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It means that the entire diseased liver will be removed and will be replaced by a new liver.
There are two types of transplant Deceased Donor and Living Donor Liver Transplant (DDLT and LDLT).
Brain dead organ donors
Most livers used for transplantation are obtained from patients who are brain dead. Brain death is usually due to a large stroke or massive trauma to the head from blunt injury.
Living Donors
Although each person has only one liver and would die without it, it is possible to donate a portion of the liver for transplantation into another individual.
This involves receiving a liver from a patient who has been declared brain dead by a team of doctors. This is commonly seen in patients who have been admitted due to a stroke or suffer from head injury secondary to a road traffic accident. After the declaration of brain death, the relatives have consented to give the “gift of life” and donate the organs of their deceased relative. The recipient (Patient suffering from liver disease) will get an entire liver.
You need to register with a recognized liver transplant centre. The hospital would then put your name on the Zonal Transplant Co-ordination Committee (ZTCC) waiting list; as per your blood group.
It is difficult to predict the waiting period as donations are very sporadic.
A relative donates a part of their liver to the recipient. Liver is the only solid organ to grow. It will regenerate, both in the recipient and the donor. It doubles in size in almost 2 weeks.
This is an important choice to help meet the organ shortage. Adults on the Cadaveric liver transplant list currently wait up to a year or more for a liver transplant. Unfortunately, a vast majority of patients waiting for transplant (on the cadaveric list) will die before a liver becomes available.
Donors must be:
| Recipient / Patient Blood group | Donor Blood group |
| O | O |
| A | A / O |
| B | B / O |
| AB | AB / A / B / O |
Rh factor (Positive /Negative) does not matter in liver transplant. Thus, “O” group is a universal donor and “AB” groups are universal recipients.
The live donor assessment is performed by a team of doctors and a transplant coordinator; who will organize the assessment process. This will involve blood tests, X-rays, CT, MRI scans and detailed cardiac test.
There are also important meeting with members of the transplant team including a surgeon, hepatologist, cardiologist, pulmonologist, psychiatrist and gynaecologist. (In female donors)
Once the potential donor is accepted a date for surgery will be chosen. A ethics committee meeting will ensure that all the necessary permissions are in place
The donor surgery lasts about 6 hours. The surgeons remove about half (Right or Left side) of the donor’s liver (depending on whether donation is to an adult or child), which is then transplanted into the recipient. Within 6 to 12 weeks the liver in donor and recipient regenerates (grows) to approximately 90% of its original size and function returns to normal.
The hospital stay is on average between 5-7 days.
Donors can usually return to work after 4-6 weeks.
However, he/ she will be unable to lift any heavy weights (More than 1 kg) for at least 3 months.
Live liver donation is major intervention and inevitably there are potential risks associated with this kind of surgery.
These include:
The recipient operation goes on for around 8-12 hours. After the surgery, the patient would be in the ICU for approximately 3-7 days and shifted to the wards after that. The patient will have to stay for another 5-12 days in the wards. (Depending on the clinical condition)
The patient will have 3-5 tubes in his body and will be generally on a ventilator when he is shifted from the OT to the ICU.
Continuous and vigorous monitoring will be done in the ICU. Your doctor will keep a close watch on the patient’s clinical observation, blood test and any abnormal findings. The relatives will be constantly counseled and informed of the patient’s condition.
The risks in general would be the following. A detailed explained and counseling would be done by the transplant team
If you experience severe complications (mentioned above), the stay in ICU and ventilator may be prolonged.
This is a critical period. Unfortunately, a proportion of these patients do not survive this period. The worldwide acceptable mortality rates are in the range of 5-10%.
Generally, after 3 months. Depending on your clinical condition and liver function test, the doctors will deem you fit to resume your duties and lead a normal life again.
Around 10-12 medication in the first month. These gradually reduce to 2-3 after 3 months and only one single tablet after 9-12 months. The most important medicine would be the immune-suppressive medications that need to be taken life long and cannot be changed or dose-adjusted without your doctor’s permission.
The main aim of a liver transplant is to replace the unhealthy liver with a healthier one, thus leading to the restoration of regular health of the patient. A number of critical liver diseases can be cured by going for liver transplant.
It's important that the donor and recipient understand the risks and benefits involved in liver transplant. Our transplant coordinators advice them on the right procedures that are to be followed during the entire liver transplant process.
When the liver is transplanted from one person (the donor) into another (the recipient), the immune system of the recipient triggers the same response against the new organ that it would have against any foreign material, setting off a chain of events that can damage the transplanted organ. This process is called rejection. It can occur rapidly (acute rejection), or over a long period of time (chronic rejection). Rejection can occur despite close matching of the donated organ and the transplant patient.
After the liver transplant, you will receive medications called immunosuppressant. Immunosuppressant weaken your immune system's ability to reject your new liver. These medications slow or suppress your immune system to prevent it from rejecting your new liver. Immunosuppressant drugs greatly decrease the risks of rejection, protecting the new organ and preserving its function. These drugs act by blocking the recipient's immune system so that it is less likely to react against the transplanted organ. A wide variety of drugs are available to achieve this aim but work in different ways to reduce the risk of rejection. They may include steroids, cyclosporine, tacrolimus, sirolimus, and mycophenolate mofetil. You must take these drugs exactly as prescribed for the rest of your life.
Immunosuppressant drugs lower a person's resistance to infection and can make infections harder to treat. Although these medications are meant to prevent rejection of the liver, they also decrease the ability of the body to fight off certain viruses, bacteria, and fungi. The organisms that most commonly affect patients are covered with preventive medications. However, avoiding contact with people who have infections is very important.
Here is a list of signs and symptoms that may indicate liver graft rejection:
None of these symptoms are specific for rejection; but they are important enough that when they occur, they should prompt a call to your doctor who will decide whether the situation warrants further investigation or should be observed for the time being.
It is very important to realize that rejection of transplanted liver is quite variable. Some patients will feel perfectly well, only to discover that their liver is being attacked by their immune system. In fact, it is more likely than not that there will be minimal or no symptoms of rejection.
Optimism is the need of the hour. Most liver transplant operations go well. About 90 percent of transplanted livers are still working after 1 year. Sometimes the liver takes a long time to work. There are varying degrees of failure of the liver, however, and even with imperfect function, the patient will remain quite well. If there are complications – say, the new liver fails to function or your body rejects it, your doctor and the transplant team will decide whether to replace the failing transplanted liver by a second (or even third) transplant operation. Unfortunately, there is no dialysis treatment for livers as is possible with kidneys. Researchers are experimenting with devices to keep patients with failing livers alive while waiting for a new liver.
Certainly. After a successful liver transplant, most people are able to go back to their normal daily activities. Getting your strength back will take some time, depending on how sick you were before the transplant. Your doctor will be able to tell you how long your recovery period is likely to be.
Studies have shown that women who undergo liver transplantation can conceive and give birth normally, although they have to be monitored carefully because of a higher incidence of premature births. Mothers are advised against nursing babies because of the possibility of immunosuppressive drugs being transmitted to the infants through breast milk.
When an organ becomes available for donation, it's checked to make sure it's healthy.
The blood and tissue type of both donor and recipient are also checked to ensure they're compatible. The better the match, the greater the chance of a successful outcome.
People from the same ethnic group are more likely to be a close match. Those with rare tissue types may only be able to accept an organ from someone of the same ethnic origin.
Better matching of the donor organ to the recipient will improve transplant outcomes and benefit the overall waiting list by minimizing graft failure and need for re-transplantation.
