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Home  Medical Treatment - Liver Transplant |
Liver Transplant
Explore this section to learn more about liver transplant surgery, why it is needed, and what its long-term effects are.
What is Liver Failure and What are its causes?
This is a potentially fatal condition in which the liver progressively stops performing its function resulting in episodes of jaundice, accumulation of fluid in the body, blood vomiting and confusion. Conditions such as Hepatitis B or Hepatitis C infection, excess alcohol consumption, diseases such as Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis can cause this state.
Can it be treated?
With modern medicine, it is now possible to treat most such cases successfully. While a proportion of patients with acute liver failure can recover by receiving treatment in specialised liver ICUs such as the one available at Apollo hospital New Delhi , most other patients ultimately require liver transplantation. Medicines, and other measures such as draining ascites and stopping the blood vomiting by endoscopy are only temporary and do not halt the progress of the disease. Most such patients die within a few months to a year unless liver transplantation can be performed.
When is a liver transplant needed?
Liver transplantation is needed for patients who are likely to die because of liver failure ( in less than one year ). Many diseases can cause liver failure. The most common is cirrhosis, which is the scarring and death of liver cells. Cirrhosis caused by hepatitis C is the most common reason for liver transplants.
Other conditions that may ultimately require a liver transplant include:
- Diseases of the bile ducts, including biliary atresia, primary biliary cirrhosis and primary sclerosing cholangitis, which can cause liver failure if there is a backup of bile in the liver.
- Some inherited diseases, such as Wilson’s disease, in which dangerous levels of copper build up in the body, and hemochromatosis, where the liver is overwhelmed by iron.
- Primary liver cancer or cancer that affects only the liver.
- Alcoholism which can cause cirrhosis.
What is a liver transplant?
A liver transplant is surgery to replace a diseased liver with a healthy liver. When a patient receives a liver transplant, the entire liver is removed. It is then replaced by either a complete new liver or a portion of a healthy liver. (Once transplanted, a piece of a healthy liver can grow into a normal-size liver.)
In most cases, the new liver or liver tissue comes from a deceased donor. It is becoming more common, however, for patients to receive liver tissue from a living donor, who may be a family member. In this case, the transplant surgeon removes part of the donor's liver and uses it to replace the patient's liver.
Facts About Liver Transplant:
- It is the only cure for advanced stage Cirrhosis
- It is always advised to be done as soon as it is recommended. Timely done its success rate is 80%
- One can return to normal lifestyle after transplant but close follow up is required with your surgeon
Liver Transplant Procedure
The patient will be under general anesthesia throughout the surgery. Once asleep, the transplant surgeon will make an incision shaped like a boomerang on the upper part of the abdomen. The surgical team will then remove the patient's old liver, leaving portions of his major blood vessels in place. The new liver will then be inserted and attached to these blood vessels and to the patient's bile ducts. To help with bile drainage, a tube will also be inserted in the bile duct during surgery.
Preparing the Patient for Surgery
The patient may receive an enema to clean out his intestines and prevent constipation after surgery. His chest and abdomen will be shaved clean to prevent infection, and an intravenous (IV) line will be inserted in his arm or just under his collarbone to give medication and keep him from getting dehydrated. The patient will also be given a sedative to help him relax and feel sleepy before going to the operating room.
IMPORTANT:
Because transplantation is a major surgical procedure, the patient may need a transfusion. Today, all blood is screened very carefully; the likelihood of contracting a disease is very small. Any concerns that the patient has regarding the source of the blood should be relayed to the transplant team during the waiting period, before getting to the hospital. Most hospitals offer the option of "autotransfusion" - this is when the patient donates his own blood before surgery. His own blood is stored and then used during transplantation.
Waking Up in the Intensive Care Unit (ICU)
After the surgery, the patient will wake up in the intensive care unit after the anesthesia wears off.
This is what the patient should expect:
- Some pain and discomfort, which medication will help to relieve.
- A tube will be inserted through the patient's nose. This tube will run down the patient's throat and into his stomach. This tube will keep the stomach empty, to help prevent nausea and vomiting.
- A tube may be inserted into the patient's throat to help him get enough oxygen. It will be connected to a breathing machine called a ventilator. The patient should try to relax and let the machine breathe for him. The patient will not be able to talk with this tube in place, but he will only need it for a few days. Nurses will do everything they can to help the patient communicate. The patient's throat may feel sore or scratchy for a few days afterward.
- The patient will be asked to cough periodically to keep his lungs clear. If it hurts to cough, the patient should ask someone to support his abdomen.
- The patient will have an IV line in his arm or neck under the collarbone, which will be used to give fluids and medication for the first few days after surgery.
- For several days after surgery, the patient will have a catheter in his bladder to drain urine. He may feel uncomfortable, and may feel that he has to urinate constantly, but it is only temporary.
- During surgery, several drains will be placed in or near the incision. These drains will be removed 5 to 10 days after surgery.
The length of a hospital stay will depend on a patient's progress. A patient is encouraged to talk to someone on his transplant team if he is uneasy or uncomfortable.
Post-Transplant
Following surgery, liver transplant patients typically spend one to two days in the Intensive Care Unit and remain hospitalized for five to 10 days. Patient education begins in the early postoperative period and continues after hospital discharge.
When recipients leave the hospital, they are assigned a post-transplant nurse coordinator and given a supply of medication, instructions and phone numbers to call with questions or for emergencies. In the early post-transplant period, patients are sent frequently in the outpatient clinic.
Going Home
Once at home, the patient maintains regular contact with the post-transplant nurse coordinator. The patient must have lab work completed weekly for the first four months post-transplant and then twice a month for the first year. Lab work can be done by the patient's local physician or a community lab. Results are sent to the nurse coordinator for review with a physician. The coordinator can assist the patient with home care issues, medication questions and refills, as well as respond to general questions and concerns.
Patients are advised to maintain regular contact the Mediserve Team even after going back home . We shall always be there to provide any further clarifications or assistance that you may need from us.
To receive an approximate idea of cost and other information regarding treatments, please contact us.
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