ of the body than liver, severe active infection, active substance abuse, irreversible brain defect, advanced heart or lung disease can get disqualified for a liver transplantation as the outcome can be unsuccessful.
Doctor may suggest various test including blood tests, diagnostic tests (x-rays, ultrasounds, a liver biopsy, colonoscopy, dental exams, psychological and social assessment) to evaluate if the patient is qualified for liver transplant. If the patient is accepted as right candidate for the transplant, his/her name will be placed on a national transplant list according to the need and urgency. Patient will be notified when the organ is available from the deceased donor and if a living person is donating a part of their liver to you, the surgery will be planned at convenience of the donor and the patient or when required. The donor should be in good health and should have good match of blood type with the recipient.
There are mainly three types of liver transplant:
1. Orthotopic transplant – is the most common type of liver transplant where whole liver is taken from recently deceased person (donor). Surgeon will make an incision in the patient’s abdomen and remove the liver. The donor liver then will be placed and connected to the blood vessels and bile ducts. The incision will be closed using surgical clips. Surgeon will attach drainage tubes to drain away extra fluids that may usually remain attached for several days after surgery.
2. Live donor transplant – living donor (close family person, or close relative) will have a surgery to remove either the left or right side of their liver (right side of liver is generally recommended for adults and left is smaller and suited for children). After the donor surgery, patient liver will be removed and replaced with the donor’s liver lobe and then will connect blood vessels and bile ducts. The transplanted lobe and donor’s lobe will quickly regenerate themselves and re-grow to their normal size within two three months post the transplant.
3. Split donation - when the donor liver becomes available from a recently deceased person and both the adult and a child are suitable candidates to receive it then the donated liver will be split into the right and left lobes. The right lobe (larger) will be transplanted into the adult and the left (smaller) lobe will transplanted into the child.
There can be some risk or complications post liver transplant surgery:
• Abnormal bleeding
• Blocked blood vessels
• Leakage of bile or blocked bile ducts
• Rejection of new organ (liver lobe)
Patient will be kept in ICU for monitoring the conditions or some symptoms/signs of complications for few days. Then will be shifted to the regular hospital room for 5-10 days depending on the condition of the patient. It can take 6 to 8 months for getting fully healed after the transplant. Patient can go back to normal routine after few months and need to take suggested medications on time, maintain healthy lifestyle and food habits. Regular follow ups should be done.