LIVER
What is a liver?
The liver is the largest internal organ in your body. An average adult liver weighs approximately 2% of the total body weight. It is located in the right side of the abdomen just beneath the diaphragm and behind the lower ribs. The liver has a right and a left lobe. Beneath the liver lies the gall bladder which is the reservoir for bile.
What does the liver do?
The liver is responsible for many of the body's metabolic and manufacturing functions including:
- The metabolism of carbohydrates into glucose (sugar) so your body can use it for energy.
- Detoxification (cleaning) of harmful substances from the body, this includes alcohol, drugs including the products from what you eat and drink.
- Production of bile, a yellow-green substance that helps your body absorb fats
- Metabolism and production of proteins, including proteins that aid in blood clotting
- Maintenance of normal balance of hormones.
- Filtering blood to remove bacteria and other particles.
- Storage of minerals and vitamins for your body's use later on.
- Host defense to assist in fighting infection
What are the causes and symptoms of chronic liver disease?
As you see, the liver has complex functions. Even the smallest disturbance in any of the functions has a profound effect on the body.
'What is acute (fulminant) liver failure?
Fulminant liver failure is potentially life threatening. The toxins accumulate in the blood and cause brain to swell. If not treated in timely fashion with liver transplant, patients die. Common causes include paracetamol poisoning, acute hepatitis B, and Wilson's disease etc.
What are the indications for liver transplant and what is the success rate?
When the risk of surgery out weigh risk of waiting, liver transplantation surgery is indicated. This happens when MELD score reaches more than 14. At this point, risk of death in waiting is about 23% every 3 months, while survival after liver transplantation is close to 90% at 1 year.
What is MELD score and how is it calculated?
Model for End stage Liver Disease (MELD) is a complicated formula and it takes in bilirubin, INR (function of liver) and creatinine (function of kidney) to give us the MELD score.
How good is MELD score in predicting the risk?
In general MELD is an accepted way to predict risk in waiting for liver transplant. How ever the experts are aware of many things that matter are not represented in this score. The provision for these factors has been made in 'exceptions' for the MELD score for eg: Hepatocellular cancer, low sodium, quality of life, life threatening GI bleeds etc.
What is the duration of liver transplantation surgery?
From the time you move into the operation theatre, till we finish surgery it takes about 8 to 10 hours. After making an incision resembling the inside of 'Mercedes Benz' sign, the liver is mobilized and disconnected from its blood vessels and the bile duct. Then the new liver is put in and all the necessary connections are made, which include inferior venacava, portal vein and hepatic artery. Bile duct is either connected to the recipient's bile duct or to a loop of the small intestine. Drains are then placed and your abdomen is closed in layers.
How do I get a liver?
You can get liver either from a brain dead donor or from a living person who is willing to share with you a part of their liver.
What is brain death or who is a brain dead donor?
Law of the land recognizes brain death as equivalent to death. These are typically victims of accident or people with intracranial catastrophe who don't have any blood circulation to the brain but their heart is still beating. It is just a matter of time before everything comes to standstill and all the organs of our body stop functioning. Our understanding of death has improved and the government has laid down regulations to identify such patients and promote organ donation.
How do I get a live donor?
Live donor is a person who is attached or related to you and is willing to share a part of their liver with you. They have to be a healthy adult (>19 years of age) and less than 50 years of age of compatible blood group type.
How safe is live donor liver transplant?
Donor safety is our priority. We perform appropriate tests to ensure safety of both the donor and recipient. We go ahead only if it absolutely safe for both of them. The data from all over the world estimates the risk for the donor to be around 0.2% to 0.3%. The remnant liver of the donor will grow back to almost its full size in about 6 weeks. The piece of the liver the recipient gets will also grow to meet his requirement.
What is the quality of life for live donor after the surgery?
The donor stays in the hospital for about 1 week. They take about 3 to 4 weeks to recover fully and get back to work. There is no long term risk and there is no need to take any medications.
Which is better? Live donor or Cadaver donor liver transplant?
The outcomes are comparable. Live donor liver transplant can be planned and performed when the recipient is medically optimized so that the outcomes are optimal. While in cadaver donor liver transplant, we will not be able to predict the timing. Demand is more and supply is less. As per the government`s regulations, we maintain a list of our recipients and the livers are allocated on first come first served basis.
