The liver is the body’s largest internal organ, weighing about 3 pounds in adults. It is located below the diaphragm on the right side of the abdomen.
The liver performs many complex functions in the body, including:
- Makes most proteins needed by the body
- Metabolizes, or breaks down, nutrients from food to make energy, when needed
- Prevents shortages of nutrients by storing certain vitamins, minerals, and sugar
- Makes bile, a compound needed to digest fat and to absorb vitamins A, D, E, and K
- Makes most of the substances that regulate blood clotting
- Helps the body fight infection by removing bacteria from the blood
- Removes potentially toxic byproducts of certain medications
When Is a Liver Transplant Needed?
A liver transplant is considered when the liver no longer functions adequately (liver failure). Liver failure can happen suddenly (acute liver failure) as a result of viral hepatitis, drug-induced injury or infection. Liver failure can also be the end result of a long-term problem. The following conditions may result in chronic liver failure:
- Chronic hepatitis with cirrhosis.
- Primary biliary cholangitis (previously called primary biliary cirrhosis, it isa rare condition where the immune system inappropriately attacks and destroys the bile ducts)
- Sclerosing cholangitis (scarring and narrowing of the bile ducts inside and outside of the liver, causing the backup of bile in the liver)
- Biliary atresia (a rare disease of the liver that affects newborns)
- Wilson’s disease (a rare inherited disease with abnormal levels of copper throughout the body, including the liver)
- Hemochromatosis (a common inherited disease where the body has too much iron)
- Alpha-1 antitrypsin deficiency (an abnormal buildup of alpha-1 antitrypsin protein in the liver, resulting in cirrhosis)
How Are Candidates for Liver Transplant Selected?
Specialists from a variety of fields are needed to determine if a liver transplant is appropriate. Many health care facilities assemble a team of such specialists to evaluate (review your medical history, do tests) and choose candidates for a liver transplant. The team may include the following professionals:
- Liver specialist (hepatologist)
- Transplant surgeons
- Transplant coordinator, usually a registered nurse who specializes in the care of liver-transplant patients (this person will be your primary contact with the transplant team)
- Social worker to discuss your support network of family and friends, employment history, and financial needs
- Psychiatrist to help you deal with issues, such as anxiety and depression, which may accompany a liver transplant
- Anesthesiologist to discuss potential anesthesia risks
- Chemical dependency specialist to aid those with history of alcohol or drug abuse
- Financial counselor to act as a liaison between a patient and his or her insurance companies
Types of Liver Transplant
There are three main ways a liver transplant can be carried out:
Deceased organ donation transplant – involves transplanting a liver that has been removed from a person who died recently
Living donor liver transplant – a section of liver is removed from a living donor; because the liver can regenerate itself, both the transplanted section and the remaining section of the donor’s liver are able to regrow into a normal-sized liver
Split donation transplant – a liver is removed from a person who died recently and is split into two pieces; each piece is transplanted into a different person, where they will grow to a normal size.
The Liver Transplant Process
The general procedure that takes place during a liver transplant is:
The patient is put under general anesthesia to block and numb the pain
Incision is made to open up the abdominal area to access the liver
Evaluation of the abdomen for abnormalities to prevent liver transplant complications
Mobilization of the native liver and isolation of important structures such as veins and arteries
Transection of the structures attached and removal of the native, diseased liver
New liver is attached, all blood vessels and bile ducts are connected before closing the incision
Ensuring adequate control of bleeding and closure of the incision
Complications of Liver Transplant
Some of the main problems associated with liver transplants include:
- The body rejecting the new liver
- Bleeding (haemorrhage)
- Bile Leakage
- The new liver not working within the first few hours (primary non-function), requiring a new transplant to be carried out as soon as possible
- An increased risk of picking up infections
- Loss of kidney function
- Problems with blood flow to and from the liver
- An increased risk of certain types of cancer – particularly skin cancer
Post-Liver Transplant Procedure:
After the surgery the patients are taken to the recovery room for a few hours before being taken to the intensive care unit (ICU). They are closely watched in the ICU for several days, and their vitals are monitored.
Blood samples will be taken often to check the new liver. The doctors will also check that the kidneys, lungs, and circulatory systems are all working. Anti-rejection medicines will be administered and closely watched to be sure that the patients are getting the right dose and the right mix of medicines.
When the doctors feel the patient is ready, they will be moved from the ICU to a normal ward. Patients will slowly be able to move about more and walk around for longer periods of time. The doctors will then teach them how to take care of themselves when they go home