Liver Transplant

A liver transplant is a surgical procedure in which a diseased or damaged liver is replaced with a healthy liver from a donor. It is typically performed on patients with end-stage liver disease or acute liver failure, where other treatments have not been successful or are not feasible.

There are two main types of liver transplants:

Deceased Donor Liver Transplant (DDLT): In this type of transplant, the healthy liver is obtained from a deceased donor who has agreed to donate their organs. The donor liver is then matched to a suitable recipient based on factors such as blood type, body size, and medical urgency.

Living Donor Liver Transplant (LDLT): In a living donor liver transplant, a portion of a healthy person's liver (usually a family member or close relative) is surgically removed and transplanted into the recipient. The remaining portion of the donor's liver regenerates over time, providing both the donor and recipient with functional livers.

Indications 

Liver transplant is usually recommended when the liver has been damaged to the point where it can no longer perform its functions normally. This is known as end-stage liver disease or liver failure.

The liver can become damaged gradually as a result of infection, illness, or alcohol. This damage causes the liver to become scarred, which is known as cirrhosis. Liver failure can also occur very rapidly due to inflammation and death of liver tissue (necrosis).

Preparation

Preparation for liver transplant surgery may involve the following steps:

• A comprehensive medical evaluation including blood tests, imaging studies (such as ultrasound or MRI), liver biopsy, and other specialized tests to assess the patient's overall health, liver function, and suitability for transplantation.
• Informing your doctor of any allergies to medications, anesthesia, or latex
• Providing your physician with a list of medications or supplements you are taking
• Disclosing any recent illnesses or other medical conditions you may have
• Abstaining from food or drink for at least 8 hours prior to surgery
• Signing an informed consent form after the pros and cons of the surgery have been explained

Surgical procedure

In general, a liver transplant surgery may involve the following steps:

• The patient is given general anesthesia to ensure they are unconscious and pain-free during the surgery.
• The surgeon makes an incision in the abdomen to access the liver.  The type and location of the incision may vary depending on the specific technique used.
• In a deceased donor liver transplant (DDLT), the donor liver is prepared by removing any damaged or diseased tissue and preserving the healthy portions of the liver. In a living donor liver transplant (LDLT), the donor's liver segment is prepared for transplantation.
• The surgeon carefully disconnects the patient's diseased liver from the surrounding blood vessels, bile ducts, and other structures. The liver is then removed from the body.
• The healthy donor liver (or liver segment in the case of LDLT) is implanted into the recipient's body. The surgeon connects the blood vessels and bile ducts of the donor liver to the recipient's blood vessels and bile ducts, ensuring proper blood flow and bile drainage.
• Once the donor liver is securely implanted and functioning, the surgeon closes the incision with sutures or staples. Drainage tubes may be placed temporarily to remove excess fluid from the surgical site.

Postoperative care

After the surgery, the patient is taken to the intensive care unit (ICU) or a specialized transplant unit for close monitoring. Vital signs, liver function tests, and other parameters are monitored closely to detect any complications and ensure the new liver is functioning well. The patient receives post-operative care, including pain management, fluid and electrolyte balance, immunosuppressive medications to prevent rejection of the transplanted liver, and monitoring for any signs of infection or rejection. As the patient recovers, they will undergo rehabilitation to regain strength, mobility, and independence. This may include physical therapy, occupational therapy, dietary counseling, and follow-up appointments with the transplant team.

Risks and Complications

Risks and complications associated with liver transplant include:

• Infection
• Bleeding
• Organ rejection
• Organ dysfunction
• Side effects of immunosuppressive medications
• Biliary complications

Summary

Liver transplantation is a major surgical procedure that requires expertise, coordination among healthcare professionals, and ongoing care to optimize outcomes and improve the patient's quality of life. After transplantation, patients require lifelong medical care and maintenance, including immunosuppressive medications to prevent rejection of the transplanted liver.