Liver Transplantation

What is Liver Transplantation?

Liver transplantation is a surgical procedure to replace a damaged or diseased liver with a healthy one. The liver is situated in the upper right portion of your abdomen and performs some of the body’s vital functions such as:

• Production of bile juice
• Storing sugars in the form of glycogen
• Purifying blood from harmful substances
• Making proteins that help in blood clotting
• Fighting infections by removing microorganisms from the blood

A whole liver or part of the liver may be transplanted from another person (donor). Usually, a family member or a close relative is the donor and your surgery will be planned well in advance. The liver can also be transplanted from a deceased donor if you enroll your name as a liver transplant candidate. On acceptance, you will be notified about the availability of a donor liver depending on the severity of your current health condition. Certain tests will be performed to confirm matching your liver with the donor.

A team of healthcare providers including a Psychologist, Anaesthesiologist, Nutritionist and Liver transplant surgeons work together to prepare you for the surgery.

Indications for Liver Transplantation

Liver transplantation is indicated for liver failure that usually develops slowly over time. Each time your liver is injured, it repairs itself and produces a small amount of scar tissue. Excess scar tissue (cirrhotic liver) is formed when your liver is exposed to the damaging factors over a long period of time, making it difficult to repair itself. A cirrhotic liver can become cancerous or no longer function (liver failure). Sudden failure may also occur due to toxins or hepatitis.

Preparing for the Procedure

Both living donor and recipient follow a similar protocol of surgery preparation and procedure.

Your healthcare provider will assess your symptoms and explain the procedure of a liver transplantation. You will have to sign a consent form to confirm your permission for the surgery. The donor will have to take a psychological test to confirm that he/she is comfortable with their decision to donate.

You will be advised to stop eating 8 to 10 hours prior to the surgery. Certain imaging tests and blood tests may be ordered. Special tests such as Doppler ultrasound and echocardiogram may be ordered. Any special instructions will be provided by your surgeon.

Liver Transplantation Procedure

The surgery is performed under general anaesthesia and involves the following steps:

• You will wear a hospital gown and lie on your back.
• An IV line is started in your arm to make you sleep during the procedure.
• A catheter is placed in your bladder to drain urine.
• A tube will be placed into your lungs (through the mouth) to help you breath.
• Your heartbeat and blood pressure are closely monitored.
• A nasogastric tube will be placed to drain secretions from your stomach.
• The skin at the surgical site is shaved and cleaned with an antiseptic solution.
• An incision will be made below your ribs and the diseased liver is carefully exposed.
• Blood supply to the diseased liver is cut off.
• Special surgical procedures are performed to separate the diseased liver
• If a living donor is used, a part of their healthy liver is separated.
• The healthy liver is then transplanted into the recipient’s body.
• The blood vessels and bile duct are re-attached to the donor’s liver.
• The incision is closed with surgical sutures and a bandage is applied.

After the Surgery

Initial recovery takes place in an intensive care unit (ICU). Your breathing tube will be retained for a few days to help you breath. You will receive intravenous pain medications and antibiotics. A liquid diet is initiated once your feeding tube is removed. After a few days, you will be moved to a private room where you will recover for about 2 to 3 weeks.

Recovery at Home

You will be advised to avoid driving and any strenuous activities for a few weeks. A nutritionist may help you plan your diet. Walking multiple times a day is beneficial for the recovery. Liver regeneration begins almost immediately after surgery and a full liver may be formed within a few months (Both donor and recipient). Recipients are instructed to take prescribed anti-rejection medications for life to prevent rejection of the liver by their immune cells.

Complications

Both donor and recipient may experience surgery complications such as pain, discomfort, allergic reactions, nausea, scar tissue formation, infection and bleeding. Long term use of anti-rejection medications in recipients may cause diabetes, bone-thinning and high cholesterol.

Contraindications

Your healthcare team may not recommend a liver transplantation if you have:

• Cancer
• Severe illness
• High blood pressure
• Active substance abuse
• Uncontrolled infection
• Uncontrolled psychiatric disease