A liver transplant is a major surgery done to replace a liver in a patient whose liver no longer functions adequately to maintain the vital functions of the body.
Liver dysfunction could be due to various reasons. When the liver functions fail in a short time, it is called “acute liver failure”, whereas if it occurred within a longer period, it is termed “chronic liver failure”. Chronic liver failure occurs once the complications of chronic liver disease take place, mainly due to cirrhosis. In Sri Lanka non-alcoholic fatty liver disease and alcohol abuse are the two main causes of cirrhosis.
Liver transplant is a complicated procedure, which needs extensive evaluation of the donor (the person who donates the liver) and the recipient (Patient). The donor could be “live”, where a part of the liver is transplanted letting the organ to grow into its optimum size after the surgery, or “deceased”, where the organ of an otherwise healthy patient who has died due to brain death is used for transplantation. In Sri Lanka, it is the “deceased donor liver transplant” that happens commonly.
Doctors assess the patient clinically and by blood tests to grade the severity of the illness to decide how urgently the transplant is required. The decision to transplant is taken by experts in multiple fields such as a transplant surgeon and a gastroenterologist/ hepatologist after a discussion with the patient and their family. Thereafter, the patient has to undergo a series of tests. Once the physical and mental fitness is optimized, the patient is listed for the transplant. The wait time for a blood group matched liver varies widely.
During the surgery, the transplant surgeon makes a long incision over the abdomen and removes the diseased liver and places the donor liver in the same place. Then the surgeon connects the blood vessels and bile ducts to the donor liver. Surgery may take up to 12 hours, depending on the situation. Once the new liver is in place, the surgeon closes the surgical incision. After an intensive management in ICU (Intensive care unit), patient is transferred to a high dependency unit/ward. Multiple immunosuppressants (drugs to control the immunity in order to prevent any rejection) are started with careful monitoring. Although some drugs can be stopped, most patients need to take lifelong treatment.
Once the functional status of the new liver is established, the patient can spend a near normal life. However, regular clinic follow-up for monitoring, early detection and management of possible complications is needed for an indefinite period.