Life-saving liver transplants

 Today, we look at the best treatment option for both adult and paediatric patients with end-stage liver disease: liver transplantation. 

Liver transplant is a surgical procedure in which a diseased liver is replaced with a healthy new liver. The success rate of liver transplantation is quite high, and after a successful transplant, patients with end-stage liver disease are able to resume normal activities. The cost of liver transplantation is relatively high due to resource utilisation and the involvement of specialists from a variety of fields including a surgeon, hepatologist, intensivist, anaesthetist, and radiologist, who work as a team throughout the treatment period, including before and after the actual surgery.

The surgery itself usually takes anywhere between 4-10 hours, depending on the status of the patient. A diseased liver is taken out and then the anastomoses of all hepatic vessels and bile duct are performed. It is also necessary to determine whether the tissue types of the new liver are compatible with the recipient.

The liver transplantation is considered a viable treatment option for patients with end-stage liver disease only if the prognosis is that the disease will be less likely to recur in the new liver, if other treatments have failed, and if, without the transplant, the patient is not expected to live longer than 6 months to 1 year. The patient must also be in good enough health to undergo major surgery, and this includes having all other organs functioning effectively. Also, the patient must have the mental capacity to understand and accept the risks and complications of this major treatment option.

As we’ve mentioned before, end-stage liver disease is caused by hepatitis B and C, alcohol or other substances, acute liver failure, metabolic disorders such as Wilson’s disease, early liver cancer, and congenital biliary atresia.

When the liver becomes so badly damaged that it is not able to function properly, complications occur. Liver transplantation is considered when any of the following conditions appear:

 

> Coma caused by liver disease

> Extreme bleeding in the gastrointestinal tract

> Build-up of fluid in the abdomen cavity (ascites)

> Infections in the abdomen

> Bleeding disorder

> Jaundice

> Fatigue and inability to complete normal activities

> Liver cancer

> Poor growth in children

 

Today, liver transplantation has a success rate of more than 90 per cent and most patients are able to resume their normal activities after recovering from the surgery. However, there is a chance that the body may reject the new liver, so a lifetime medication is used to suppress the immune system and prevent it from fighting against the new liver. The dosage can be reduced over time. There is also a small chance of complications, such as lack of function in the new liver, blockage of the blood vessels, infection, and extreme bleeding after liver transplantation, so it is important to continue with regular physical examinations after the surgery.

A liver for transplantation come from 2 major sources: brain-dead donors and living donors. Brain-dead donors are patients with severe trauma, injury, or disease in the nervous system THAT causes brain death. The patients and their family must have expressed their intent to donate their organs and the consent of their family is also needed. Living donors are blood relatives or legal spouses who have expressed their intent to donate an organ to the patient. However, the donor and recipient must have compatible blood types and similar anatomy.

Livers used for transplantation must come from people who have just died and the liver must still be functioning during the preparation period and before transplantation. Although a living donor may agree to donate a part of their liver, it will put the donor at risk of complications from liver rejection.

Generally, the earlier during their illness that a patient receives a liver transplant, the greater the chance of success.

 

 

Assoc Prof Teerha Piratvisuth is a specialist in liver and gastroenterology and Dr Bunthoon Nonthasoot is a Hepatobiliary Surgeon at Samitivej Sukhumvit Hospital. Call (02) 711 8822-4.