The only cure for advanced liver failure is liver replacement. Liver transplant extends life expectancy and infuses unprecedented quality of life. Patients with acute or chronic liver failure lead to shrinkage of the liver and can be benefited from liver replacement. Liver transplant is recommended when the chance of patient survival drops below 48 months. The patients with this stage of liver failure will have 95% chance of dying without a transplant within 2 years. The best indicator to determine the prognosis is the MELD SCORE (Modified end stage liver disease score). A MELD score > 12 indicates the need to evaluate and recommend liver transplantation. Clinical incidents like, GI bleed, peritonitis, recurrent fluid collection in the belly or attacks of liver coma are indications for early liver transplantation. Once patients are prognosticated based on the MELD score, it is advisable to transplant them early. Longer wait will deteriorate the health of the patient and adversely influence the outcome of transplant in more advanced stages.
In a liver transplant procedure the diseased liver is removed completely by surgery and replaced with either a new part liver or whole liver. Blood vessels and bile duct are connected with the patient’s structures and blood is allowed to flow through the new organ. This takes approximately 8 to12 hours (longer for living donor transplants). Patient is managed in the ICU for 2-3 days and 2-3 weeks in a dedicated special ward.
An appointment to meet the liver transplant team is followed by a detailed medical evaluation. Based on the clinical and lab results you will be advised about the treatment choices. Identification of a related part liver donor is the quickest way to get a liver transplant and it involves donor evaluation and ethical/legal committee clearances. Those with no related donors are kept on a waitlist for cadaver liver transplant, where the wait could be long.
Liver being the only solid organ that can regenerate completely after part removal, it can be donated with reasonable safety (95.5%), by any healthy relative with blood group and weight match. Donor fitness is assessed by evaluation. In living donor surgery 50% of the liver is removed surgically and implanted into the patient. Donors are discharged within 10 days and 90% of the part removed regenerates within 3 months, though the liver function returns to normal range within 2 weeks.
Close follow up is done for 2-3 months by regular blood tests and scan tests. Immunosuppressant medicines are given regularly for life. The survival after liver transplant is 90% at 1 year and 75-80% for lifetime. All forms of physical, sports, scholastic and sexual activities are usually restored within 3 months of transplant.