The liver is a dark red-brown conical organ, weighing about 1.2 kilograms. The liver is located in the upper right part of the abdomen, below the diaphragm, and is divided into two main lobes, the left and the right, with hundreds of smaller lobes. The liver receives blood from the hepatic artery and the hepatic portal vein, and plays a critical role in various metabolic functions in the body.
The liver is the primary center for controlling the levels of chemicals in the blood. It regulates chemicals, secretes the gallbladder to remove waste, and processes the blood coming from the intestines. It performs more than 500 functions, including protecting the body against infection, producing vital proteins, removing substances from the blood, secreting the gallbladder to remove waste, digesting fats, producing proteins that control blood clotting, and converting excess sugar into glycogen for energy storage.
The liver can only function normally at 30% after 70% of it has been removed. This enables large affected parts in cases of liver cancer to be safely removed. Similarly, more than half of a donor's liver can be removed for transplantation without risk or effect on liver function.
The liver is the only organ capable of regeneration after large parts of it have been removed. Within a few weeks, the small remaining portion of the liver swells back to its original size, which justifies the safety of a half-liver transplant in patients with liver failure.
Causes: Viral infections (hepatitis A, B, C, D, E), overdose of certain medications, exposure to chemicals.
Symptoms: Flu-like symptoms, jaundice, nausea, vomiting, loss of appetite, abdominal pain, itching.
Diagnosis: Specific laboratory tests, liver function tests, medical history, physical examination.
Treatment: Depends on the cause, severity of the disease, and overall health; most cases recover naturally; severe cases may require hospitalization.
Note: As of writing this text, vaccines for hepatitis C, D, or E are not available. Preventive measures may vary from one region to another; therefore, advice from the medical team is necessary to determine the best preventive strategies.
Causes: Hepatitis viruses, excessive alcohol consumption, autoimmune diseases, some medications, metabolic disorders.
Diagnosis: Comprehensive medical history, physical examination, specific viral laboratory tests, liver function tests, or liver biopsy.
Treatment: Individualized approach to stop liver damage; discontinuing certain medications causing chronic hepatitis symptoms, avoiding excessive alcohol consumption; essential also for recovery in cases of chronic liver diseases caused by alcohol.
Prevention: Vaccinations (hepatitis A and B for children), blood transfusion screening, antiviral medication for those exposed to hepatitis B to help prevent infection.
Preventing Liver Cancer:
1. There are two levels of prevention: Avoiding alcohol consumption and preventing the spread of Hepatitis B and C viruses.
2. Infection can be transmitted through sexual contact, contaminated needles, and blood.
3. Preventive measures include using disposable needles, comprehensive screening of blood donors, and vaccinating all infants and non-infected individuals against the Hepatitis B virus.
4. The second stage of prevention focuses on patients with liver cirrhosis to prevent liver cancer through timely liver transplantation.
5. Liver cirrhosis can also result from genetic diseases that cannot be completely avoided.
Preventing the Spread of Viral Hepatitis:
1. Good hygiene is key to stopping the spread of hepatitis.
2. Vaccinations, such as Hepatitis B vaccine, are part of routine vaccination programs.
3. Blood products are regularly tested for Hepatitis B and C viruses and the Human Immunodeficiency Virus (HIV) to reduce the risk of infection.
4. Preparing antibodies can help prevent Hepatitis B infection.
5. The goal is to focus on high-risk areas and individuals, including those with a family history of Hepatitis B or C infection, undergoing surgeries, dental care, intravenous drug use, unprotected sexual practices, kidney dialysis procedures, and medical and non-medical staff. These are just some examples of risk factors.
Who Needs Liver Transplant?
Patients suffering from liver cirrhosis and considering a life expectancy of less than a year may benefit from liver transplantation. Severity ranges from Grade A to Grade C, and most Grade C patients are eligible. Symptoms include black stools, vomiting blood, jaundice, and more.
Types of Liver Diseases Requiring Liver Transplantation
Liver transplantation is primarily required for adults suffering from advanced liver cirrhosis, leading to end-stage liver damage. Other common factors that lead to liver failure and necessitate liver transplantation include Hepatitis B and C, autoimmune liver diseases, fatty liver accumulation, genetic liver inflammation, excessive alcohol consumption, biliary atresia in children, liver tumors, and benign liver tumors.
