Who Needs a Liver Transplant?
Liver Transplant is necessary in Three broad categories of patients
Chronic Liver Disease:
Here the liver is damaged over a prolonged period by continued and repeated injury. The cause of injury could be chronic viral infections such as hepatitis C or hepatitis B infection, prolonged abuse of alcohol. Recently, fatty liver disease is on the rise due to unhealthy dietary habits and sedentary life style. Over a period of time, fatty liver disease can lead to inflammation (damage) of the liver and this can also cause chronic liver disease. Long-term diabetes is another cause of chronic liver disease due to fat accumulation in the liver.
Uncommon causes of chronic liver disease are primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune liver disease where the own cells damage the liver due to their inability to recognize the liver as its own.
The chronically damaged liver goes through the stages of fibrosis and cirrhosis during which the liver becomes hard and shrunken. This affects the liver function causing jaundice, encephalopathy (confusion, forgetfulness, slowing of thought process), swelling of the abdomen and feet and abnormalities in the ability of blood to clot. The hardened liver increases the resistance to blood flow through the liver causing complications, such as blood vomiting, blood in stools and fluid in the abdomen. The third serious problem with cirrhosis is the development of liver cancer. Liver transplantation cures all these problems of cirrhosis by replacing the damaged liver with a new healthy liver.
Severity of Chronic Liver Disease:
Not all patients with cirrhosis need transplantation. Liver transplantation is only advised when the risk of serious complications and death is high enough to justify a major operation such as liver transplantation.
In most instances, a careful history, clinical examination and standard blood tests can help in estimating the severity of liver disease and the risk of complications. Symptoms of end stage liver disease include
- Accumulation of fluid in the abdomen (Ascites)
- Infection of this abdominal fluid, called Spontaneous Bacterial Peritonitis, is even more ominous.
- Deteriorating kidney function along with liver function (Hepatorenal Syndrome)
- Vomiting of blood or passage of black stools suggestive of bleeding from the stomach and intestine.
- Altered consciousness, confusion or slow mentation (Hepatic encephalopathy)
Scoring system to assess need for Liver Transplantation:
Child Pugh score (CPT) and the Model for End Stage Liver Disease score (MELD score). As a general rule, patients with MELD score greater than 15 have a survival benefit with transplantation. In addition, presence of liver cancer on a background of cirrhosis is a strong indication for liver transplantation, provided the tumor stage fits into internationally recognized criteria.
Liver Cancer:
Patients with cirrhosis develop liver tumors. Surgical removal of these tumors is complicated by the poor liver function. In such cases, liver transplantation is the ideal cure as it completely removes the tumors and also removes the diseased liver, which is the breeding ground for these tumors. However all patients with liver tumors are not suitable for transplantation and the liver team will carry out a detailed evaluation before suggesting transplant as an appropriate treatment.
Acute Liver Failure:
Some patients with Acute Liver Failure can deteriorate despite aggressive medical treatment and in these patients, liver transplantation is a true life-saver. These patients qualify for urgent liver transplantation in most organ allocation systems around the world. Since the availability of this surgery, survival of patients with acute liver failure has improved from less than 20% to over 80%.
Other indications for Liver Transplantation:
Other indications for liver transplantation include problems in liver function, which can damage the liver (Tyrosinemia), other organs (Hyperoxaluria damaging the kidneys). These are discussed in greater detail in the section of liver diseases in the childhood age group.
