Know about Liver Transplant

Being placed on the waiting list :

Results of the patient’s liver function tests & other factors are used to assess the severity of the patient’s illness, how urgently the patient needs a transplant & patient’s place on the liver transplant waiting list.

Transplant waiting list priority is determined by two scoring systems called Model for End-stage Liver Disease (MELD) for adults & Pediatric End-stage Liver Disease (PELD) for children younger than age 12.

 

A specific formula is used to determine MELD scores, which can range from 6 to 40. The scores estimate the risk of death within 90 days without a transplant. A high MELD score indicates the urgent need for a transplant.

As deceased-donor organs become available, they are allocated according to MELD scores & classified by blood type. People with higher MELD scores are generally offered donated livers first. Time spent on the liver transplant waiting list is used to break ties among people with the same MELD scores & blood type.

 

Some liver conditions, such as liver cancer, may not result in a person getting a high MELD score. The transplant center can request additional MELD points for people with specific diseases if they meet defined exception criteria.

In addition, adults with acute liver failure are exempted from the MELD-based donor organ prioritization system & may be placed higher on the transplant waiting list according to the severity of their disease.

Waiting for a new liver

The wait for a donor liver can vary greatly. Some people wait days, while others wait months or may never receive a deceased-donor liver.

As patients wait for a new liver, complications due to liver failure are treated medically to make patients as comfortable as possible.

Complications of end-stage liver failure are serious & patient may be frequently hospitalized. If the clinical condition deteriorates, the MELD score is updated accordingly.

Living liver donors

Living-donor liver transplants are done using a small portion of a liver from a healthy, living person. Living-donor liver transplants were initially used for children needing a liver transplant because suitable deceased-donor organs are scarce. Now, it is also an option for adults who have end-stage liver disease.

 

 

Living-donor liver transplants offer an alternative to waiting for a deceased-donor liver & allow the organ recipient to avoid possible health complications of waiting for a transplant. The first step is to identify a living donor who is healthy and able to safely undergo a major surgical procedure. The donor’s age, blood type & organ size are also critical considerations in determining whether the patient & the donor are a match for a living-donor liver transplant.

 

Most living liver donors are close family members of the liver transplant candidate. If the patient has a family member who is willing to donate part of his or her liver to the patient, he should talk to his transplant team about this option.

 

 

Living-donor transplants have good results, just as transplants using livers from deceased donors. But finding a living donor may be difficult. Living liver donors go through extensive evaluation to ensure they are a match with the organ recipient & to assess their physical and mental health. The surgery also carries significant risks for the donor.

 

The transplant team can discuss the benefits & risks with the patient & the potential donor.

Staying healthy

Whether the patient is waiting for a donated liver or transplant surgery is already scheduled, the patient should work to stay healthy. Being healthy & as active makes it more likely patient will be ready for the transplant surgery when the time comes. It may also help speed a patient’s recovery from surgery. 

Patient should:

    • Take medications as prescribed
    • Follow diet & exercise guidelines
    • Keep all appointments with the health care team
    • Stay involved in healthy activities, including relaxing and spending time with family & friends
    • Stay in touch with the transplant team, & let them know of any significant changes in health. If the patient is waiting for a donated liver, make sure the transplant team knows how to reach the patient at all times. Patient should keep his packed hospital bag handy, & make arrangements for transportation to the transplant center in advance.
After liver transplant:
    • Patient is advised to have frequent check-ups as he continues recovering at home. The transplant team designs a check-up schedule for the patient. Patient may undergo blood tests a few times each week at first & then less often over time.
    • Patient is prescribed medications after liver transplant, many of them are to be taken for the rest of their life. Drugs called immunosuppressants help prevent the immune system from attacking the new liver. Other drugs help reduce the risk of other complications after the transplant.

Around six months or more is expected as a recovery time before the patient feels fully healed after the liver transplant surgery. The patient may be able to resume normal activities or go back to work a few months after surgery. How long it takes to recover may depend on how ill the patient was before the liver transplant.

Results
Liver transplant survival rates :

Chances of a successful liver transplant & long-term survival depend on the patient’s particular situation.

In general, about 75% of people who undergo liver transplant live for at least five years. That means that for every 100 people who receive a liver transplant for any reason, about 75 will live for five years, and 30 will die within five years.

People who receive a liver from a living donor often have better short-term survival rates than those who receive a deceased-donor liver. But comparing long-term results is difficult because people who have a living donor usually have a shorter wait for a transplant & aren’t as sick as those who receive a deceased-donor liver.

Survival rates among liver transplant recipients also vary among transplant centers.

Coping and Support :

It’s normal to feel anxious or overwhelmed while waiting for a transplant or to have fears about rejection, returning to work or other issues after a transplant. Seeking the support of friends & family members can help the patient cope during this stressful time.

The transplant team can also assist the patient with other useful resources & coping strategies throughout the transplant process, such as:

    • Joining a support group for transplant recipients. Talking with others who have shared patient experiences can ease fears & anxiety.
    • Sharing experiences on social media. Engaging with others who have had a similar experience may help the patient adjust to his changing situation.
    • Finding rehabilitation services. If the patient is returning to work, his social worker may be able to connect him with rehabilitation services.
    • Setting realistic goals and expectations. Recognize that life after transplant may not be the same as life before transplant. Having realistic expectations about results & recovery time can help reduce stress.
Diet and nutrition

After a liver transplant, it is especially important to eat a well-balanced diet to help the patient recover & keep the liver healthy.

The transplant team includes a nutrition specialist (dietitian) who can discuss the patient’s nutrition and diet needs & answer any questions the patient has after the transplant.

In general, the diet after liver transplant should be low in salt, cholesterol, fat & sugar.

To prevent damage to the new liver, it’s important to avoid alcohol. Patient is advised not to drink alcoholic beverages or use alcohol in cooking.

Exercise

Exercise & physical activity should be a regular part of a patient’s life after a liver transplant to continue improving their overall physical & mental health.

Soon after the transplant, the patient should walk as much as he can. Then, depending on the patient’s progress, he can start incorporating more physical activity into his daily life.

Walking, bicycling, swimming, low-impact strength training & other physical activities can all be a part of a healthy, active lifestyle after transplant. But the patient has to check in with his transplant team before starting or changing his post-transplant exercise routine.