liver transplant

What Could Lead Up To A Liver Transplant Surgery?

A liver transplant, also known as a hepatic transplant, is a surgical procedure to save someone’s life when the liver fails or functions abnormally. It is a process in which a diseased or damaged liver is surgically removed, replacing it with either a full liver or part of a healthy liver transplanted from a donor.

The liver is a “powerhouse” organ for the body given the list of vital functions that it performs

The liver is the body’s largest abdominal organ and is located in the right upper abdomen, weighing about three pounds (approximately 2% of body weight). Though a single organ, the liver can broadly be divided into two parts – right and left lobes and 8 independent segments, each having its own blood supply and biliary drainage. A healthy and properly functional liver is essential because it is responsible for performing several vital functions as described below:

  • It is the main organ which metabolizes and removes harmful substances ingested by the body, helps in breaking down the nutrients obtained from food, makes chemicals reactive and generates energy when required. It also maintains hormonal balance;
  • It has a hepatic artery which supplies oxygenated blood, a vein that carries blood from the intestines into the liver and also drains bile formed in the liver. Blood is then delivered to the heart through the three hepatic veins;
  • As a filter it removes and eliminates bacteria, potential toxins, alcohol, certain medicines and impurities generated in the body, thus helping to fight and prevent infections and regulates immune responses;
  • It produces necessary substances or elements that include glucose (energy source), proteins that regulates clotting of blood, growth and building muscles. It also produces bile, a fluid stored in the gallbladder to absorb cholesterol, fats or vitamin A, D, E,K that are fat-soluble;
  • It stores essential vitamins, minerals and sugar. It is responsible for converting food into required chemicals that are necessary for staying alive and for growth and development.

Liver disease occurs when these essential functions are disrupted due to a damaged liver and impaired liver function.

liver transplant What are the signs and symptoms people may experience due to liver damage?

People with liver damage may experience non-specific symptoms but they get more severe as the damage progresses due to accumulation of toxins in the body. Some of these include:

  • Jaundice (appearance of yellow skin and eyes)
  • Pain and swelling in the abdomen, ankles and legs
  • Pale or dark-colored stool and urine
  • Intense itching, bruising
  • Fatigue, weakness, nausea or vomiting of blood
  • Mental or cognitive problems

When is a liver transplant required?

Liver transplant is usually considered as a last alternative when liver diseases is in the final, life threatening stages and cannot be treated with medication. The factors determining if a liver transplant should be considered or not include:

  • Severity of the liver damage
  • Metabolic, physical and mental condition
  • Whether the transplant can extend the person’s life.

What causes severe liver damage, eventually requiring a liver transplant?

Some of the diseases and disorders that can create an eventual need for a liver transplant include:

Acute and Chronic hepatitis

Chronic hepatitis with cirrhosis: It is a persistent liver inflammation due to infections, Hepatitis B, Hepatitis C, fatty or alcoholic liver. It gradually damages the liver causing failure of liver or liver cancer and cirrhosis. Cirrhosis, which is severe scarring of liver, is the most common condition that necessitates a liver transplant. It mostly develops due to hepatitis infection and chronic alcohol addiction.

Fulminant hepatic failure: It is a sudden failure of the liver within a week’s time due to viral infections, toxins or drug induced injury to the liver (cancer medicines)

Intrahepatic Cholestasis

Idiopathic neonatal hepatitis: It is dysfunction and inflammation of the liver affecting infants, fetus and neonates. It is the transformation of cells in liver and its patent bile ducts caused due to genetic disorders, virus or metabolic disorders that occurs mostly during the first three months of child’s life.

Alagille syndrome:  Also recognized as bile duct paucity syndrome, it is a damage of the liver due to abnormalities occurring in the bile duct thus making them narrow, resulting in a build-up of bile and scarring of the liver. It affects functions of liver and other organs including the heart. People with this disorder may experience jaundice, poor growth, fatty deposits, loose stool, etc.

Familial intrahepatic Cholestasis (Byler disease): It is a disorder of chronic cholestasis which usually occurs in infants and can lead to cirrhosis from birth to three months of life. It causes liver failure when the liver cells are unable to secrete bile (digestive fluid). The child may experience itching, jaundice, weight gain, enlargement of liver and portal hypertension as a result of this condition.

 Traumatic and Post-surgical Biliary Tract Diseases

Hepatic tumors:

Hepablastoma: It is a rare childhood cancerous tumor in the liver that usually affects infants from birth to four years of age and can spread to other parts of the body.

Hepatocellular carcinoma: It is the most common and primary malignant liver tumor found in adults who have chronic liver disorders or diseases like cirrhosis caused by hepatitis B or hepatitis C infections. Weight loss, jaundice or upper abdominal pain can be the signs of the disease but usually appear very late in the last stages of cancer, often ultimately requiring a liver transplant.

