Liver Transplant

Liver Transplant and its various aspects

What is Liver Transplantation?

Liver transplantation is the surgical removal of a diseased liver and its replacement with a healthy one.

Who needs a liver transplant?

Anyone with a long standing (chronic) or sudden (acute) liver failure due to severe liver diseases needs to be considered as a candidate for a liver transplantation. The common diseases requiring transplant are advanced liver disease (Cirrhosis) due to Hepatitis C, Hepatitis B, Primary sclerosing cholangitis, Primary Biliary cirrhosis, Biliary atresia in children and Metabolic diseases. Acute hepatic failure due to acute viral, drug induced or alcohol-induced hepatitis may also need transplantation. Liver transplant is also done for primary liver cancers in certain circumstances.

When a patient needs liver transplant?

Those with end-stage chronic liver disease complicated by tiredness, fatigue, weight loss, repeated attacks of blood in the vomit or stool, low serum albumin or prolonged prothrombin time. Repeated hospitalization for intractable ascitis, infection in the ascitis, attacks of excessive drowsiness, mental confusion (encephalopathy) or coma are considered for liver transplant as life saving measure.

Where does the donor liver come from?

Donor liver comes from two sources
a) Deceased Donor Liver Transplant (DDLT): This liver is taken from a brain dead person (where there is no chance of survival after withdrawal of life support).

b) Living Donor Liver Transplant (LDLT): A living person donates a part of his/her liver (right or left lobe) to one of his/her relative dying from liver failure.

Who can be a living liver donor?

A live liver donation is a precious gift from a living person. Any healthy person aged 18-65 years who is of matching blood group with the recipient can be a living liver donor. Eligibility of a person for liver donation is judged after detailed examination and tests by the transplant team, where donor safety is considered first.

How the Liver Transplant surgery done?

Two team of experienced surgeons work at a time in two well equipped operation theaters. One team removes the diseased (cirrhotic) liver. The blood that flows into the liver will be blocked or sent through a machine to return to the rest of the body. Another group removes a part of healthy liver from a donor and then prepares it. The surgeons put the healthy liver (Graft) in place and reconnect to the blood vessels and bile ducts. It allows blood flow to start in the new liver. Liver transplantation time is about 12 to 14 hours.

What happens to the donor liver after the donation?

The donated part of the liver regrows (regenerates) from the remaining liver, which completes after 6-12 weeks of donation.

What happens to the recipient after the transplant?

The donated liver (graft) grows quickly in the recipient’s body and performs the functions as new liver (central organ) according to the metabolic demand of the body.

What is rejection and how it is prevented?

Defense system (immune system) of our body keeps us healthy by fighting against the substances that don’t belong to individual’s body. After a transplant our defense system fight against the new liver from other person and try to destroy it by a process called rejection. Rejection is prevented by anti rejection drugs (immunosuppressants) after the transplant. The common drugs are steroids, cyclosporine, tacrolimus, sirolimus and mycophenolate mofetil.

What is the success of living donor liver transplant?

Successful living donor liver transplant recipient survive 01 year 85%, 05 years 69% and 10 years 61%. The success rate is better in children than adult population.

What are the problems after liver transplant?

Recipient can get infections more easily. He will need to stay away from people who are the probable sources of infections. Avoid to get infected by hepatitis B & C virus. The immunosuppressants and other drugs may also increase the chance of getting infections. It also causes increase of blood pressure, weight gain, rise in cholesterol level, diabetes, bone weakness and kidney damage.

Can one go back to daily activities after liver transplant?

Yes, after a successful liver transplant most people can go back to their normal daily activities. Getting your strength back will take some time though depending on how sick you were before the transplant.

Immunosuppresion after Liver Transplant?

Immunosuppressive drugs are started immediately after liver transplant to prevent rejection. It must be maintained for the rest of the life. Initial cost is high for first few months, but subsequently reduces to one or two medicine at the end of the year and single medicine in 2-4 years time, which needs to be taken life long. Liver functions and drug level also needs to be evaluated repeatedly.

Liver transplantation at BIRDEM Hospital

BIRDEM hospital is a specialized tertiary care hospital of Bangladesh. It has many subspecialties specially, the department of Hepato-Biliary-Pancreatic Surgery, which deals the complex surgery of the liver, biliary system and pancreas. This organized unit in co-ordination with other specialties has successfully performed the first two liver transplants of Bangladesh at BIRDEM hospital. The department is working hard to make a full-fledged Liver transplant centre at BIRDEM, so that our patient with end stage liver disease will continuously get the liver transplant services in their own country.

Cost of liver transplant in abroad and Bangladesh?

In European and other advanced countries it is about two (02) crore taka. In neighboring country it is about 30 to  40  lacs taka. In Bangladesh we are planning to do the liver transplant in minimum cost considering the socio-economic status of our people, which will be lowest in any centre of the world.