A liver transplant is a surgical process that involves the excision of an ill functional liver and replacement with a healthy one from a deceased or a living donor. A liver transplant is a life-saving treatment that can save people whose liver function is mostly failing or has progressed to fulfill end-stage liver disease (ELD).

The liver favors not just detoxification, but utilization and digestion of nutrients, transforming of ingested substances into metabolites, synthesis of proteins, and a slew of its vital body functions. When a failed liver cannot take out the dangerous substances, the toxins accumulate and stay in the blood current. A patient may have to face many complications like these, which can be potentially hazardous in the long run. The final option is liver transplant which is the only method that can give the recipient patient a new liver and will normalize liver function again.

Who Needs a Liver Transplant?

  • Cirrhosis – Cirrhosis is scarring of the liver, often caused by hepatitis, alcoholism, or fatty liver disease. As cirrhosis worsens, the liver becomes unable to perform essential functions.
  • Liver Cancer – Liver cancer, or hepatocellular carcinoma, can develop in damaged livers with cirrhosis. Some patients may be eligible for a transplant.
  • Acute Liver Failure – Acute liver failure, also known as fulminant hepatic failure, is a rapid deterioration in liver function caused by drug overdoses or viral infections.
  • Genetic Diseases – Some inherited diseases, like Wilson’s disease and alpha-1 antitrypsin deficiency, cause liver problems. Transplantation may help stop disease progression.
  • Biliary Atresia – This childhood disease causes progressive scarring of the bile ducts, leading to liver failure if not treated with a transplant.

To be considered for a liver transplant, patients must meet certain criteria. They must have irreversible, life-threatening liver disease and a good chance of transplant success and survival. Age, cancer status, heart health, and abstinence from alcohol are also considered. Many transplant centers require at least 6 months of no alcohol use before adding someone to the waiting list.

The Transplant Process

The process for liver transplantation involves several stages, including patient evaluation, placement on the waiting list, finding a suitable donor, and performing the surgery.

  • Evaluation Process – Patients who hold liver transplant that are performed in transplant hospitals necessarily perform tests and medical examinations to determine whether the candidates fulfill all the required criteria to be placed on the transplantation waiting list or not. A list of investigations is done by doctors where they look at the past medical history of the patient, discern the stage of liver disease, check the health status of the other organs, and conduct psychological and social evaluations to establish the right transplant candidate.
  • Waiting List – Once approved, patients are placed on the national transplant waiting list. Waiting time varies greatly based on blood type, body size, geographic location, and severity of illness.
  • Organ Matching – When one liver is detected to be available at the transplant center, it is compared to the different aspects such as blood type, body size, level of inconvenience, waiting time, and distance for an effective match.
  • Surgery Procedure Overview – The patient is scheduled for surgery to excise the severely ailing liver and transplant a healthy one obtained from donation. The donor liver is put into position and linked to the same blood vessels and bile ducts. The liver transplant surgery takes about 4-12 hours generally. After surgery, the patient will be transferred to the intensive care unit.

Immunosuppressant Medications

Patients who have undergone liver transplants must take long-term immunosuppressant medicine to avert the situation where the immune system recipes against the new liver. These medications are termed immunosuppressants which may allow the body to host the new organ properly.

Purpose of Medications

Immunosuppressants specifically do not just prevent organ rejection after liver transplant, they also suppress the immune response. These drugs are necessary to the immune system to prevent its rejection because it will dismiss the new liver as foreign and try to destroy it. Immunosuppressants enable the recipient to heal from the point of transplant onward and thereby develop a fully functional new liver.

Types of Medications

The main classes of immunosuppressants used after a liver transplant include:

  • Corticosteroids such as prednisone are often utilized to provide general immune suppression post-transplant.
  • Calcineurin inhibitors like tacrolimus or cyclosporine are crucial in post-transplant regimens as they block immune cell activation and prevent rejection of the new organ.
  • Antiproliferatives like mycophenolate block immune cell proliferation and growth. These are commonly paired with calcineurin inhibitors.
  • mTOR inhibitors like sirolimus that block cell growth and proliferation. These may be used if other medications cause too many side effects.