What should I do while waiting for cadaver liver?
You have take your medicines as per the hematologist's recommendation. It is also important to restrict salt to about 2gm/day and follow fluid restriction as recommended. There is no need to restrict your proteins, infact you will need more proteins to maintain health. You must also continue physical activity and perform exercise to maintain muscle mass. They will help you recover faster and smoother after surgery.
What happens after the surgery?
After the surgery is over, you will be taken to liver transplant ICU. You will still have breathing tube in. There will be a few tubes in your neck (used for giving fluids and medicines); they will also be used to monitor your heart function. Once we are sure that your liver is functioning just fine and bleeding has stopped, we will wake you up and take the breathing tube out. After that, we will start you on oral diet and start immunesupression medications.
How long do we stay in the hospital?
Typically recipients stay in the hospital for 5 to 10 days.
What are the complications?
Immediate post operative complications are bleeding, bile leak, and hepatic artery thrombosis. Bleeding most often settles on its own with appropriate medical management. Sometimes we may have to re-explore to control bleeding. Bile leak can be treated with ERCP but sometimes may require re-operation. Hepatic artery thrombosis (HAT), if identified early, will need re-exploration to take out the clot and to reanalyze it. If it continues to clot, most of them will require urgent re-transplantation. Fortunately, HAT is very rare.
How long will I have to take medicines?
You will need to take medicines for rest of your life. These medicines (immune suppressants) help your body get used to the new liver. In the first three months, you will have a lot of medicines. Our aim is to get it down to one medicine at the end of one year.
What precautions do we take after discharge?
Once we are satisfied with your surgical recovery, we teach you and your family about the kind of care you need, hygiene required and to be maintained at home and we also will teach you everything you need to understand regarding your medicines. Our dietician will teach you about the foods that you can eat and what you need to avoid. Physiotherapist will teach you some health maintenance exercises.
What are the common causes of liver disease needing liver transplant in children?
Common indications for liver transplantation in children are biliary atresia, hepatoblastoma, Wilson's disease, alligile syndrome, alpha 1 antitrypsin deficiency, hemochromatosis and various metabolic syndromes like MSUD, certain urea cycle defects, crigler najjar syndrome, familial hyper cholestorelemia etc.
Why do liver transplant for children with biliary atresia?
The bile ducts fail to grow in some children. Some children respond to Kasai procedure (Porto enterostomy) for variable period of time. Majority of them progress to end stage liver disease and will need liver transplant.
How will I know if kasai procedure for my child is working?
If bilirubin is >2mg/dl, jaundice is worsening, worsening ascities (fluid in the abdomen), vomiting of blood, not eating well and not growing well are clear cut signs that liver disease is worsening and are indications for liver transplantation.
How safe is liver transplantation in children and what is the success rate?
Majority of the children tolerate this kind of surgery very well. We have highly trained and dedicated surgeons, anesthetists, and pediatric intesivists to take care of your child. We also have state of the art operation theater and intensive care facility and the best available machines in the world. All of them contribute to care for your child. Success rate is higher if transplant is done in a timely fashion. Overall success rate is >95% at 1 year in a very experienced center.
How do we get liver for our child?
It is very important to match the size of liver to the size of your child. Most of the children need either left lobe of the liver or left lateral segment of an adult liver. These livers can come from either a brain dead person or from a live donor. Waiting time for cadaver liver may be very long and may compromise the success of your child`s surgery. While live donor liver transplant is absolutely safe and it can be done when your child is fit. This will definitely improve your child`s outcome.
Will our child grow well?
The liver will grow with your child. With appropriate treatment, it is possible for your child go to regular school, grow like any other person and do a job. They can have normal relationship and females can even have children.
Why choose Fortis?
Thank you for choosing Fortis Chennai, we approach your care as a team. The team consists of highly trained professional all working towards your well being. The members of the team include doctors, nurses, dieticians, physiotherapists and a whole lot of supporting staff. Our doctors are trained at the best centers in the world. We have the best available equipment. Our results are comparable to the world literature.
