Liver Transplant

Liver Transplant

What is liver transplantation?
liver transplantation

Liver transplantation is surgical procedure to replace a failing or damaged liver with a healthy well- functioning one. The most commonly used technique is orthotropic liver transplantation, in which entire liver is removed and replaced by the donated liver.

Liver transplantation is universally the standard of care for treatment of end stage chronic liver disease or cirrhosis and is a life saving operation for patients with acute liver failure. Donated liver can from a living donor or a deceased (brain dead, cadaveric) donor. This article to make patients familiar with benefits and risks of liver transplantation

What are the signs and symptoms of liver disease?

Signs and symptoms of liver disease and result of some blood tests are commonly used to determine severity of liver disease,which in turn determines the treatment required.Some formulae and scoring system universally used for severity assessment are the Child –Pugh –Turcotte(CTP) score,CTP Class (A,B or C) and Model for End Stage Liver Disease(MELD) score,PELD score in patients with early liver disease have minimal symptoms , low score and may not require a transplant.Patients with advanced disease have severe symptoms,high score and need an patients with advanced disease have severe symptoms,high scores and need an early transplant.Patients who have secondary effects of I liver disease on other organ systems,such as kidneys)hepato-renal syndrome),lungs(hepato-pulmonary syndrome),brain and may also need an early transplant. Patients with liver cancer are often diagnosed on routine screening tests such as ultrasound,CT scan or MRI.They might require an transplant even without sever underlying liver disease. Patients with acute liver failure generally have a normal (non cirrhotic) liver and therefore have the potential for regeneration and recovery.However, beyond a certain degree of damage, recovery is unlikely.The need and urgency of transplant is determined by kings college criteria. Some patients might have an irreversible liver disease but not enough to warrant a transplant,whereas other might be too sick to benefit from a transplant.This assessment can best be made by doctors who spacialize in liver disease i.e.liver transplant surgeons and hepatologists. Transplantation will be offered only if the benefits of a liver transplant outweigh its risks. Liver transplant is not offered to patients with current alcohol abuse problems,those with uncontrolled active infections,widespread cancer or severe,untreatable diseases of the brain,heart or lung.

Deceased donor (brain dead,cadaveric) transplant

Brain death is sudden death after an accident,brain hemorrhage or stroke with irreversible brain damage,not compatible with life.Brain dead patients may be artificially maintained on a ventilator and supportive medicines for a short duration and may be able to donate their organs for transplantation,if their family so desires.Donation by single deceased donor can allow as many as nine life saving organ transplant and numerous life-enhancing tissue replacements. Livers from deceased donors are matched with recipients blood group and size,offered to the first patient on the waiting list,and if suitable, transplanted.The whole liver is usually transplanted,although sometimes it may be divided into two portions and offered to two patients,generally a child and an adult. Unfortunately, the number of patients in need of a transplant have far outnumber the availability so much organs; therefore not all patients are able to undergo a deceased donor liver transplant.

Living donor transplant:

Living donor can donate one of a paired organ such as a kidney or one lobe of the liver.Living donors are family members or close relatives of the patient.

Reserve:

even 25% of the liver can provide sufficient function for a persons;therefore,one can easily tolerate removal of a large portion of the liver.

Regeneration:

Liver has the capacity to regenerate/re-grow back to its normal size.the process starts soon after division/ transplantation of the liver in both the donor and the patient.About 90-100% of regeneration happens within 2-3 months. Because of the these properties,50-70% of normal liver can be safety removed and the remaining liver provides adequate function until complete regeneration.A margin of safety is always kept for the donor when planning transplant.Lliving donor liver transplant is based on two remarkable qualities of the liver Reserve:even 25% of the liver can provide sufficient function for a person;therefore,one can easily tolerate removal of a large portion of the liver. Generally, patients need a liver which is 0.8-1% of their body weight to recover well from the operation, which commonly correspond to a right lobe for an adult patient, left lobe for an adolescent and left lateral segment for a small child.In India,more than 80% of transplants are from living donors that is in contrast with western countries where more than 90% of transplant are by deceased donors livers

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