Overview

The liver is the largest internal organ that plays an indispensable role in nurturing and protecting the human body. As a tip of the iceberg, the liver performs several critical functions such as removing toxins from the blood, providing nutrients, warding off infections, etc.

But in fact, the liver is thought to be responsible for up to 500 separate functions in the human body. A healthy liver is key to leading a healthy life, so taking care of it is important.

Several liver diseases can prevent the organ from performing its critical functions. Some common liver diseases are either caused by a virus, namely, Hepatitis A, B, and C, or by the constant abuse of alcohol, drugs, or any exposure to poisons.

Treatment of all liver diseases involves immediate medical care to slow its progression, minimize the symptoms and reduce further complications.

In India, liver transplantation has been recognized as an established treatment for the end-stage liver disease over the last decade. Liver transplant in India has unique features that have contributed to the steady increase in deceased and living donor transplantations. This article gives a brief overview of the surgical procedure.

Understanding Liver Transplant and who needs it

A liver transplant or hepatic transplant is a surgical procedure that is performed to remove a diseased or injured liver to replace it with a healthy liver from a deceased or living donor.

Micrograph of non-alcoholic fatty liver disease (Source: Wikipedia)

In India, around 2 lakh people die of liver diseases every year. If liver disease has reached the last stage and medical treatment cannot heal the liver, the only option left is to undergo a liver transplant.

Liver metastases (Source: Wikipedia)

Liver diseases that are severe enough to require a liver transplant come from several causes.

These causes may vary across age group, for instance:

• In adults, the most common need for liver transplantation is cirrhosis. Cirrhosis is a late-stage liver disease wherein the healthy liver tissue is replaced with scar tissue, leaving the liver permanently damaged.

Diffuse cirrhosis (Source: Wikipedia)

• In children, the most common need for liver transplantation is biliary atresia. Biliary atresia is a rare condition in which the common bile duct between the liver and the small intestine is blocked or absent, making liver transplantation to be the only effective treatment.

Who may not qualify for a Liver transplant

Around 50,000-60,000 people require a liver transplant in India every year. However, to be considered as an eligible candidate for liver transplantation, you will first need to undergo a thorough transplant evaluation. However, there is a broadly classified list of persons who are not eligible to get a liver transplant:-

1. 65 years and above with any other chronic illness.
2. History of chronic and ongoing drug and/or alcohol abuse that cannot be successfully treated before the transplantation.
3. History of chronic and on-going liver disease such as Hepatitis B.
4. Has significant brain damage, and it is thought to be irreversible.
5. Having a serious and on-going heart, lung, or nerve disease that is untreatable.
6. Diagnosed with aggressive cancer such as bile duct cancer, lymphomas, bone cancer.
7. Diagnosed with vascular disease of the liver that occurs when the blood clot occurs in the hepatic portal vein. Medically termed as Portal Vein Thrombosis (PVT).
8. Diagnosed with a progressive kidney failure mostly seen in people with severe liver damage, most often called cirrhosis. Medically termed as Hepatorenal Syndrome (HRS).
9. Diagnosed with a condition of increased blood pressure within the arteries of the lungs. Medically termed pulmonary hypertension.
10. Diagnosed with a severe or uncontrollable infection such as Human Immunodeficiency Virus (HIV).

Eligibility criteria for Liver Transplant

Liver transplant is usually reserved for patients who have significant complications due to end-stage chronic liver disease, that is when the liver fails to perform 80-90 percent of the critical functions.

Ground glass hepatocytes (Source: Wikipedia)

Liver transplants are evaluated by specialists from a variety of fields who ensure that the transplant is appropriate. The evaluation includes a review of the patient’s medical history and a variety of tests performed by the transplant team to ensure that the surgery can be performed safely.

Outlook and the success rate         

Liver transplant in India has evolved over the past years from a rarity to a common procedure that is available across the whole country. India is currently observing a golden period in liver transplantations, and the fact that it is now at the forefront of living donor liver transplant (LDLT) in the world is a testament to it.

Budd-chiari syndrome (Source: Wikipedia)

The country has a success rate of over 95%, and ten-year survival is over 80% at advanced and well-equipped liver transplant centers. The fact that The Centre for Liver and Biliary Sciences in India at MAX Hospital in New Delhi alone contributes to conducting 2600 plus successful liver transplant surgeries every year for the past 20 years stands as a testament to it.