Liver Transplant is a surgical procedure to replace a diseased or a non-functioning liver with a healthy liver from a donor. Liver Transplant is a last resort measure and is undertaken only when all other treatment options have been exhausted. The liver performs more than 500 vital functions in a human body, and it is impossible for any mechanical device to replicate its functions that are why in the case of liver failure, transplantation is the only viable option to save the life of the patient.
Indications for Liver Transplantation
Liver failure can happen all of a sudden due to certain medical complications or could be a result of some long-term ailment that had been diagnosed too late resulting in Liver failure. Patients who are candidates for liver transplantation are suffering from one or more of the following conditions: -
- Acute Liver Failure
This condition is also known as Fulminant Hepatic Failure, where a normal and healthy liver suffers sudden massive injury leading to liver insufficiency. There are various causes that can lead to this condition like viral infections, ingestion of toxic mushrooms or drug reactions. Patients with Acute Liver Failure may die within days if they do not receive a transplant. They are always a priority for a liver transplantation.
- Chronic Liver Disease
Liver possesses an amazing capability to repair and heal from injuries itself. However, due to repeated injury and repair procedure, leads to Liver Cirrhosis i.e. permanent scarring. Once the liver reaches this stage, it cannot heal itself. Cirrhosis stops the liver from functioning properly, and though medicines might control the symptoms, transplantation is the only permanent cure.
- Alcoholic Liver Disease
Excessive consumption of alcohol over an extended period of time leads to permanent and irreversible damage to the liver. In such cases, Liver Transplantation is the only way out to save the patients life. A six month complete abstinence period is mandatory before proceeding with the transplant, to ensure the success of the transplant.
- Viral Hepatitis
Hepatitis B and Hepatitis C are the two most serious forms of viral infections that affect the liver. They lead to the development of liver cirrhosis that causes permanent damage to the liver. Liver Transplantation is recommended in patients with viral hepatitis for longevity.
- Cholestatic Liver Disease
It is a condition that is caused due to impairment in formation of bile. This is a slowly progressing disease with profound effects on the liver, leading to cirrhosis. It prevents the liver from functioning normally with worsening symptoms every day. Due to the complexity of the disease, Liver transplantation is the only therapy to treat it.
- Metabolic Liver Disease
It is a condition in which due to fat accumulation in the liver cells there is severe inflammation that leads to scarring of the liver. This condition is also called Non-alcoholic steatohepatitis. Only Transplantation provides a permanent cure for the disease.
- Vascular Disorders
A Vascular disorder like Budd-Chiari syndrome leads to clotting in hepatic veins which result in reduced blood flow through the liver. Transplantation is the only way to treat this ailment.
- Autoimmune Disease
Various autoimmune disease leads to the body’s immune system attack the organ thinking of it as an infection. Some of the ailments like Autoimmune hepatitis, Caroli’s disease, Primary Biliary Cirrhosis, Primary Sclerosing Cholangitis can only be healed through Liver Transplant.
Hepatocellular Carcinoma, the primary cancer of the liver. It originates from the cells in the liver especially in a liver already suffering from cirrhosis. It can also spread to other organs like lungs and bones. Transplantation is a definite cure for cancer unless it has already spread to other organs.
Various other ailments like a complicated polycystic liver disease with hemorrhage, portal hypertension infection, biliary obstruction pain, massive cystic enlargement, etc also require liver transplantation to be cured.
Contra-Indications for Liver Transplantation
There are many patients who need liver transplantation, but not all of them are fit candidates for the procedure. Liver Transplantation is a serious surgery which takes a toll on the body, and a patient needs to be physically fit to go through the entire procedure. Along with it, they should be able to handle any complications, take medicines regularly, comply with follow-up visits, abstain from alcohol. Following are the conditions that are total contra-indications to a Liver Transplant: -
- Alcohol and Substance Abuse - If a patient has a history of alcohol and substance abuse like tobacco, and has not been able to observe the recommended abstinence for six months before the transplant, then they are not suitable candidates for transplantation, as in their case the transplant is likely to end up as a failure.
- Severe Cardiopulmonary Disease- If a patient has a mean pulmonary arterial pressure greater than 50 mmHg is an absolute contraindication for transplantation as they are unlikely to survive the procedure with the post-procedure mortality rate being almost 100%.
- Age: - People with over 60 years of age have a high risk of cardiopulmonary diseases, as a result, their post-transplant survival rate is relatively low. Careful evaluation is required to determine if they are physically fit to undergo the procedure.
- Obesity: - Morbidly obese patients i.e. with a BMI above 40 need to be carefully analyzed before the procedure as due to cardiovascular morbidity their mortality rate post operation is relatively high.
- HIV Infection: - earlier HIV patients were strictly denied the liver transplant due to related complications but now with the help of more effective medications, their survival rate has improved. However, in case of uncontrolled HIV infection, drug-resistant HIV, malnutrition, etc. transplant is usually denied and can be done only after close consultation with experts.
- Cancer spread outside liver: - if the primary liver cancer has spread outside the liver to the lungs or bones, then it is a strict contraindication to the transplant.
- Other Infections: -
Bacterial or fungal infections should be treated completely before the transplant. If any of these infections are present in the body, then it is a contraindication to the transplant.
Who requires Liver Transplant
In addition to the medical condition mentioned above for indication for liver transplant, due to the long waiting list, patients are carefully selected to determine their eligibility for a liver transplant. Following are the conditions which are necessary to be entitled to the transplant: -
- A limited life expectancy usually less than 2 years due to liver dysfunction.
- Patient Suffering from Acute Liver Disease.
- Patients rendered physically incapable, and quality of life seriously deteriorated due to the chronic liver ailment.
- All other possible treatments have been ineffective.
- No other options than a liver transplant for extension of life expectancy and proper hepatic functions.