Liver Transplant

Types of Liver Transplant

These are the types of liver transplant

• Living donor liver transplant
• Deceased donor liver transplant
• Domino donor liver transplant
• Auxiliary liver transplant
• Split type

• Deceased Donor Liver Transplant:
  In this type of transplant, surgeons insert the liver of a dead body by removing the damaged liver of the patient. Two types of deceased donors preferred in this case are;

• Died of brain hemorrhage   
• Died of heart attack (cardiac death)
  
  This process takes place while the patient is under anesthesia. The surgeon makes an incision that extends to the liver. The site and size of the incision depend on the surgeon and the patient’s anatomy. The surgeon detaches the blood vessels and bile ducts from the liver to put the donor's liver. In the final part, the surgeon connects the bile ducts and blood vessels with the liver.   

• Living Donor Liver Transplant:
  In this type, the living donor donates a portion of his liver. The liver is the only part of the body that regenerates and regains its normal size in weeks.

• Domino Donor Living Transplant:
  It is a rare type of transplant where a person with familial amyloidosis donates his liver to someone else. That person gives his liver because it still works and is in healthy condition. The symptoms of this disorder do not develop immediately, so the transplant team needs to assess whether you are suitable for this transplant or not.

Symptoms of Liver Failure

 If the liver failure is primal, these symptoms occur usually

• Fatigue
• Nausea
• Diarrhea
• Lack of appetite

If the liver failure is at an advanced stage, the patient feels

• Abdominal pain and swelling
• Jaundice
• Bleeding
• Mental illness
• Lack of concentration
• Insomnia
• Coma
• Swelling of body
• Fluid buildup in body and legs

Causes of Liver Failure

Following are the causes of liver failure

• Cirrhosis (scarring of the liver referred to as cirrhosis). In cirrhosis, typical liver tissues replace by scar tissues which leads to the damage to the liver
• Metabolic diseases of the liver
• Alcohol consumption in excess
• Vascular diseases of the liver
• Hemochromatosis and Wilson's disease (genetic diseases)
• Hepatocellular carcinoma
• Primary sclerosing cholangitis
• Primary biliary cirrhosis
• Biliary Artesia (in children)
• Liver cancer
• Hepatitis 

Types of Liver Failure

Commonly it is of two types

• Acute Liver Failure:When the liver fails abruptly, it is known as an acute liver failure which is quite rare. More often, the side effects of some medications lead to acute liver failure.

• Chronic Liver Failure:When the liver fails slowly, it is known as chronic liver failure. It occurs in months or years, and in this condition, a liver transplant is the best treatment to consider.

Liver Transplant Criteria

• How to choose a transplant center?
  Before narrowing down one, get detailed knowledge about the liver transplant center. The center must have the latest techniques for transplants. Learn about the extra services they give to their patients. Ask questions about the whole procedure, conditions, and requirements before and after the surgery.       

• Evaluation of the Patient:
  The transplant center does the surgery if the patient is healthy enough to bear the whole procedure. They don’t do surgery if the patient drinks alcohol. Additionally, if he has metastatic cancer or other complications, they refuse to do the surgery.

• Different tests:
  The surgeon performs some tests on the patient before putting him on the waiting list for a liver transplant. The transplant team examines the ultrasound of the liver, urine and blood tests, heart tests, and other general health tests are required.
  
  A patient’s consultation with a dietitian, psychiatrist, and social worker is also necessary. Additionally, the financial and addiction councils are needed.

• Transplant team:
  A transplant team includes a surgeon, a hepatologist (specialized in treating the liver), a psychiatrist, transplant nurses, a dietitian, a social worker, and a financial coordinator.

• Waiting List:
  After assessing the result of medical tests, the transplant team enlists your name on the waiting list and applies a scoring system, MELD (model for end-stage liver disease) for adults. If the MELD score of the patient is high, it means the patient is in urgent need of a transplant. PELD is a scoring system for children.

When to Call Your Doctor?

 If you see the symptoms of liver damage in yourself or your family member, you should consult with a specialist. Don't look any further, as DoctorFindy is here to help you in this regard. DoctorFindy is an online health portal that provides a lot of health facilities.

Book your appointment with the liver transplant team of your choice through DoctorFindy. We give the facility of an online video consultation with all renowned transplant centers from top cities of Pakistan.

You can book your regular checkups with the help of DoctorFindy. Even after the liver transplant, you can schedule your meeting with your transplant team through DoctorFindy.

Liver Transplant Procedure

The patient wears a gown and lies back on the operating table with the tubes attached to check blood pressure, heart rate, and breathing rate.  The anesthesiologist assesses blood pressure, heart rate, and oxygen level.

The surgeon makes a wide cut under the ribs on both sides that passes over the breast bone. The surgeon replaces the donor liver with the damaged one at the site and connects blood vessels to the new liver. Finally, he closes the cut with stitches and applies the dressing.

• After The Surgery:
  The patient stays in the hospital for 5-10 days approximately. While going home, the transplant team frequently checks the patient to check if the patient is taking medications regularly and following a diet as suggested by the dietitian.

• Eat at least five servings of fruits and vegetables regularly
• Whole grains
• Fiber-containing food
• Drink enough water
• Avoid grapefruit and alcohol
• Follow your dietitian's instructions
• Take fat-free dairy products

Cost in Pakistan

 The cost of a liver transplant in Pakistan is Rs. 3 million to Rs. 5 million.

Recovery Time

Usually, patients recover fast after a living donor liver transplant. It takes six months or more to recover, but the patient takes medications for the rest of his life.

Risks and Complications

Complications may occur due to the surgery itself or the medications; the patient takes to prevent rejection of the donor's liver. Some common risks and complications could be;

• Blood clotting
• Leakage of blockage of bile duct
• Donated liver failure
• Infection
• Blockage of blood vessels
• Mental illness
• Liver diseases may come again
• Rejection of donated liver

• In Long Term:
  Some complications may occur as the side effects of anti-rejection medicines. For example;

• Diarrhea
• Diabetes
• Bone thinning
• High blood pressure
• High cholesterol
• Headache
• Suppress the immune system
• Infection