Who needs liver transplant?
According to international guidelines a patients who has advanced liver cirrhosis with life expectancy of less than one year should be considered for liver transplant. Acute liver failure is an emergency were patients require urgent liver transplant if conservative management fails to improve liver. All patients with child C liver cirrhosis and select child B cirrhosis should be considered for liver transplant.
Common indications of liver transplant
- Alcohol induced liver cirrhosis- is most common indication of liver transplant
- Acute liver failure (ALF)- due alcohol binge, hepatotoxic drugs require early liver transplant if patients’ conditions deteriorate with medical management. A patient of ALF should be transferred to center were liver transplant facility is available as almost 50% patients eventually require a liver transplant
- Hepatitis B/C induced liver cirrhosis- chronic hepatitis B/C is common cause of chronic liver cirrhosis leading to end stage liver disease. Virus titers improves with hepatitis B/C medications but advanced liver cirrhosis is indication for liver transplant.
- Non alcoholic fatty liver disease (NAFLD)- obesity, fatty liver leading to NASH and cirrhosis is becoming a leading indication of liver transplant worldwide
- Liver cancers- liver transplant is indicated in early stage of hepatocellular carcinoma. Study shows that small hepatocellular carcinoma are best treated by liver transplant with minimal risk of recurrence. Transplant removes cancer as well as takes of primary liver cirrhosis.
- Primary biliary cirrhosis (PBC)- liver transplant is indicated when PBC leads to liver cirrhosis.
- Biliary atresia- is most common indication of liver transplant in pediatric age group
- Budd chiari syndrome (BCS)- early stage of BSC is managed with hepatic venous stenting. When cirrhosis sets in leading to end stage liver disease, liver transplant is only salvage option
- Wilsons disease
- Sclerosing cholangitis
Types of liver transplant
The person who donates part (graft) or full organ (in case of brain dead) is called donor and the patient in whom the graft/ organ is implanted is called recipient. There are 2 types of transplants based on organ donation
- Deceased (cadaveric) donor liver transplant- were organ donor is brain dead person whose organs are harvested for transplant after donor family gives consent and legal procedures are met. The transplant depends on availability of graft.
- Living donor liver transplant- were a family person usually a healthy first degree relative donates a part of liver for his patient without endangering the life of donor.
Evaluation for transplant
The donor and recipient undergoes a serious of investigations and clearance from various departments including cardiology, neurology, hepatology, pulmonary, psychiatry, nephrology, gynecology (for females) before being considered fit for transplant surgery. Tumor evaluation for HCC (hepatocellular carcinoma) is done for recipient.
Donor evaluation
A healthy person who is between 18 to 55 years of age, preferably a first degree relative can be a potential liver donor. We donot accept family friends, well wishers, neighbors, staff etc. as donors The part or amount liver graft taken from donor is decided after CT scan of abdomen. In case donor liver is unhealthy or fatty he/she is kept on diet, medications an exercise so as to improve his liver functions before surgery.
Donor first degree relative
- Spouse
- Children’s- sons, daughters
- Parents- father, mother
- Siblings- brother, sisters
- Grandparents and grandchildren’s
Blood groups compatible for transplant
Recipient | Donor |
A | A,O |
B | B,O |
O | O |
AB | A, B, O, AB |
Legal Authorization committee
- As per Human organ transplantation act, it is mandatory for donors parents, elder brothers, sister or (if married) to appear for legal authorization committee meeting
- HLA /DNA tests are done to establish relationship
Surgery (operation)
Both donors and recipient are taken in operation theatre (OT) nearly same time. Donor surgery is started first and after assessment of donor liver, recipient is taken up for surgery. Both the OT goes side by side. In both donor and recipient, the gall bladder is removed without any adverse effect.
Follow up and medications
- Recipients sutures/staplers are removed at 3-4 weeks
- Donors’ sutures are most of the time absorbable and do not require removal
- Most of the donors are discharged from hospital within 10 days and require a medication for a maximum period of 1 month. They require follow up at 3 months and 1 year interval
- Most recipients are discharged from hospital within 3 weeks. Patients require life long immune-suppressant medications, investigations and follow up