Different Methods of Liver Transplantation
There are two main methods of liver transplantation: deceased or living donor liver transplantation. In the first method, a healthy liver is entirely removed from a deceased donor and transplanted into the patient after removing the diseased liver. The availability of deceased donors may be uncertain, and patients are placed on waiting lists based on different criteria. The liver can be transplanted as a whole or divided into two parts to be transplanted into two patients.
In the second method, a portion of a healthy liver from a first-degree or second-degree relative is used to replace the patient’s damaged liver. The liver components regenerate for both the patient and the donor, reaching their normal size and shape within a few months after surgery.
Qualifications for Living Liver Donors
Living liver donors must meet specific qualifications, including being first or second-degree relatives, aged between 18 and 55 years, and in good health. The liver size and blood type of the donor should match the recipient’s. Individuals with kidney or liver diseases, other serious illnesses, or carrying human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) are not eligible to donate.
Recovery After Liver Transplantation
After transplantation, Patients are transferred to the Intensive Care Unit and connected to a ventilator. It can be removed gradually after 24–48 hours, patients are closely monitored in the Intensive Care Unit. Once they recover, they are transferred to a regular hospital room for further observation. The hospital stay usually lasts from two to three weeks, followed by a home recovery period lasting from three to six months. Patients must follow a strict diet regimen, lifestyle plan, and prescribed medication schedule by the surgeon.
Qualifications for Living Liver Donors
Living liver donors must meet specific qualifications, including being first or second-degree relatives, aged between 18 and 55 years, and in good health. The liver size and blood type of the donor should match the recipient’s. Individuals with kidney or liver diseases, other serious illnesses, or carrying human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) are not eligible to donate.
Donor Evaluation
Before performing liver transplantation surgery, potential donors undergo a series of clinical and evaluative tests to ensure their suitability for the procedure. These tests may include medical imaging, blood tests, radiographic imaging, general diagnostic tests, and consultations. If initial tests are favorable, more specific liver tests may be conducted, such as magnetic resonance imaging and computed tomography of the abdomen or pelvis, dobutamine stress echocardiogram, chest X-ray, and electrocardiogram.
Pre-Transplant Evaluation:
The patient undergoes a comprehensive evaluation to determine the need for liver transplantation. This process takes 5-7 days in the hospital.
Liver Transplantation Surgery:
Liver transplantation is a treatment for advanced liver cirrhosis or primary liver cancer.The diseased liver is removed and replaced with a healthy liver from the donor. It is a complex procedure that takes 6 to 9 hours.It can be done using a deceased or a living donor’s liver. The success rate ranges from 80% to 97%, and careful follow-up is required, but patients can resume a normal life.
The Importance of Liver Transplantation
Liver transplantation is a life-saving option for patients suffering from severe liver disorders. Despite the complexity of the surgery, the survival rate after a successful liver transplant is relatively good. However, survival prospects can vary for each patient due to individual factors. Adhering to post-care instructions plays a crucial role in the success rate.
Recovery After Liver Transplantation
After transplantation, Patients are transferred to the Intensive Care Unit and connected to a ventilator. It can be removed gradually after 24–48 hours, patients are closely monitored in the Intensive Care Unit. Once they recover, they are transferred to a regular hospital room for further observation. The hospital stay usually lasts from two to three weeks, followed by a home recovery period lasting from three to six months. Patients must follow a strict diet regimen, lifestyle plan, and prescribed medication schedule by the surgeon.
Medications:
Immunosuppressive drugs prevent rejection of the donor’s liver.
Self-Care at Home
Self-care at home is an essential part of the recovery process. There may be a need for periodic visits and evaluations after leaving the hospital for the first few months. It may take around six months to fully return to work or regular activities. Patients must maintain a disciplined lifestyle and follow recommended dietary guidelines and take immunosuppressive medications as directed to prevent rejection of the transplanted liver.
Recovery:
Patients can resume normal activities within a month after surgery and have an excellent chance for a normal and long life.
Follow-Up:
Regular visits are required to monitor progress and liver function. The frequency decreases with the patient’s stable condition.
