“A liver transplant is not just a surgery—it’s a second chance at life.”

 A liver transplant is a complex surgical procedure in which a diseased or malfunctioning liver is replaced with a healthy liver from a deceased or living donor. The liver is a vital organ responsible for various essential functions, including detoxification, metabolism of nutrients, production of bile, and synthesis of proteins. When the liver becomes severely damaged or fails to function properly, a liver transplant may be the only viable option to sustain life.

Liver transplant becomes necessary when an individual’s liver is unable to perform its functions adequately due to liver failure, which can occur in both acute and chronic forms.

1. Acute Liver Failure: This occurs suddenly and is often caused by conditions such as drug overdose, viral hepatitis, autoimmune hepatitis, or acute fatty liver of pregnancy. Acute liver failure can rapidly lead to life-threatening complications and requires immediate medical intervention.
2. Chronic Liver Failure: This develops gradually over time and is commonly associated with chronic liver diseases like cirrhosis, hepatitis B or C infection,non-alcoholic fatty liver disease , or alcoholic liver disease. In chronic liver failure, the liver progressively loses its ability to function properly, leading to complications that can be fatal if left untreated.

Liver transplantation may also be performed for individuals with primary liver cancer, specifically hepatocellular carcinoma (HCC), which is the most common form of liver cancer.

The survival rate without a liver transplant depends on the severity of liver disease and the underlying cause. Acute liver failure is a medical emergency, and without a transplant or intervention, survival is usually measured in days to weeks. In cases of chronic liver failure, the prognosis is more variable. Some individuals may live for several years with medical management, while others may experience a rapid decline in health.

Liver transplantation has become a well-established procedure worldwide. The number of liver transplants performed each year varies by country and region, but it is estimated that thousands of liver transplants are performed globally. The demand for liver transplants often exceeds the supply of donor organs, leading to waiting lists and the need for strict criteria for patient selection.

Before undergoing a liver transplant, a comprehensive evaluation is performed to assess the patient’s suitability for the procedure. This evaluation typically includes a thorough medical history, physical examination, and a series of tests, such as blood tests, imaging studies (such as CT scan or MRI), liver biopsy , and cardiac evaluation. These tests help determine the severity of liver disease, identify potential complications, and assess the patient’s overall health.

The matching of donors’ livers with transplant recipients is a complex process that involves several factors. The primary considerations for matching include blood type compatibility, body size compatibility, and the severity of the recipient’s condition. The United Network for Organ Sharing (UNOS) and similar organisations in different countries maintain extensive waiting lists and allocate organs based on a scoring system that considers these factors.

Donor livers for transplantation come from two main sources: deceased donors and living donors.

1. Deceased Donors: Deceased donor livers are obtained from individuals who have experienced brain death or cardiac death. These organs are carefully evaluated to ensure they are healthy and suitable for transplantation. Deceased donor livers are in limited supply, and the availability depends on the number of individuals who register as organ donors and the occurrence of suitable organ donations.
2. Living Donors: In some cases, a living person can donate a portion of their liver for transplantation. The liver has a remarkable ability to regenerate, allowing the remaining liver in both the donor and the recipient to grow and regain full function. Living donor liver transplantation offers the advantage of avoiding the waiting list and can be scheduled at a convenient time for both the donor and recipient.

Liver transplant surgery involves several surgical risks, early post-operative issues, and long-term complications that every patient should understand before the procedure.

• Bleeding During Liver Transplant: Significant bleeding can occur during or right after the operation, sometimes requiring blood transfusions.
• Bile Duct Complications: Problems such as bile duct leaks or narrowing (strictures) can occur after surgery, affecting bile flow and overall liver function.
• Blood Clots After Transplant: Clots may develop in the blood vessels connected to the transplanted liver. These can block or reduce blood flow and may lead to serious vascular issues like thrombosis or stenosis.
• Primary Graft Failure: In rare cases, the new liver may not function properly from the start. This complication is life-threatening and may require another transplant.
• Post-Transplant Infections: Patients are more prone to infections after surgery because of immunosuppressive medications that lower the body’s defences.
• Neurological Complications: Some recipients may experience confusion, seizures, or other neurological symptoms shortly after the procedure.