Patients usually take a combination of 2-3 medications to prevent rejection. Doctors carefully monitor blood levels of immunosuppressants and adjust dosing as needed.

Side Effects

Immunosuppressants can cause several side effects such as:

  • Increased risk of infections due to suppressed immunity
  • Kidney problems like toxicity from calcineurin inhibitors
  • Increased cancer risk
  • Metabolic effects like diabetes, high blood pressure, high cholesterol
  • Bone loss and fractures
  • Headaches, tremors, acne, and excess hair growth from corticosteroids

Doctors may adjust medication doses to minimize side effects once the liver is stably engrafted and monitor patients closely.

Importance of Adherence

It is critical for patients to strictly adhere to their prescribed immunosuppressant regimens. Missing even a few doses can allow anti-donor antibodies to form and start attacking the transplant. Rejection can quickly lead to liver failure and the need for another transplant.

Recovery After Transplant

After a liver transplant, most patients will need to stay in the hospital for 1-2 weeks. This allows the medical team to monitor for complications and make sure the new liver is functioning properly.

  • Hospital Stay – The patients will be followed in the intensive care unit for 3–4 days after surgery, through the administration of IV fluids, antibiotics, and medicines. Patients shall expect their doctors to carry out routine blood tests for the assessment of the working new liver. Patients are now being moved to regular recovery rooms in a hospital that were previously used for critically ill persons only. Once the patients are ready, they are then passed on instructions on how to take care of the incision site properly and how to identify the signs of infection after which, they are discharged.
  • Follow-up Care – After discharge from the hospital, there will be frequent follow-up visits with the transplant team. Usually, the first visits are weekly. Doctors watch for complications such as infection, bleeding, or liver rejection. Bloodwork and scans will be ordered to check liver function. Also, anti-rejection medication must be followed. At the same time, any symptoms like fever, fatigue, nausea, or jaundice should be reported to the doctor immediately.
  • Diet and Lifestyle Changes – Attention to a balanced diet is even more important after a liver transplant because nutritional needs are greater during recovery. Also, alcohol is strictly prohibited, as it can damage the new liver. Patients should avoid grapefruit and pomegranate, which interact with the drug. Activity and exercise can be gradually increased under the guidance of the transplant team. Lifting more than 10 lbs is prohibited at first.
  • Physical Therapy – Physical therapy such as walking, stair climbing, and core exercises are essential to regain movement and strength after surgery. Also, breathing exercises are important to prevent pneumonia after surgery. Techniques like incentive spirometry are used for that. These activities should be gradually increased after going home. After surgery, it may be normal to feel tired or weak for 6-8 weeks.

Risks and Complications

While liver transplantation has become a life-saving procedure for many people with liver failure, it does come with some risks and potential complications. Some of the main risks include:

  • Rejection – After a liver transplant, the immune system may attack the new liver, known as rejection. Recipients take immunosuppressant medication to prevent this, but rejection can still occur. Mild cases may be treated with medication adjustments, but severe cases can cause liver failure again.
  • Infection – Immunosuppressants used to prevent organ rejection weaken transplant patients’ immune systems, leading to a higher risk of infections, viral, and fungal infections. Antibiotics are prescribed to prevent infections, but if they occur, they can be severe and require hospitalization.
  • Bleeding – Both during and after surgery, bleeding is possible. Transfusions of blood can be required. If bleeding is caused by problems with blood vessels, more surgery can be needed.
  • Biliary Complications -The bile ducts can be disrupted during surgery, leading to bile leaks or blockages. This may require more surgery or stenting procedures to repair the bile ducts.
  • Recurrence of Liver Disease – Patients with liver diseases such as hepatitis C and autoimmune liver disease need regular check-ups to monitor for recurrence and may require additional treatments.