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Liver Transplantation: A New Hope

   

Liver is the largest solid organ in the body , located on the right side of the abdomen . Liver performs approximately 500 important functions daily to keep the body healthy . Liver Cirrhosis means normal liver cells are replaced by scar tissue. Many people with cirrhosis have no signs or symptoms at all and feel quite well , this is called compensated cirrhosis , whereby despite scarred tissue there are healthy liver cells performing the necessary functions . Over time some people with compensated Cirrhosis will decompensate as the scarred liver cells are no longer capable of performing all its functions resulting in various complications such as vomiting blood, ascites( swelling abdomen) , swelling of feet , confusion due to inability to clear toxins from blood ( hepatic encephalopathy ) and jaundice. Decompensated Cirrhosis is the commonest reason to have Liver transplantation. Although , Alcohol is one of the most common causes of cirrhosis , there are many reasons for cirrhosis such as chronic Hepatitis B and C , Non Alcohol Fatty liver disease(NAFLD: which occurs due to obesity , Diabetes , High Cholesterol). The incidence of these three conditions continues to increase resulting in higher prevelance of cirrhosis and its complication such as Liver cancer , which is now the 4th commonest cancer in the world . There are several liver conditions which may not progress to cirrhosis and still require a liver transplantation such as Fulminant Hepatic failure ( FHF ) which can be caused by viruses, drugs, toxins, and genetic conditions such as Wilsons disease .

Liver Transplantaion is the only hope for patients with liver failure as there is no liver dialysis to rescue these patients like those with Kidney failure.

Liver Transplantaion is the only hope for patients with liver failure as there is no liver dialysis to rescue these patients like those with Kidney failure.

Liver transplantation means removing a part or whole of the liver from a deceased or live person and replacing damaged organ in other person.

Liver Transplantation is of two types- Live Donor Liver transplantation

( LDLT) where a part of liver is removed from the live person and transplanted to the patient . Deceased Donor Liver transplantation (DDLT) - where part or the whole liver is removed immediately from patient who is brain dead( cadaver ) but has functioning organs and transplanted to patient with liver failure . Initial attempt to transplant liver were carried out in animals like dogs and cats. However, first human liver transplant was carried out in 1963 , which was unsuccessful as patient lived for few days and succumbed to death . In 1967 , the first successful liver transplant was performed in America by Dr Thomas Starzl. There have been many advances since then and by early 1980’s , liver transplantation was widely accepted as treatment of choice for advanced or end stage liver disease ( cirrhosis) or liver failure . Due to advances in surgical techniques and newer medication ( immunosuppressive agents ) to prevent rejection , 85% patients who might have otherwise died are able to survive and return to active lifestyle.

 

The challenges of choosing the correct candidate who will benefit from liver transplantation and organ allocation still remains, despite several decades of performing this procedure successfully . There are several differences in organ donation rates in the West compared to East. In America, and European countries, where the donation rate is higher, it is predominant cadaver program whereas in Asian countries including India , 90% of cases of Liver transplantation are from live related donors . There is a small risk

( 0.3- 0.5%) of live donor dying from this procedure, therefore it would be ideal to boost the cadaver program to overcome the national organ shortage. However, there are very few families willing to donate organs of their loved ones after death due to lack of awareness, infrastructure and cultural beliefs. Due to sparse cadaver organ donation, many patients die on the waiting list for liver transplantation . There is an urgent need to raise public awareness and invest in the infrastructure for organ donation in several parts of the country.

Currently, Liver Transplantation is only available in private sector and is an expensive procedure approximately 20-25 lac . There needs to be an initiative from the Government to make this facility available in teaching and government hospitals , so that the poor can also avail of this treatment when required .

Finally , success of Liver Transplantation depends on team work including, Transplant co-ordinator, Liver specialist , Transplant surgeon, Radiologist ,Intensivist , Microbiologist, Histopathologist and caregivers of the patient . The transplant team needs to work together with the patient and their family to allay their fear and answer any questions related to this highy specialized procedure . We will need to progressively work towards increasing the centres with skilled manpower which provide the appropriate training to the entire team so that this facility can become widely available in various parts of the country .

   Jully 16th, 2016


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