A few facts about liver transplantation
Only cure for advanced stages of cirrhosis
Can be done by donation by a brain dead person or by a close relative with matching blood group
Done in time, it carries 80% success rate
Close follow up is essential after transplant
Life can be completely normal after transplant
Who needs a transplant
According to international guidelines, any patient suffering from liver cirrhosis who is assessed to have a life expectancy of less than a year should be considered for a transplant. Severity of liver disease is graded from A to C. Usually all Grade C and most grade B patients are candidates for transplant. Any patient with any of the liver failure symptoms listed below should seek specialist opinion so that liver experts can assess whether a transplant or drug treatment is more suitable for them. In any case, the better the condition of the patient at the time of transplant, the better are the results of surgery. In patients who are critically ill in ICU, malnourished, have active infection, or other organ damage such as kidney impairment at the time of the operation, the results of transplantation are dismal. Therefore, timely transplant is of essence in obtaining good results. A timely transplant done on a patient who is in a reasonable condition, with a good donor liver has around 80% chance of success.
In most instances, the above causes initially result in Hepatitis which can usually be treated. However, if the offending factor is not removed or treated on time, cirrhosis develops and then it is usually too late to change the course of the disease.
Symptoms of liver failure due to cirrhosis
Water in the abdomen (ascites)
Drowsiness and mental confusion
Excessive bleeding from minor wounds
Low hemoglobin and other blood counts
Pre-transplant evaluation (Transplant Assessment)
The liver specialist usually suggests this evaluation once he has diagnosed end-stage liver disease. Recipient evaluation is done in three phases and normally takes 5-7 days in hospital.
1. To establish definite diagnosis, determine the severity of liver disease and the urgency of the transplant.
2. To determine the fitness of the patient for a transplant. The other systems such as heart, lungs, kidneys, blood counts are tested and the presence of any infection is ruled out. The liver specialist then decides how successful the surgery is likely to be depending on the status of the patient and the cause and severity of liver disease.
3. The final phase entails the psychological and mental preparation of the patient. The patient and the family are counseled about the procedure, hospital stay, the likely course after surgery, follow up and aftercare.
After evaluation, the patient is either placed on the waiting list for cadaveric donation, or , if there is a willing and blood group matched family donor available, he/she is evaluated for donation and a transplant is scheduled. While on the cadaver waiting list, the patient follows up with the Transplant Team until a suitable liver becomes available. If the patient's condition shows signs of deteriorating, we normally suggest the family to consider living liver donation.