Possible Complications After Transplantation
Complications may arise after liver transplantation, including transplant rejection, recurrence of liver diseases, infections, diabetes, bone weakness, and excessive weight gain. Regular doctor visits and adherence to prescribed treatments and preventive measures are necessary for long-term health maintenance.
Living After Liver Transplantation:.
Often, liver diseases can be “silent,” and patients may not be aware of any issues until liver damage becomes severe or advanced. When examining different liver functions, the signs and symptoms of liver diseases can be explained.
The inability to properly metabolize nutrients leads to tissue wasting, especially in the muscles. The accumulation of bilirubin, responsible for yellowing of the skin and urine (jaundice), and bile acids, which may cause chronic itching in some patients, occurs due to the liver’s inability to secrete bile properly. Easy bruising and bleeding, initially from the gums, occur due to reduced absorption of vitamin K and a deficiency in blood clotting proteins. Massive gastrointestinal bleeding partly results from blood being redirected away from its usual path through the liver to alternative channels in the esophagus, which may rupture under pressure.
Liver scarring and decreased protein synthesis in the blood, both important for maintaining fluid balance in the body, contribute to fluid accumulation in the abdomen and legs. Toxins generated in the stomach can lead to drowsiness, forgetfulness, loss of concentration, confusion, and even coma if the liver cannot process them properly. Additionally, the damaged liver is much slower at dealing with alcohol and drugs, leading to increased sensitivity to their use.
Furthermore, insufficient removal of microorganisms or germs, from the blood coming from the digestive tract partly explains the increased susceptibility to severe infections in liver patients.
Diet and Nutrition After Liver Transplantation:
To maintain the health and normal function of the liver while preventing excessive weight gain, you may need to adjust your diet. By maintaining a healthy weight, you can prevent inflammation, high blood pressure, and other conditions. Your nutritionist and other members of your treatment team will work with you to create a healthy eating plan tailored to your needs and lifestyle.
Your nutritionist will provide you with a range of healthy food options and meal planning suggestions. After liver transplantation, your nutritionist may advise you to include the following foods:
For liver transplant patients, every reputable hospital in Delhi offers an integrated strategy. The diet is specifically planned for these individuals by nutrition experts. By following a nutritious diet, we discovered the secret of maintaining excellent health after liver transplantation:
Calcium:
Calcium helps strengthen bones prone to fractures and osteoporosis due to the use of prednisone (a drug used to treat liver transplant recipients). Calcium is abundant in dairy protein and many green plants. Nuts and seeds are excellent sources of calcium.
Fats:
In addition to slowing down recovery, increased bad cholesterol can lead to other health problems. However, healthy fats can have positive effects on your health. Consuming seafood from cold waters, such as tuna, provides plenty of omega-3 fatty acids, which are very beneficial to your health. Nuts, vegetable oils, and seeds are also excellent sources of good fats.
Fiber:
Fiber has many advantages and can be particularly helpful in maintaining a healthy weight. Consuming whole grains to get an adequate intake of dietary fiber because fresh fruits and vegetables contain a high percentage of fiber. Pasta and wheat-based grains are among the fiber-rich foods in this category.
Protein:
Any experienced liver transplant specialist in Delhi, Mumbai, or any other medically advanced place, will advise protein to form a quarter of the diet for at least two months after liver transplantation. You should have protein in all your meals and drinks if you want long-term health benefits. Lean meats, eggs, fish, and poultry are also satisfying options for non-vegetarians. Vegetarians can benefit from soy milk, and they don’t need to fear as dairy products, beans, and lentils are also excellent sources of protein. Additionally, nuts and seeds are protein sources. A key tip is to consume low-fat dairy products to prevent weight gain.
Vitamin D:
Prednisone use also increases the risk of bone loss, which can be prevented by including vitamin D in your diet. Dairy products, fresh orange juice, and fatty salmon are excellent sources of vitamin D nutrition.
Incorporating these foods into your daily diet will be beneficial. Blood sugar levels can be controlled by avoiding excessive sugar levels. To prevent side effects and related problems, it is essential to avoid potassium supplementation (if recommended by a doctor).