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FAQ’s On Liver Transplantation and Liver Surgery

Liver is the largest solid organ of the human body. It performs many functions which are vital to life. As there is no effective way to substitute liver functions, either by medicines or mechanical equipments, when liver failure is too severe and irreversible, liver transplantation may be a life-saving option.

Apollo Hospitals is among the few recognised transplantation centres in the country and has one of the largest transplantation registries. As liver transplantation is a major surgical procedure, the patients and the family have a quite a lot of concern areas. This brochure provides brief answers to some frequently asked questions.

The information contained herein is of a general nature and should not be constitute as specific medical advice. Please consult your doctor for more details.

What does my liver do?

  • It helps digest your food
  • It clears some wastes from your blood
  • It makes proteins that help your blood to clot
  • It makes proteins, some of which are required for the repair of ongoing wear and tear
  • It stores the food that is used for energy (glycogen).
  • The liver also helps control the way your body uses food and it works with the body’s defense system
  • It helps use and store vitamins
  • It makes chemicals that protect the body.
  • It breaks down many poisons and drugs

What are the signs of liver problems?

Some signs of liver problems are:

  • Feeling tired all the time
  • Muscle wasting (becoming skin and bones)
  • Fluid built up in the abdomen (ascites), Swollen hands/ legs.
  • Yellow skin and eyes (jaundice)
  • Forgetfulness, confusion or coma (encephalopathy)
  • Itching
  • Bruising, bleeding easily and nose bleeds
  • Blood in vomitings, bloody I black bowel movements
  • Feeling weak and sick in your stomach, and losing appetite

What is liver transplantation?

Liver transplantation is surgery to remove a diseased liver and replace it with a healthy one. This kind of surgery has been done for four decades. Across the world, thousands of people have had liver transplants and now lead normal lives. Liver transplants can help adults and children.

What are the reasons for a need to liver transplant?

Liver Transplantation may be required for Chronic Liver Disease or Acute Liver Failure

In adults, the most common reason for liver transplantation is Liver cirrhosis. Cirrhosis is caused by many different types of liver injuries that destroy healthy liver cells and replace them with scar tissue. Cirrhosis can be caused by viruses such as hepatitis B and C, alcohol, autoimmune liver diseases, built-up of fat in the liver and hereditary liver diseases.

In children, the most common reason for liver transplantation is biliary atresia. Bile ducts, which are tubes that carry bile out of the liver, are missing or damaged in this disease and obstructed bile causes cirrhosis

Other reasons for needing liver transplantation are certain liver cancers, benign liver tumours and hereditary diseases.

Sudden or rapidly developing liver failure may sometimes affect children and adults. The common causes are certain viral illnesses and reaction to some medicines like excess dose of pain killers and even certain herbal/traditional medicines.

A liver transplant can save life if undertaken at the right time.

How will I know whether I need a Liver transplant?

Based on your sickness and liver disease status, your doctor may recommend you to the liver transplant unit for further evaluation. You will meet the liver transplant team. The team is usually led by a liver transplant surgeon and includes liver specialists (hepatologists), nurses and other health care professionals. The transplant team will arrange blood tests, x rays and other tests to help make the decision about whether you need a transplant and whether a transplant can be carried out safely.

Other aspects of your health like the condition of your heart, lungs, kidneys, immune system and mental health will also be checked to be sure you’re strong enough for surgery.

Can anyone with liver problems get a transplant?

You cannot have a transplant if you have:

  • cancer in another part of your body
  • serious heart, lung, or nerve disease
  • active alcohol or illegal drug abuse
  • an active, severe infection inability to follow your doctor’s instructions

The liver transplant team will evaluate you for your fitness to undergo liver transplant.

How long does it take to get a new liver?

If the transplant team recommends that you need a transplant, your name will be placed on a waiting list with your consent. Your blood type, body size and how sick you are, plays a role in deciding your place on the list.

While you wait for a new liver, you and your doctor should talk about what you can do to stay strong for the surgery. You will also start learning about taking care of a new liver.

Where do the livers for transplants come from?

Whole livers come from people who are brain dead but have their organs working. These people are on breathing machines in various hospital ICUs. This type of donor is called a “deceased donor/cadaveric donor”.

Alternatively a healthy person in the family can donate a part of his or her liver for the patient with liver failure. This kind of donor is called a ‘living donor’.

The living donors and donated livers are tested before transplant surgery. The testing makes sure the liver is healthy, matches your blood type and is the right size so that it has the best chance of working in your body.

How will I know when I am going to have a liver transplant?

