Liver Transplant

Liver transplant is surgery to replace a diseased liver that no longer functions properly with a healthy liver from a deceased donor.

Some facts about Liver Transplant:

• Liver transplant is safe when performed by experienced surgeons by using appropriate technology.
• One cannot live without liver as it is a vital organ of human body which is located in the right upper quadrant of the abdominal cavity.
• Metabolism of drugs and toxins, removing degradation products of normal body metabolism such as clearance of ammonia and bilirubin from the blood, and synthesis of many important proteins and enzymes such as factors necessary for blood to clot are some of the critical functions of liver.
• The hepatic artery and the portal vein also known as hepatocytes, and bile ducts are the two channels through which blood enters the liver.
• Blood leaves the liver through the hepatic veins and drain into the inferior vena cava that immediately enters the heart.
• Bile is a liquid that is produced by liver which helps dissolve fat and eliminate metabolic waste and toxins through the intestine.
• Bile is produced by each hepatocyte and is excreted into microscopic channels that join to form bile ducts.
• A single 'hepatic duct' can be created by joining the bile ducts that brings bile into the intestine.
• Usually Liver transplant is a treatment option for people who have significant complications due to end stage chronic liver disease or liver failure.
• Living donor liver transplant is an alternative for the people who are waiting for a deceased donor liver to become available as when the number of people waiting for a liver transplant greatly the number of available deceased donor livers.
• A living donor can be a family member or someone whose blood type is a good match.
• Some part of the liver from a healthy person can be donated for living donor liver transplant as the human liver regenerates and returns to its normal size shortly after surgical removal of part of the organ and the person can have healthy lives with the liver that is left.
• The part that will be received as a new liver by the person who has under gone liver transplant will also grow to normal size in a few weeks.

Necessity of Liver Transplant:

• A liver transplant is recommended if you have chronic liver failure or end stage liver disease which is a serious, life threatening liver disease.
• The most common cause of end stage liver disease is Cirrhosis which is a chronic liver disease. The liver stops from working properly when healthy liver tissue is replaced with scar tissue.
• When tissue in the liver dies, it leads to Acute hepatic necrosis. Acute infections and reactions to medicine, drugs or toxins can be the possible reasons for this.  
• Biliary atresia is rare disease of the liver and bile ducts that occurs in newborns that may lead to end stage liver disease.
• End stage liver disease can happen because of Viral hepatitis resulting from either Hepatitis B or C.
• Metabolic diseases are disorders that can change the chemical activity in cells affected by the liver may lead to end stage liver disease.
• Primary liver cancers are cancerous tumors that start in the liver can also lead to end stage liver disease.
• End stage liver disease can also happen due to Autoimmune hepatitis which is a redness or swelling of the liver. It occurs when the immune system o your body attacks your liver.

Evaluation process for Liver Transplant:

• You will be referred to a transplant center for evaluation if your healthcare provider thinks you may be a good candidate for a liver transplant.
• A variety of tests will be conducted by the transplant center team to decide whether to place your name on a national transplant waiting list.
• A transplant surgeon, a hepatologist, transplant nurses, a social worker, a psychiatrist or psychologist, a dietitian, a chaplain, or an anesthesiologist can be included in transplant center team.
• Psychological and social evaluation, blood tests and some diagnostic tests including X-rays, ultrasounds, a liver biopsy, heart and lung tests, colonoscopy, and dental exams will be conducted for the transplant evaluation process.
• A liver transplant can not be done if you have a current or chronic infection that can’t be treated, have metastatic cancer,  severe heart problems or other health problems, serious condition that would not get better after a transplant, are not able to follow a treatment plan or drink too much alcohol.
• Your name will be placed on a national transplant waiting list if you are accepted as a transplant candidate.
• You will be get the notification when an organ is available.
• You will have to go to the hospital right away after getting the notification to get ready for surgery.       

Preparation for Liver Transplant:

• The procedure will be explained by the healthcare provider to you. You can sk him or her any questions you have about the surgery.
• You will be asked not to have any food or drink after midnight for a planned living transplant.
• You should not eat or drink once you are told a liver is available if your liver is from a donor who has just died.
• A sedative will be given to you before the surgery to help you relax.
• You may have to follow other instructions based on your medical condition.

Procedure for Liver Transplant:

• A hospital stay is required for a Liver transplant surgery.
• You will be given a gown to wear during the procedure.
• An intravenous line will be given in your arm or hand.
• Catheters will be put in your neck and wrist or put under your collarbone or in the area between your belly and your thigh to check your heart and blood pressure, and to get blood samples.
• The hair may be clipped off if it is too much at the surgical site.
• A catheter will be put into your bladder to drain urine and a tube will be inserted into your lungs by the anesthesiologist to help you breathing through a ventilator.
• Your heart rate, blood pressure, breathing, and blood oxygen level will be monitored by the anesthesiologist during the surgery.
• Just under the ribs on both sides of your belly an incision will be made which will extend straight up for a short distance over the breast bone.
• The diseased liver will be carefully removed from the nearby organs and structures by the doctor.
• The blood flow into the diseased liver will be stopped by clamping the attached arteries and veins.  
• Blood flow to your new liver will be started after attaching it to your blood vessels. Any bleeding will be checked by the surgeon where you have stitches.
• The donor liver will be attached to the bile ducts and the incision will be closed by using either surgical staples or stitches.