Biliary Atresia: It is the most common disorder, due to defects of liver and bile ducts affecting newborns and requires liver transplantation.

Metabolic diseases

Alpha-1 antitrypsin deficiency: It is an inherited or genetic disorder causing liver or lung disease. It is inherited from parents and occurs between twenty to fifty years of age, resulting in liver damage or scarring. People may experience colds, chronic bronchitis, shortness of breath, loss of weight or appetite, jaundice, blood in vomit or stools.

Wilson’s disease: It is a rare inherited disorder which is characterized by abnormal accumulation of copper in the body including liver, brain and other vital organs. It affects the liver by not releasing copper into the bile. It can be progressive or acute and may damage the liver affecting other organs of the body. People with this disorder experience abdominal pain or swelling, fatigue, lack of appetite, poor coordinated movements, depression,  jaundice, fluid build-up in abdomen or legs.

Neonatal Hemochromatosis: It is a severe inherited disease which occurs in fetal or newborns due to accumulation of large amount of stainable iron in the the extrahepatic sites which are toxic and cause organ damage. It progresses rapidly with a life threatening complication and damages the liver within the first few days of child’s life. Children with the disease are usually born premature and may experience low blood sugar, jaundice, edema and blood clotting abnormalities.

Tyrosinemia: It is a genetic metabolic disorder which usually appears in first few months of life and is characterized by the inability to break down the amino acid tyrosine which is a building block of most proteins. As it progresses it mainly damages the liver. Inadequate weight gain, liver enlargement, fever, vomiting swelling in abdomen and spleen can be experienced, leading to cirrhosis.

Glycogen storage disease (Type 1, 2, 3, 4): It is a rare genetic enzyme disorder inherited from both parents wherein a flawed or missing enzyme is unable to use glycogen properly, affecting the functions of liver or muscles because the primary place of glycogen storage is liver and muscle tissue. Slow growth, intolerance of heat, enlargement of liver, weak muscle tone, bruising, cramps or swollen belly may be noticed.

Maple Syrup Urine Disease (MUSD): It is a genetically inherited disorder which causes accumulation of proteins. Children may suffer metabolic crises and severe neurological damage. Poor appetite, irritation, disturbed sleep pattern, distinctive odor of maple syrup in the sweat and urine may be noticed. It usually occurs from birth to eight years of life.

Acute hepatic necrosis: It is a rare syndrome, also recognized as fulminant hepatic failure which is toxic injury to the liver, leading to rapid decline in hepatic functions within days or weeks and may cause serious complications. Nausea, vomiting, swelling or pain in abdomen, disorientation and  jaundice are typical symptoms.

Cholestatic liver disease: It is a disorder of impaired bile flow due to bile duct, pancreas or liver disorders. People may experience jaundice, dark urine or light stools, itching.

Congenital hepatic fibrosis: It is a rare genetically inherited disorder which is present at birth affecting liver, renal and hepatobiliary systems. Children may experience abnormal shape of liver, blood in vomiting, swelling in abdomen with increased risk of inflammation of the bile ducts

Other liver diseases that could require a liver transplant

Cryptogenic cirrhosis: It is an end-stage or irreversible liver disease which usually develops in adults caused by cirrhosis. Loss of weight or appetite, jaundice, enlargement of blood vessels, fatigue can be experienced in affected people. People may develop portal hypertension (high blood pressure in the vein supplying blood to the liver), hepatocellular cancer or type 2 diabetes.

Congenital hepatic fibrosis: It is a genetically inherited childhood disease that affects and impairs functions of the renal system, caused due to bile ducts that develop abnormally, malformation of the blood vessels in the embryonic structure of hepatic portal system and building up of fibrosis (scar tissue) which restricts fluids movement in blood vessels. People may experience enlargement of bile ducts, jaundice, abdominal pain and fever.

Caroli disease:It is a rare inherited congenital disorder which leads to widening of intrahepatic bile ducts due to fluid-filled sacs or lumps formed in the bile ducts. It results in high portal hypertension, abdominal pain or fever.

What are some of the typical tests required to assess the need for a liver transplant?

  • Tests of blood count, blood type, liver and kidney functions, blood clotting, electrolytes are obtained to check the severity of the illness;
  • CT scan of the abdomen and pelvis to check the liver size and tumors;
  • Ultrasound which checks the liver functions and its surrounding organs;
  • ECG and Chest X-Ray to check the functions and activities of the heart;
  • Mammogram or Pap smear test for women;
  • Skin test performed using purified protein derivative (PPD) to check if there is any tuberculosis.