Liver Transplant Surgery

Liver transplantation is a critical medical intervention that becomes necessary when the liver faces end-stage disease or failure. A range of underlying causes can lead to this dire situation, making liver transplants a life-saving procedure. 

A liver transplant may also be a treatment option in rare cases of sudden failure of a previously healthy liver. The number of people waiting for a liver transplant greatly exceeds the number of available deceased-donor livers.

When Is It Necessary To Have A Liver Transplant?

A liver transplant involves replacing a very damaged or diseased liver with a healthy one. Here are indications for the need for liver transplant surgery: 

• End-stage liver disease (ESLD) is a chronic condition associated with progressive damage of the liver, and it mostly ends up being liver failure. Typical causes range from chronic viral hepatitis spirits: B or C, cirrhosis from a somber alcohol habit or fatty liver disease, primary biliary cirrhosis, and primary sclerosing cholangitis to biliary atresia, metabolic diseases such as Wilson's disease and hemochromatosis, and advancing on to liver cancer or hepatocellular carcinoma.

• Acute liver failure: It is an abrupt and severe insult to the liver during which the organ suffers acutely; these injurious agents may be a virus (such as hepatitis A or B), drug-induced liver damage (such as acetaminophen overdose), exposure to a poison or toxin, or an autoimmune disease.

• Some genetic conditions affect the liver, and chronic liver diseases such as NAFLD and autoimmune liver diseases can all progress to grave-stage cirrhosis, which gives rise to complications such as jaundice, fatigue, and fluid retention.

• Certain types of liver tumors: Liver tumors such as hepatoblastoma and HCC could potentially need a transplant if they fulfill certain criteria. In these situations, the transplant can take the tumor out of the liver, which means a chance for recovery.

Types Of Liver Transplant Surgery:

Three kinds of liver transplantation are available depending on the recipient's needs.

1. Deceased donor liver transplant: The most common liver transplant, which replaces the diseased liver with a healthy one from a deceased donor. The new liver is placed in the same anatomical position as the diseased one and is connected to its blood vessels and bile ducts.

2. Living donor liver transplant: From the living donor, a healthy portion of the liver is taken and transplanted into the recipient. The liver from the donor partly regenerates in a few months and gives the recipient a functional liver. This procedure is usually preferred for infants and small children or adults.

3. Split liver transplant: This transplant divides a deceased donor's liver into two parts for transplantation to different recipients, increasing the availability of livers for transplant.

Benefits of Liver Transplant

Liver transplantation poses life-changing advantages to persons with liver disease or failure. Some important advantages are listed below:

• Prevention of liver cancer: Liver transplants may prevent liver cancer in patients with chronic liver disease by restoring normal liver function. 

• Improved Energy Levels: Increased energy levels resettle the individual with a transplant to engage in activities otherwise ditched. 

• Reduced Symptoms: Liver transplants provide relief from symptoms such as fatigue, jaundice, swelling, and itching. 

• Enhanced Mental Clarity: Enhanced liver function can deliver improved cognitive decisions, concentration, and mental well-being. 

• Greater Independence: Improvements in health give people greater independence over their daily living. 

• Increased Survival Rates: Liver transplants increase survival rates of end-stage liver disease, allowing for longer and healthier life. 

• Long-Term Success: Care and management should allow liver transplant recipients to live for many years after transplantation. 

• Return to Daily Life: Most go back to jobs or school, travel, and enjoy life after a liver transplant. 

• Exercise and Recreation: These promote health while better health enhances relationships and social life. 

• Improved Fertility for Women: Liver transplants improve women's fertility to conceive following the procedure.

Risks and Complications of Liver Transplant

• Surgical Risk: Liver transplant surgery includes risks such as bleeding, infection, blood clots, bile leaks, liver dysfunction, and complications of anesthesia.

• Complications after transplantation: Complications of this transplant such as rejection, infection, side effects of drugs, kidney problems, graft failure, bile duct issues, and psychological challenges are potential complications after liver implants.

• Long-term risk: There is a concern about the repetition of the original disease and the increased risk of cancer. Chronic rejection can damage the transplanted liver and cause a reduction in function. If the risk of heart disease increases due to changes in medication and lifestyle in recipients of liver transplants.

Liver transplantation is a complex surgical procedure that involves replacing a diseased or failing liver with a healthy liver from a living or deceased donor. It is a life-saving intervention for individuals facing end-stage liver disease. Here's a detailed overview of the liver transplant procedure:

Before Liver Transplant Surgery

• Evaluation and Assessment: The transplant team will take a good history, conduct tests, and assess psychological and social well-being, nutritional status, and blood grouping for donor compatibility.

• Awaiting a Donor Liver: Urgency for liver transplant is measured according to the MELD score (Model for End-Stage Liver Disease). If the score is high, the need is deemed highly urgent. Keep trying to stay as healthy as possible: remain active, eat well, use medications, and go for check-ups regularly.

• Pre-Transplant Preparation: The transplant team will give the recipient an overview of the process, its risks and benefits, and post-care and complications. Emotional support and counseling will be part of the workup.

• Call for Transplant: The patient will be called urgently for evaluation when the liver is ready. A pre-op exam will ensure you're transplant-ready.

During Liver Transplant Surgery

• Anesthesia: The administration of general anesthesia will ensure that the recipients are unconscious and free of pain during the entire procedure. 

• Incision: A large incision will be made in the abdominal cavity to access the liver. The location and extent of the incision may vary according to the specific needs of the particular situation for that patient. 

• Extraction of the pathological liver: The surgeon will detach the bile ducts and blood vessels that are attached to the diseased liver. Only then will the liver be removed. 

• Placement of the donor's liver: The donor's liver will be placed in the same location as that of the patient. The donor's bile ducts and blood vessels will then be connected to the bile ducts and blood vessels of the recipient.

• Closure: After the donor liver has been securely seated and functionally tested, the surgeon will close the incision with sutures or staples. 

Surgeon providers place a nasogastric tube to drain the stomach and a catheter into the bladder for urine drainage. The duration of the entire liver transplant operation depends on the complexity of each case and may last for several hours or more.

After Liver Transplant Surgery

• In Hospital or ICU: After surgery, there may be a stay in the hospital for a few days or up to a few weeks, depending on the level of complications in the case. The first few days may require strict observation in the ICU.

• Medications: The recipient has to be on immunosuppressive medications for the rest of the patient's life to prevent rejection of that new liver.

• Rehabilitation: To regain previous strength and mobility, he/she will need to collaborate with a group of medical experts. 

• Regular follow-up visits: To monitor and evaluate the patient, the transplant team must see the patient regularly.

• Lifestyle changes: Recipients may need to adopt a healthier lifestyle, including a balanced diet, regular exercise, and no alcohol or tobacco.