When the liver is available from a family member, you will be prepared for the surgery as it is a planned one. In the living donor surgery, both you and the donor will be in surgery at the same time.

If your new liver is from a cadaver, your surgery starts when the new liver arrives at the hospital. You will be intimated of the availability of the organ and will have to reach the hospital at a short notice (usually a few hours).

What happens during liver transplant surgery?

The surgeon will disconnect your diseased liver from your bile ducts and blood vessels before removing it. The blood that flows into your liver will be blocked or sent through a machine to return to the rest of your body. The surgeon will put the healthy liver in place and reconnect it to your bile ducts and blood vessels. Your blood will then flow into your new liver.

How long does the surgery take?

The surgery can take from 8 to 14 hours. While the surgeon removes your diseased liver, other doctors prepare the new liver.

What to expect after the operation?

You will stay in the hospital for an average of 10 – 14 days to be sure your new liver is working. During this time your doctor will check for bleeding, infections and rejection. There will be regular blood tests and radiological investigations like ultrasound or CT scan. Sometimes, a liver biopsy (taking a small piece of the liver for analysis) may also be required.

You will take medicines to prevent rejection of your new liver and to prevent infections. During this time you will start to learn how to take care of yourself and use your medicines to protect your new liver after you go home.

In the hospital, you will slowly start eating again. You will start with clear liquids then switch to solid food as your new liver starts to work.

You will be made to do exercises after the operation. The physiotherapist will help you with the exercises. You will be taught exercises that you will have to continue at home even after you are discharged from the hospital.

What is rejection?

Rejection occurs when your body’s natural defences, called the immune system, damage the new liver. Your immune system keeps you healthy by fighting against things that don’t belong in your body, such as bacteria and viruses. After a transplant, it is common for your immune system to fight against the liver and try to destroy it.

How is rejection prevented?

To keep your body from rejecting the new liver, you will take medicines. These drugs are called immuno-suppressants. Immuno-suppressants weaken your immune system’s ability to reject your new liver. These medicines have to be continued life-long. The doses of these medicines will be adjusted from time to time by your doctor depending on levels of these medicines in your blood.

Do immune-suppressants have any side effects?

Yes. You can get infections more easily because these drugs weaken your immune system. You will need to stay away from people who are sick. These drugs may also increase your blood pressure, increase cholesterol, cause diabetes, weaken your bones and may damage your kidneys in the long run. Steroid drugs may also cause changes in how you look by causing weight gain. Your doctor and the transplant team will monitor these effects and may treat you for any complications that may occur.

What are the signs of rejection?

Rejection is most common in the initial few months after liver transplant. This is the time when you will be having frequent blood tests. Thus, majority of the times, rejection will be diagnosed early based on these results. Often rejection does not make you feel ill. Sometimes rejection can cause pain, fever, jaundice, changes in liver function tests.

Often, a liver biopsy is needed to be sure that the transplanted liver is being rejected. For a biopsy, the doctor takes a small piece of the liver to examine under a microscope.

What if the transplant does not work?

Liver transplants usually work. More than 90 percent of transplanted livers are still working after 1 year and about 75% livers are working at 5 years after transplant. If the new liver does not work or if your body rejects it, your doctor and the transplant team will decide whether another transplant is possible.

How do I take care of my liver after I leave the hospital?

At the time of discharge from the hospital, the Transplant team will give you detailed counseling and advice regarding the medicines, blood tests, diet, physiotherapy exercises, and hygiene. You will have regular blood tests and will see your doctor often to be sure your new liver is working well. You will need to avoid sick people and report any illnesses to your doctor. You will need to eat a healthy diet, exercise and not drink alcohol. You should take the prescription medicines regularly as per instructions. Any new medicine has to be taken only after consulting your doctor. Do not start or stop any medicine on your own. You may contact your doctor or the Liver Transplant coordinator with any doubts.

Yes. After a successful liver transplant, most people can go back to their normal daily activities. Getting your strength back will take some time, depending on how sick you were before the transplant. You will need to check with your doctor when you can start activities.

Work- After recovery, most people are able to go back to work.

Diet – Most people can go back to eating as they did before. Some medicines may cause you to gain weight and others may cause diabetes or a rise in your cholesterol. Meal planning and a balanced low-fat diet can help you remain healthy. Detailed dietary counseling will be done during your stay in the hospital. You may also meet the dietician after discharge.

Exercise – Most people can engage in physical activity after a successful liver transplant.

Sex – Most people return to a normal sex life after liver transplantation. It is important for women to avoid becoming pregnant in the first year after transplantation. You should talk to your transplant team about sex and reproduction after transplantation.

