Liver Transplant Surgery

Liver transplant is a major surgical procedure which aims at the overall improvement of quality of life in patients who are affected with chronic liver disease. Though it is a major surgical procedure with several risks associated with it, its success rates are reported in literature. It is advised to ask your consulting specialist about the benefits and risks associated with the procedure. For a transplant to be successful it is essential to follow the pre-operative and post-operative instructions, maintain a healthy lifestyle and continue the medication as suggested by your consulting specialist.

Your liver is the largest glandular organ of the body that is divided into four lobes of unequal size and shape. Liver performs many important functions. Liver helps to produce substances that break down fats, convert glucose to glycogen, produce urea (the main substance of urine), make certain amino acids (the building blocks of proteins), filter harmful substances from the blood (such as alcohol), storage of vitamins and minerals (vitamins A, D, K and B12) and maintain a proper level or glucose in the blood. The liver is also responsible for producing cholesterol. It produces about 80% of the cholesterol in your body.Your liver is located below your diaphragm, but primarily in the upper right section of your abdomen. Most of it is contained within the ribcage, but it also extends over into the upper left abdomen and the middle of your upper abdomen. This is because the liver is such a strange shape, dome like and irregular with two large lobes and two smaller lobes. When you breathe, your liver actually gets pushed down by your diaphragm, sending the lower edge down past the lowest rib.The liver works diligently to keep you free of disease. Because of its importance in your body, any sign of trauma to the organ itself or any liver function trauma in general is a major problem. Liver damage can be attributed to various reasons due to which liver failure may occur or the liver may fail to perform its functions.Cirrhosis is an abnormal liver condition in which there is irreversible scarring of the liver that eventually prevents the liver from functioning properly. The scar tissue thus formed blocks the flow of blood through the liver and slows the processing of nutrients, hormones, drugs, and naturally produced toxins. The scar tissue also slows the production of proteins and other substances made by the liver. Some of the most common causes of cirrhosis of the liver are Hepatitis C, fatty liver, and alcohol abuse. Some of the symptoms of liver failure due to cirrhosis are black stool, blood vomiting, water in the abdomen, drowsiness and mental confusion, excessive bleeding from minor wounds, Jaundice, Kidney dysfunction, Excessive tiredness, Low hemoglobin and other blood counts.A patient suffering from liver cirrhosis and who is assessed to have a life expectancy of less than a year is generally considered for a Liver transplant surgery.  Patients who are suffering from severe liver disease should consult a liver doctor at the earliest. The medical treatment or the liver transplant surgery (as per doctor’s recommendation) would be more effective if  the problem is diagnosed and treatment is started early. If a liver transplant surgery is done timely on a patient who is in a reasonable health condition, with a good donor liver then there are high chances of success.A liver transplant surgery starts with a detailed evaluation and a battery of tests for both the recipient and the donor. The evaluation of the recipient is done in three phases to establish definite diagnosis, determine the severity of liver disease and the urgency of the transplant. The functioning of all the vital organs is properly checked. Before the liver transplant procedure the patient, donor and other family members are counseled about the procedure, hospital stay, the likely course after surgery, follow up and aftercare in order to help them to make up their mind and understand the process thoroughly.There are two types of Liver Transplant Surgery

1. Cadaveric donor (deceased donor) liver transplant
2. Living Donor Liver Transplant

In a Cadaveric Donor Liver Transplant, the liver is taken from a Cadaveric Donor for transplantation. A Cadaveric Donor is a brain dead person (refers to the irreversible end of all brain activity and the patient is on advanced life support system). In this case a donation is possible from a person whose family wishes to donate the person’s organs before discontinuing life support. Cadaveric transplants are not practical for overseas patients since in India there is long waiting list for Cadaveric Donors since cadaveric organs are not frequently available and the wait for such donors may extend to several months.In a Living donor Liver Transplant surgery, the donor is a living and active person. In this case the liver donation is possible from a close relative of the recipient. Due to a lack of cadaveric donors in India, majority of the transplants currently performed are living donor liver transplants whereby a portion of the patient’s relative’s liver is removed and is used to replace the diseased liver of the patient.