What is liver transplant?
A liver transplant is a surgical procedure that removes a diseased liver and replaces it with a healthy liver from a donor. Most livers are obtained from deceased donors, though it is possible to obtain a healthy liver part from a living donor too. Liver transplant is usually a last attempt to rescue critically ill patients.
Living donor for liver transplant: Patients with end-stage liver disease may receive a segment of liver from a healthy living donor. Both donor and recipient liver segments eventually grow to their normal sizes in a few weeks.
Deceased donor for liver transplant: In this case, the donor may be a victim of an accident, in which case his or her heart still continues to beat while the brain stops functioning. Such a person is considered legally dead.
Why does one need liver transplant?
Liver transplant is considered in case of liver failure, when the liver stops functioning normally. Conditions that lead to liver failure may include:
- Chronic hepatitis with cirrhosis
- Primary biliary cirrhosis, in which the immune system attacks the bile ducts
- Sclerosing cholangitis, or narrowing or scarring of bile ducts inside and outside the liver, leading to backup of bile in liver
- Biliary atresia, a rare disease affecting newborns
- Wilson’s disease, a rare inherited disease that causes abnormal levels of copper in body
- Liver cancer
- Alpha-1 antitrypsin deficiency, causing cirrhosis due to build-up of Alpha-1 antitrypsin protein in liver
- Hemochromatosis, a common genetic disease that causes accumulation of excess iron in body
Which specialist should be consulted in case of signs and symptoms?
A team of specialists evaluate a patient’s condition and medical history to select for liver transplant. The team generally includes hepatologist (liver specialist), transplant surgeons and anaesthesiologist.
What are the screening tests and investigations before the surgery?
The patient must carry all prior doctor records of their liver condition, x-rays, history of medication and liver biopsy slides to be pre-evaluated for liver transplant.
The following tests are also performed to check the patient’s candidacy for transplant and preparatory processes:
- Blood tests to determine blood type, clotting and biochemical condition of blood and to determine liver function.
- Echocardiogram to check heart.
- Pulmonary function study to determine the lung’s ability to exchange oxygen and carbon dioxide.
- Doppler ultrasound to check the condition of blood vessels to and from liver (i.e. if they are open).
- Computed tomography to create images of liver, to see its size and shape.
- AIDS testing and hepatitis screening.
What is the procedure for liver transplant surgery?
A liver transplant may take between six to twelve hours during which surgeons remove the failing liver and replace it with a donor liver. It is a major procedure and surgeons place several tubes in the body to maintain its normal functioning during the process and afterward too for few days.
The following tubes are placed:
- A tube through the windpipe allows the patient to breathe. The tube is connected to a ventilator that helps expand the lungs mechanically.
- A nasogastric tube is inserted through the nose into the stomach. It drains secretions from the stomach till bowel functions return to normal after the operation.
- A catheter is placed to drain urine.
- Tubes are placed in the abdomen to drain fluid and blood from around the liver.
- Sometimes, a T-tube is placed in the bile duct to drain bile into a small pouch outside the body to be measured daily.
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“Liver transplant,” MayoClinic.com, Mayo Clinic Staff, https://www.mayoclinic.org/tests-procedures/liver-transplant/basics/definition/prc-20014076
“Liver transplant,” MedlinePlus, NLM, NIH, https://www.nlm.nih.gov/medlineplus/ency/article/003006.htm
“Liver transplantation,” WebMD.com, https://www.webmd.com/digestive-disorders/digestive-diseases-liver-transplantation?page=2
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