Living – Donor Transplantation

What is a Living – donor Liver Transplant?

A living-donor transplant is when someone who is alive gives a part of his/her liver to a person who needs a transplant. Family members, such as parents, sisters, brothers, adult children or a spouse, may offer to give part of his or her healthy liver. Thiscan be done because healthy liver can grow new tissue. After the transplant, the liver parts of both the donor and person in need will grow and form complete organs.

What are the benefits of Living – donor Liver Transplantation?

The best reason for a living-donor transplant is that it shortens the waiting time for a liver. The timing of the surgery can be planned. The chance for a successful transplant is increased. Today, thousands of patients await liver transplantation but only handful cadaveric organs become available every year. A living-donor transplant gives those in need an early transplant before their liver failure gets worse and their lives are in danger.

Who can become a donor?

People who want to be liver donors are carefully checked to ensure that they can safely give a part of their liver and to make sure that their liver is healthy. The first concern is the safety of the donor as well as being sure that the graft will work for the person in need. In general, liver donors must:

  • Be in good general health
  • Have a blood type that is a close match to the blood of the person in need
  • Not have a selfish motive for donating
  • There should be no pressure of any kind on a person to donate part of his liver nor should there be any money given or received.

What are the major risks in donating a liver?

As with any major surgery, there will be pain from the incision, which will get better with time. Other risks to the donor include bleeding, infection and temporary bile leaks. Fatalities in transplantation have been reported from certain transplant centers in the world but this is rare. Most have full recoveries and are alive and well. The donors will not need to be on any long term medications.

What is involved in the Donor-evaluation process?

Donors undergo a thorough check-up that includes blood tests, physical examination, ultra-sonography, CT scan, MRI, tests for the heart & lungs, etc.

It takes 2 to 4 days for a donor to go through these tests. In an emergency situation, it can be done in as little as 48 hours.

What happens during donor surgery?

An incision is made at the upper part of your abdomen. The donor’s liver is split into two parts. One part is removed for the transplant. The gallbladder is almost always removed too. The surgeon then closes the wound with sutures or staples. These are later removed at a follow-up visit to the surgeon’s office. The liver begins to heal and grow new tissue. It takes about 8-12 weeks for the liver to grow back to its normal size.

How long is the donor hospitalized?

Donors stay in the hospital for upto 7 days after surgery. They may spend their first night after surgery in the ICU. The next day, they often go to the general surgical floor where the nurses have experience in caring for liver donors. Donors are encouraged to get out of bed and walk as soon as they are able.

How long before the liver donor is fully recovered?

For the most part, it takes about 4 weeks to recover from surgery. In the month after leaving the hospital, donors return to the hospital regularly to be checked. Donors often get back to work within 3 to 6 weeks.

Pediatric Liver Transplantation

Liver transplantation is now one of the best treatments for fatal liver disease in children. New drugs and ways of doing surgery have greatly improved the patient survival rates.

Why do children need liver transplants?

  • Biliary atresia: This is a disease in which a child is born with no bile ducts. It is the most common reason for liver transplants in children
  • Problems in digesting and using food: “inborn errors of metabolism”
  • Liver cancers: Some liver cancers are found only in children.
  • Sudden liver failure: This is a sudden liver failure that can cause death. It can have many causes. Mostly it comes from too much paracetamol or other drugs. In this kind of liver failure, a liver transplant can cure the problem if it is done early.

What are the donor organ options that are used for transplantation in children?

Living-donor transplant: A piece of a liver comes from an adult living donor and is used as a transplant for a child. Over the past 10 years, nearly 1000 of these transplants have been done throughout the world. They have been just as successful as transplants of whole organs.

Reduced-size liver graft: A piece of a liver is taken from a brain¬ dead person (cadaver donor).

Do children get the same anti-rejection drugs as adults?

In general, children get the same type of drugs that adults get. However, children may have different side effects.

Therefore, only doctors who specialize in this field should handle the follow-up of children after transplants.

What makes a transplant successful?

  • You must have good medical care.
  • Families and patients should make every effort to keep in touch with their medical teams.
  • Children who get liver transplants will need to take drugs on schedule, see their doctors often and may need more procedures.
  • Ask for counseling when you have any problems.

Apollo Hospitals Group is among the largest and the best hospital groups in the world, with over 40 hospitals across Asia, providing the entire gamut of multi-speciality and tertiary care services. It is a vertically integrated global power house in healthcare and increasingly a favoured destination for patients from several foreign countries including developed nations.