Who needs a Liver Transplant?

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 B and C are offered transplants. CPT- A patients with hepatocellular cancer are also considered for transplantation.

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 need sometime for optimization before surgery so that the results of liver transplantation can be brought at par with those who are relatively stable at time of transplantation.  Therefore, timing of the 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 excellent outcomes.

Common causes of chronic liver disease and cirrhosis include

  • Viral illnesses such as Hepatitis B and Hepatitis C
  • Alcohol induced damage to liver
  • Fatty liver disease
  • Tendency for blockage of blood vessels of liver (Budd Chiari syndrome)
  • Developmental malformations of liver as in biliary atresia in children
  • Enzyme deficiencies in children leading to chronic liver damage (Wilsons disease etc.)
  • Sometimes from still unknown factors

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.

Another reason for liver damage is Acute Liver Failure. In this following a viral infection (Hepatitis A, Hepatitis E), or due to consumption of large amount of acetaminophen, or certain drugs, which are toxic to liver, patient can develop rapid onset of liver failure. This is manifested by onset of jaundice and within a few days development of confusional state or even coma with worsening of liver synthetic functions. This is usually an emergency situation wherein if the patient doesn’t receive or respond to proper treatment, then he or she may end up requiring an urgent liver transplant.

A patient with acute liver failure should be transferred to a center where liver transplant facilities are available as early as possible, so that appropriate intervention can be done timely. Almost 50% of patients with acute liver failure can be salvaged without the need of undergoing an urgent liver transplant at specialized centers that have liver transplant facilities available.

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Why liver transplant ?

Liver Transplant is needed when a person develops either acute (sudden) or chronic liver failure. Liver transplant is a life saving procedure in this setting.
Acute liver failure (ALF) happens suddenly. It may be caused by various reasons. In India, acute viral infection from Hepatitis A and E are the commonest cause, though it may also occur from drug induced liver damage (DILI), with acetaminophen being the leading cause
Chronic liver failure, also called end-stage liver disease, is a slower process, which progresses over months, years, or decades. Most often, chronic liver failure is the result of cirrhosis, a condition in which the liver cells progressively get destroyed and are replaced with scar tissue through out the liver.