• 12Apr

    Liver transplantation – when is it done?

    Liver transplantation is a surgical replacement of a diseased liver by a normal liver taken from a donor. It is performed as a life-saving procedure in terminal liver disease or end stage liver disease. In this surgery the diseased organ is surgically removed and the donor organ is placed at the same anatomical location. The pioneer of this surgery was Thomas Starzl at the University of Colorado who performed his first successful surgery in 1960’s. Liver transplantation is now routinely performed worldwide.

    Liver transplantation has become the procedure of choice for patients with chronic or acute liver disease which is progressive, life-threatening and unresponsive to medical therapy. The demand for new livers continues to surpass its availability due to shortage of donors. In order to solve this problem, progress in science has resulted in the use of cadaver-organ liver transplantation. 

    Indications for liver transplantation

    Liver transplantation is performed in adults as well as in children. These patients have severe and irreversible liver disease for which medical or other surgical treatment has failed to improve their condition. As the condition of the patient deteriorates with each passing day, timing is of critical importance.

    The patient selection for surgery is also very important. The ideal candidates for liver transplantation are those who have experienced a life threatening complication due to loss of liver function or whose quality of life has deteriorated below acceptable standard. The better the condition of the patient prior to transplantation, the higher the success rate of transplantation.

    Liver transplantation is performed in adults as well as in children.

    Liver transplantation is performed in adults as well as in children.

    Liver transplantation in children

    There are many congenital disorders involving liver which result in irreversible damage to liver at an early age. This requires liver transplantation to prolong life without which there is a very high mortality. The most common indication for this surgery in children is biliary atresia. In this disease, there is a congenital blockage in the bile drainage system of liver. This results in jaundice and liver failure. Hereditary disorders of liver metabolism also require transplantation.

    Liver transplantation in adults

    Liver transplantation is indicated for end-stage cirrhosis due to multiple causes. Some of these conditions are discussed below.

    Sclerosing cholangitis: Inflammation of biliary passage results in obstruction and damage to structure and function of liver.

    Caroli’s disease: Multiple dilatations of the bile channels in liver are seen. This results in stasis of bile, recurrent infections and fibrosis induced obstruction of bile passage.

    Budd-Chiari syndrome: There is clot formation in hepatic veins which drain all the blood going out from liver to inferior vena cava. This results in diversion of blood away from liver and deteriorates liver function. In this condition, any associated disease which is the cause of increased coagulability of blood also requires treatment.

    The other routine indications for liver transplantation include alcoholic cirrhosis, chronic viral hepatitis, and liver cancer. Presently, chronic hepatitis C and alcoholic liver disease are the most common indications, comprising about 40% of all adult patients who undergo this procedure. Chronic alcoholics must abstain from alcohol completely before being selected.

    Successful transplant 

    A surgery is considered successful when the patient lives for one year. The current one year survival rate after liver transplantation is more than 90%. This improvement in survival has occurred due to refinements in operative technique, improvements in organ procurement and preservation, advances in immunosuppressive therapy, and even more importantly, more rational patient selection and timing.

    The decision for liver transplantation is complex and requires an experienced team of hepatologists, liver transplant surgeons, anesthesiologists and specialists in support services. After complete postoperative recovery, rehabilitation is achieved. Patients are required to strictly follow immune-suppressive drug regime. In one study, 85% of patients who survived their transplant operations returned to gainful activities.

    Anna L.

    It’s all about health!
    I have academic background in drugs related Chemical Technology, as well as extensive professional experience in pharma and medical companies. My main area of interest is everyday life medicine. The goal of my articles is to give people informative answers to the questions that bother them, to dispel doubts and some common misbeliefs and also to inspire everyone to keep healthy lifestyle.

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