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What Is Liver Transplantation?
Liver transplantation is surgery that is performed to remove a diseased liver in order to replace it with a healthy one. Such surgeries have been done for over 38 years. Several people who have had liver transplants go on to lead perfectly normal lives.
When does one require a liver transplant?
Liver disease severe enough to require a liver transplant can come from many causes. In adults, the most common reason for liver transplantation is cirrhosis. Cirrhosis is a condition in which the liver slowly deteriorates and malfunctions due to chronic injury. Scar tissue replaces healthy liver tissue, partially blocking the flow of blood through the liver. Cirrhosis can be caused by viruses such as hepatitis B and C, alcohol, autoimmune liver diseases, buildup of fat in the liver, and hereditary liver diseases. Many people who develop cirrhosis of the liver due to excessive use of alcohol also need a liver transplant. Abstinence from alcohol and treatment of complications for 6 months will usually allow some of them to improve significantly and these patients may survive for prolonged periods without a transplant. For patients with advanced liver disease, where prolonged abstinence and medical treatment fails to restore health, liver transplantation is the treatment.
In children, the most common reason for liver transplantation is biliary atresia. Biliary atresia is a rare condition in newborn infants in which the common bile duct between the liver and the small intestine is blocked or absent. Bile ducts, which are tubes that carry bile out of the liver, are missing or damaged in this disease, and obstructed bile causes cirrhosis. Bile helps digest food. If unrecognised, the condition leads to liver failure. The cause of the condition is unknown. The only effective treatments are certain surgeries, or liver transplantation.
Other reasons for transplantation are liver cancer, benign liver tumors, and hereditary diseases. Primary liver cancers develop at a significantly higher rate in cirrhotic livers as compared to normal livers, particularly in patients having liver disease secondary to Hepatitis B. Liver Transplantation at an early stage of liver cancer may result in long-term survival for select patients. However, cancers of the liver that begin somewhere else in the body and spread to the liver are not curable with a liver transplant.
How are candidates for liver transplant determined?
Evaluations by specialists from a variety of fields are needed to determine if a liver transplant is appropriate. The evaluation includes a review of your medical history and a variety of tests. The transplant team will arrange blood tests, X – rays, and other tests to help make the decision about whether you need a transplant and whether a transplant can be carried out safely. Other aspects of your health-like your heart, lungs, kidneys, immune system, and mental health-will also be checked to be sure you’re strong enough for surgery.
Can anyone with liver problems get a transplant?
You cannot have a transplant if you have: cancer in another part of your bodyserious heart, lung, or nerve diseaseactive alcohol or illegal drug abusean active, severe infectioninability to follow your doctor’s instructions
How long would surgery take?
Liver transplants usually take from 4 to 14 hours. During the operation, surgeons will remove your liver and will replace it with the donor liver. The surgeon will disconnect your diseased liver from your bile ducts and blood vessels before removing it. The blood that flows into your liver will be blocked or sent through a machine to return to the rest of your body. The surgeon will put the healthy liver in place and reconnect it to your bile ducts and blood vessels. Your blood will then flow into your new liver. Because a transplant operation is a major procedure, surgeons will need to place several tubes in your body. These tubes are necessary to help your body carry out certain functions during the operation and for a few days afterward.
What happens during this recovery period?
Initially in the intensive care unit there is very careful monitoring of all body functions, including the liver. Once the patient is transferred to the ward, the frequency of blood testing, etc. is decreased, eating is allowed and physiotherapy is prescribed to regain muscle strength. The drug or drugs to prevent rejection are initially given by vein, but later by mouth. During the transplantation, frequent tests are done to monitor liver function and detect any evidence of rejection.
What if the transplant doesn’t work?
Optimism is the need of the hour. Most liver transplant operations go well. About 80 to 90 percent of transplanted livers are still working after 1 year. Sometimes the liver takes a long time to work. There are varying degrees of failure of the liver, however, and even with imperfect function, the patient will remain quite well. If there are complications – say, the new liver fails to function or your body rejects it, your doctor and the transplant team will decide whether to replace the failing transplanted liver by a second (or even third) transplant operation. Unfortunately, there is no dialysis treatment for livers as is possible with kidneys. Researchers are experimenting with devices to keep patients with failing livers alive while waiting for a new liver.
How do I take care of my liver after I leave the hospital?
After you leave the transplant centre at the hospital, you will need to visit your doctor often to be sure your new liver is working well. You will also need to have regular blood tests to check that your new liver is not being damaged by rejection, infections, or problems with blood vessels or bile ducts. You will need to be careful about avoiding sick people and must immediately report any signs of illnesses to your doctor. Home care involves building up endurance to carry out daily life activities and recovering to the level of health that the patient had before surgery. This can be a long, slow process that includes simple activities. Walking may require assistance at first. Coughing and deep breathing are very important to help the lungs stay healthy and to prevent pneumonia. Diet may at first consist of ice chips, then clear liquids, and, finally, solids. It is important to eat well-balanced meals with all food groups. After about 3-6 months, a person may return to work if he or she feels ready and it is approved by the primary doctor. Besides a healthy diet and exercise you must abstain from alcohol, especially if alcohol was the primary cause of damage to your own liver. Before you take any medication, including ones you can buy without a prescription, you will need to check with your doctor whether it is safe for you. It is most important to diligently follow all that your doctor says to take good care of your new liver.
Can I go back to my daily activities?
Certainly. After a successful liver transplant, most people are able to go back to their normal daily activities. Getting your strength back will take some time, depending on how sick you were before the transplant. Your doctor will be able to tell you how long your recovery period is likely to be.
Work- After recovery, most people are able to resume work.Diet – Most people can go back to eating as they did before. Some medication may cause weight gain, others may cause diabetes or a rise in your cholesterol. Meal planning and a balanced low-fat diet can help you remain healthy. Transplant patients have a tendency to gain weight because of their retention of water. They are advised to lower their intake of salt to reduce or eliminate this water retention.Exercise – Most people can engage in physical activity after a successful liver transplant. Sex – Most people return to a normal sex life after liver transplantation. It is important for women to avoid becoming pregnant in the first year after transplantation. You should talk to your transplant team about sex and reproduction after transplantation.