Gastrointestinal Bleeding: As per the fact that liver gets scarred, the increase in the portal blood flow resistance takes place that further more leads to increase the pressure of venous system. This results in necessitating the alternative routes for blood to return to the heart (ACG, 2019).
Fluid Retention: One of the main functions of the liver is to synthesize the proteins circulating in the bloodstream that includes albumin. Albumin in the blood retains the fluid in the vascular space by putting forth the pressure which is known as osmotic pressure
Encephalopathy: This occurs as a result of failure of the liver to clear the ammonia and other toxins from the blood and allows the substances to accumulate. These Toxins culminate in the cognitive dysfunction that ranges from disturbed sleep-wake patterns to mild coma.
Individuals who need the liver transplant usually have one of the following diseases:
- Acute Liver Failure
- Chronic liver failure
- Viral Hepatitis
- Alcoholic Liver Disease
- Metabolic Liver Disease
- Autoimmune Liver Disease
- Genetic Liver Disease
- Vascular Liver Disease
More about Treatment
A liver transplant is defined as an operation that helps to replace the diseased liver of the patient with the entire or partially healthier liver. The procedure of liver transplant is a kind of surgical procedure where a liver is removed that is no longer able to function properly and is replaced.
Types of Liver Transplants
Liver transplantation can be carried out in the following ways:
Deceased Organ Donation: This type involves a liver transplantation where liver is taken from the person who has died recently.
Living Donor: Under this type, a section of liver is transplanted from a living donor as the liver is able to regenerate. Both the transplanted section and the remaining section has the ability to grow back into a normal size liver.
Who can donate Liver?
Brain dead organ donors
Most of the livers that are used for transplantation are mainly got from the patients with dead brain. Brain death is usually due to the large stroke or massive trauma in the head that occurs due to blunt injury or penetrated injury. This results in the failure of brain in performing all its functions including other organs. Only the liver is able to work normally in the entire body.
Cardiac death organ donors
A patient sometimes suffers with a brain injury that turns out to be devastating and carries with it a dismal neurological prognosis. This injury urges the body to fail to meet the strict criteria by making the brain dead. However, in that brain death, there are still some detectible brain functions. In this situation, the patient’s family has the decision to withdraw the medical support with the intention of allowing the patient to die.
Risks Involved in Liver Transplant
The liver transplantation carries with it a risk of significant complications. There are certain risks linked with the procedure itself and with the drugs essential to prevent the rejection of the donor liver after the transplantation process. The risk involved in the procedure includes:
Bile duct complications, including bile duct leaks or shrinking of the bile ducts
Failure of donated liver
Rejection of donated liver
Mental confusion or seizures
Who needs a Liver Transplant?
People who require liver transplants typically have one of the following conditions.
Acute Liver Failure
It is also known as hepatic failure which occurs when the healthy liver suffers with passive injury that culminates in clinical signs and symptoms of liver insufficiency.
Chronic liver failure
The liver has the ability to repair it back in reaction to the injury. Yet, the repeated injury and repair, typically if the injury has lasted for many years and even decades leads to its failure. The last stage of scarring is known as cirrhosis where the liver is no longer able to repair itself.
Who Are Not Candidates for a Liver Transplant
Below are the conditions that are said to be absolute contra-indications to the liver transplantation
Severe, irreversible medical illness that limits short-term life expectancy
Severe pulmonary hypertension (mean pulmonary artery pressure greater than 50mmHg)
Cancer that has spread outside of the liver
Systemic or uncontrollable infection
Liver Transplant procedure
Pre-procedure - Choosing a Transplant Center
While considering the centers of transplantations, you might want to know the following things:
Learn about the types of transplants that the center has been performing every year.
Ask the center about the survival rates
Make the comparison of transplant centers by the database that you can get from scientific transplant recipients.
Know the cost that be incurred prior to the process, during the process and after the process. It will also include tests, surgery, follow up appointments and transportation.
After you have made the decision about the transplant center, you will be evaluated to see that whether you are liable and meet the liver transplant requirements or not. The objectives of the evaluation process lies on the following criteria’s:
Are you healthy enough to undergo a surgery and tolerate the lifelong post transplant medications?
Are you suffering with any kind of medical conditions that would intervene in the success probability of transplantation process?
Are you willing to take medications as guided and follow the guidance of the transplantation team?
What can you expect
Prior to the Procedure
Doctors use the results of liver function test and other elements to see the prognosis and your place in the liver transplant list. After this, the organs are allocated as per the MELD scores and they are stratified on the basis of blood type. Individuals with higher MELD scores are normally offered the donate livers at first. The time used on the transplantation list is used to break the ties among the people with similar MELD score and blood type.
During the Procedure
If you are informed that a liver from a deceased donor is available, you are asked to visit the hospital. The health care team admits you to the hospital and you are undergone through an evaluation in order to ensure that you are healthy enough for the surgery.
You are administered general anesthesia. The blood supply of your liver is then disconnected by the surgeon and then the diseased liver is removed from the body. The donor liver is then located in your body and blood vessels and bile ducts are then attached again. The average time for this entire process can take up to 12 hours as per your situation. Once your liver is transplanted, the surgeon stitches to close the incision opened for the surgery. Lastly, you are taken to the ICU to begin with the recovery phase.
After the Procedure
After your liver transplant, you are expected to:
Stay back in the ICU for some days. This is important as the doctors evaluate your condition to see the indications of complications. They also test your liver to see that either it is functioning properly or not. Once you are stable, you are taken to the recovery area.
Have usual checkups while you recover at home. Your transplant team will design a checkup schedule for you and you might also undergo some blood test every week.
Potential Complications of liver transplant
Hepatic artery or clotting of the hepatic artery is one of the complications that might occur under which the blood vessels brings the oxygenated blood from the heart to the liver. This occurs in 2 to 5 percent of the deceased donor transplantation.
The second possibility could be Biliary complication. There are two types of biliary problems that are Leak or stricture. This complication might occur in 15 percent of the deceased donor cases and up to 40 percent of living donor transplants.
Immunosuppressant drugs – why required and their harmful effects?
In the procedure of your organ transplant, you will be placed on a regimen of the immunosuppressant medications to prevent your immune system from rejecting the donor organ. This can be done by means of medications that might have been prescribed including corticosteroids, tacrolimus, cyclosporine, mycophenolate, azathioprine, and sirolimus. One of the major side effects of corticosteroids is osteoporosis. It occurs when the density of bones is decreased and the risk is increased for the fractures. This can affect any bone in your body, but fractures are most commonly seen at the hip, spine or wrist.
Survival Rates after the Transplant
The chances of the successful liver transplant and long term survival depends on the specific situation. Generally, an average of 70 percent who went through the transplantation process live for five years or more. People who get a liver from a living donor usually have better short term survival rates as compared to the ones who receive a deceased donor liver.
It is quite normal to feel anxious and overwhelmed at the time of waiting for the transplant to have fears about rejection, returning to work or other issues after the transplant. Seek the support of friends and family members that could help to deal at the time of stressful time. The transplant team also assists with other resources and coping strategies at the time of transplant process that includes:
Joining the support group for the recipients of transplant by talking to the ones who have similar experiences and they can share their experience and can comfort the fears and anxiety of the patient.
Sharing experience on social media as it will allow helping the transplant recipients and donors to connect with other through social media and get motivated.
Look for the rehabilitation services: If you are returning to work, the social workers might be able to connect you with rehabilitation service offered by the state department of vocational rehabilitation.