About Liver Transplant
The liver, the largest internal organ, performs many critical functions, including:
- Processing nutrients, medications, and hormones.
- Producing bile, which helps the body absorb fats, cholesterol, and fat-soluble vitamins.
- Making proteins that help the blood clot.
- Removing bacteria and toxins from the blood.
- Preventing infection and regulating immune responses.
Why is a liver transplant performed?
A liver transplant is a treatment option for those suffering significant complications due to end-stage chronic liver disease. Also in rare cases of sudden failure of a previously healthy liver, a liver transplant may be an option. A living-donor liver transplant is possible since the human liver can regenerate and return to its standard size shortly after surgical removal of part of the organ. A liver transplant is a surgical procedure of removing a liver that no longer functions and replacing it with a healthy liver from either a deceased donor or a portion of a healthy liver from a living donor. Life expectancy after a liver transplant depends on many reasons such as the reason for transplantation, age, co-morbidities, and response to the drugs the person is put on post-transplant. Most people live on for more than 10 years after liver transplantation.
Signs of Liver Failure
Once a person has signs of liver failure, they may experience:
- Jaundice (yellow skin and eyes)
- Vomiting
- Hand tremors
- Confusion
- Encephalopathy (comatose state)
- Fatigue
- Muscle loss
- Itching all over the body
- Poor blood clotting
- Swelling over the legs
- Ascites (abnormal fluid buildup in the tummy)
- Bleeding from the esophagus (gullet), stomach, or rectum
Liver Transplant Side Effects
- Bile duct complications
- Bleeding
- Blood clots
- Failure of the donated liver
- Infection
- Rejection of the donated liver
- Mental confusion or seizures
Who is a proper Liver Transplant Candidate?
A liver transplant is a surgical procedure that replaces a diseased or damaged liver with a healthy one from a donor. A liver transplant may be the only option for people who have end-stage liver disease, which means their liver can no longer function properly and is beyond repair. However, not everyone with liver disease is eligible for a liver transplant. Certain criteria must be met to be considered a suitable candidate for this procedure:
- The severity of the liver disease: This is measured by a score called the model for end-stage liver disease (MELD), which is based on the results of blood tests. The higher the MELD score, the more urgent the need for a liver transplant. The MELD score also determines the priority of the patient on the waiting list for a deceased donor's liver. Children are given a different score called the pediatric end-stage liver disease (PELD) score.
- The overall health status of the patient: Before being accepted for a liver transplant, the patient must undergo a comprehensive evaluation that includes tests and assessments of the heart, lungs, kidneys, digestive tract, immune system, mental health, and other organs and systems. The purpose of this evaluation is to ensure that the patient can tolerate the surgery and the post-transplant medications and that there are no other conditions that could compromise the outcome of the transplant.
- The availability of a suitable donor: There are two types of donors for liver transplant; deceased donors and living donors. Deceased donors are people who have died and donated their organs for transplantation. Living donors are healthy people who volunteer to donate a part of their liver to a recipient, usually a family member or a friend. The donor and the recipient must have compatible blood types and tissue types to prevent rejection of the new liver. Additionally, family members may also be able to act as donors if they match the patient’s blood type.
- The financial and insurance situation of the patient: A liver transplant is a very expensive procedure that involves many costs, such as the surgery, the hospital stay, the medications, the follow-up care, and the possible complications. The patient must have adequate insurance coverage or other resources to pay for these expenses. The patient must also be aware of the long-term costs of maintaining a transplanted liver, such as the lifelong use of immunosuppressive drugs and regular monitoring.
Type of Liver Transplant
Different types of liver transplants may be offered to a person who has end-stage liver disease and needs a new liver to survive. The type of liver transplant depends on the source and size of the donor's liver, as well as the recipient’s condition and preference. The main types of liver transplants are:
- Orthotopic transplant: This is the most common type of liver transplant, where the entire liver of a deceased donor is transplanted into the recipient. The donor's liver must match the recipient’s blood type and tissue type to reduce the risk of rejection. The recipient’s diseased liver is removed and replaced by the donor's liver in the same location. The surgery usually takes 4 to 12 hours and requires a long recovery period.
- Split liver transplant: This is a type of liver transplant where a liver from a deceased donor is divided into two parts: a smaller left lobe and a larger right lobe. The left lobe is transplanted into a child, while the right lobe is transplanted into an adult. This way, one donor liver can save two lives. However, not all donor livers are suitable for splitting, and the recipients may have a higher risk of complications, such as bleeding or bile duct problems.
- Living donor liver transplant: This is a type of liver transplant where a part of the liver of a living donor, usually a relative or a friend, is transplanted into the recipient. The donor and the recipient must have compatible blood types and tissue types, and the donor must be healthy and willing to undergo surgery. The donor’s liver will regenerate after the surgery, while the transplanted part will grow to fit the recipient’s body.
These are some of the main types of liver transplants, but there may be other variations or combinations depending on the availability of donors and the specific needs of the recipients.
Age Restrictions for Liver Transplant
Age restrictions for liver transplants are not fixed but rather depend on various factors, such as the source and condition of the donor's liver, the health and prognosis of the recipient, and the policies and practices of the transplant center. Generally speaking, older people have a lower chance of receiving a liver transplant than younger people, because they may have more medical complications, a shorter life expectancy, and a lower quality of life after the transplant. However, age alone is not a decisive criterion, and each case is evaluated individually based on the potential benefits and risks of the transplant.
The age of the donor also affects the outcome of the liver transplant. Generally, younger donors have better quality livers than older donors, and their livers are more likely to function well and last longer in the recipients. However, due to the shortage of available organs, older donor livers are also used for transplantation, especially for older or sicker recipients who have a lower chance of getting a younger donor liver. Older donor livers may have more damage, such as fibrosis, steatosis, or reduced blood flow, which can increase the risk of complications, such as primary graft non-function, ischemia-reperfusion injury, or chronic rejection.
The decision to accept or reject a candidate or a donor for a liver transplant is made by a multidisciplinary team of experts, who weigh the pros and cons of the procedure and consider the ethical and practical implications.
The Assessment Process Before Liver Transplant
The assessment process before a liver transplant is a comprehensive evaluation that determines whether a person is eligible and suitable for a liver transplant. The process involves a series of tests, consultations, and education sessions that aim to assess the physical, mental, social, and financial aspects of the transplant. The process may vary depending on the transplant center, but it usually takes about a week and requires the presence of a caregiver or a support person.
The tests that are performed during the assessment process include blood tests, chest X-rays, lung function tests, electrocardiogram (ECG), fitness tests, echocardiogram, kidney function tests, coronary angiography, scans, and endoscopy. These tests check the condition and function of the liver and other organs and identify any potential complications or contraindications for the transplant. The tests also help to determine the severity and urgency of the liver disease, which is measured by a score called the model for end-stage liver disease (MELD) or the pediatric end-stage liver disease (PELD) for children.
The assessment process before a liver transplant is a crucial step that helps the transplant team decide on the candidacy and priority of the person for a liver transplant. The decision is based on the results of the tests and consultations, as well as the availability and suitability of a donor's liver. The decision is communicated to the person and the family, and if approved, the person is placed on the waiting list for a liver transplant. The assessment process also prepares the person and the family for the transplant journey and provides them with support and guidance throughout the process.
In general, tests might include:
- Blood tests
- X-rays and scans
- Heart tests – such as an electrocardiogram (ECG)
- Breathing tests – such as spirometry
- An endoscopy
- Abdominal ultrasound
- Complete physical examination
- Heart test for adults
- Lung function test for adults