• Acute and Chronic Rejection: The immune system may attempt to attack the transplanted liver. This can happen early (acute rejection) or slowly over time (chronic rejection).
• Side Effects of Immunosuppressive Drugs: These essential medications can lead to:
  • Osteoporosis
  • High blood sugar or diabetes
  • High blood pressure
  • Elevated cholesterol
  • Higher risk of infections
• Kidney Problems: Prolonged immunosuppressant use can damage the kidneys, leading to chronic kidney Disease.
• Cancer Risk After Transplant: A weakened immune system increases the likelihood of certain cancers, especially skin cancers and lymphomas.
• Recurrence of Liver Disease: Conditions such as hepatitis, fatty liver disease, and cirrhosis may return in the transplanted liver.

Proper preparation greatly improves both surgery outcomes and long-term recovery. This process includes choosing a transplant centre, completing evaluations, and maintaining good health while waiting.

When exploring your options, consider:

• The center’s transplant volume and success rates
• Availability of a dedicated transplant team
• Support services such as counseling, social care, and financial guidance
• Estimated costs including surgery, tests, medications, and hospital stays
• Registry data comparing outcomes across centers

A thorough evaluation is required before being approved for the transplant waiting list. This

Includes:

• Comprehensive physical exams and cancer screenings
• Nutritional assessments to optimise health before surgery
• Psychological evaluation to prepare for the emotional challenges
• Review of your support system for post-transplant care
• Addiction counselling when needed
• Financial planning for long-term immunosuppressive therapy

Once approved, patients are added to the liver transplant waiting list.

• Adults are prioritized using the MELD score, which reflects disease severity.
• Children are assessed using the PELD score.
• Your medical team will monitor and manage symptoms while you wait.

To remain eligible and improve surgery outcomes:

• Take medications exactly as prescribed
• Maintain a healthy diet and gentle exercise routine
• Attend all follow-up appointments and lab tests

Long-term success requires:

• Understanding the recovery timeline and follow-up schedule
• Having support from family or caregivers
• Learning about immunosuppressive medications and their side effects
• Financial planning for lifelong medical care

• Attending Regular Follow-up Appointments: Regular visits to the transplant center are essential to monitor the function of the new liver, assess medication levels, and address any concerns or complications that may arise.
• Maintaining a Healthy Lifestyle: Adopting a healthy lifestyle is crucial for long-term health after a liver transplant. This includes:
  • Following a Balanced Diet : A dietitian can provide personalized guidance on maintaining a nutritious diet that supports liver health and prevents weight gain or malnutrition. It is important to limit sodium intake, consume adequate protein, and avoid foods that may interact with immunosuppressant medications.
  • Engaging in Regular Physical Activity: Physical activity helps maintain overall health, cardiovascular fitness, and weight management. However, it is important to consult with the transplant team before starting any exercise regimen to ensure it is safe and appropriate for individual circumstances.
  • Avoiding Alcohol and Certain Medications: Alcohol can have detrimental effects on the liver, and it is crucial to abstain from alcohol completely after a liver transplant. Certain medications, including over-the-counter drugs, herbal supplements, and high-dose painkillers, can be harmful to the liver and should be avoided or used with caution. It is important to consult with the transplant team or pharmacist before taking any new medications.
• Emotional Well-Being: A liver transplant can be a life-changing experience, and it is important to prioritize emotional well-being. This may involve seeking support from mental health professionals, joining support groups, or engaging in activities that promote relaxation and stress management.
• Support from Healthcare Professionals and Loved Ones: Building a strong support network is crucial during the recovery process. Regular communication and collaboration with the transplant team, including surgeons, nurses, dietitians, and pharmacists, can help address any concerns or questions that may arise. Family and friends can also provide emotional support and assistance with daily activities.

• It is important to consult the Liver Transplant Surgeon if any new symptoms or complications arise, such as fever, pain, Jaundice , or changes in appetite or urine output.
• Regular follow-up appointments with the transplant team are necessary to monitor the function of the transplanted liver and adjust medications as needed. These appointments may include visits to transplant surgeons, hepatologist , and other specialists involved in post-transplant care.
• Consulting with a dietitian can provide personalised nutrition and dietary modification guidance to support liver health and overall well-being.
• Mental health professionals can offer support and guidance for emotional well-being before and after the transplant.
• Pharmacists can provide information on medication interactions and ensure that any new medications prescribed or over-the-counter drugs are safe for the transplanted liver.
• In case of an emergency, it is important to contact the transplant centre or the designated emergency contact provided by the transplant team.

Remember, self-care after a liver transplant is essential for maintaining the health of the transplanted liver and overall well-being. Regular communication and collaboration with healthcare professionals and a supportive network of loved ones can contribute to a successful recovery and long-term success after the transplant.