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All About Liver Transplant
A few facts about liver transplantation
- Only cure for advanced stages of cirrhosis
- Can be done by donation by a brain dead person or by a close
relative with matching blood group
- Done in time, it carries 80% success rate
- Close follow up is essential after transplant
- Life can be completely normal after transplant
Who needs a transplant
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According to international guidelines, any patient
suffering from liver cirrhosis who is assessed to have a life expectancy
of less than a year should be considered for a transplant. Severity
of liver disease is graded from A to C. Usually all Grade C and
most grade B patients are candidates for transplant. Any patient
with any of the liver failure symptoms listed below should seek
specialist opinion so that liver experts can assess whether a transplant
or drug treatment is more suitable for them. In any case, the better
the condition of the patient at the time of transplant, the better
are the results of surgery. In patients who are critically ill in
ICU, malnourished, have active infection, or other organ damage
such as kidney impairment at the time of the operation, the results
of transplantation are dismal. Therefore, timely transplant is of
essence in obtaining good results. A timely transplant done on a
patient who is in a reasonable condition, with a good donor liver
has around 80% chance of success.
In most instances, the above causes initially result
in Hepatitis which can usually be treated. However, if the offending
factor is not removed or treated on time, cirrhosis develops and
then it is usually too late to change the course of the disease.
Symptoms of liver failure due to cirrhosis
- Black stool
- Blood vomiting
- Water in the abdomen (ascites)
- Drowsiness and mental confusion
- Excessive bleeding from minor wounds
- Jaundice
- Kidney dysfunction
- Excessive tiredness
- Low hemoglobin and other blood counts
Pre-transplant evaluation
(Transplant Assessment)
The liver specialist usually suggests this evaluation
once he has diagnosed end-stage liver disease. Recipient evaluation
is done in three phases and normally takes 5-7 days in hospital.
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To establish definite diagnosis, determine
the severity of liver disease and the urgency of the transplant.
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To determine the fitness of the patient for
a transplant. The other systems such as heart, lungs, kidneys,
blood counts are tested and the presence of any infection
is ruled out. The liver specialist then decides how successful
the surgery is likely to be depending on the status of the
patient and the cause and severity of liver disease.
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The final phase entails the psychological
and mental preparation of the patient. The patient and the
family are counseled about the procedure, hospital stay, the
likely course after surgery, follow up and aftercare.
After evaluation, the patient is either placed on
the waiting list for cadaveric donation, or , if there is a willing
and blood group matched family donor available, he/she is evaluated
for donation and a transplant is scheduled.
While on the cadaver waiting list, the patient follows up with the
Transplant Team until a suitable liver becomes available. If the
patient's condition shows signs of deteriorating, we normally suggest
the family to consider living liver donation.
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