Dr. Subhash Gupta
Liver transplantation has now become a well-accepted modality for the management of end stage liver disease. Liver transplantation involves removing the diseased liver from the patient and replacing it with healthy liver either from a brain dead person or more commonly with partial liver from a healthy donor. Retrieval of organs from brain dead people involves removal of organs from individuals whose brain has stopped functioning (typically resulting after head injuries and brain hemorrhage), but their heart and breathing functions are being supported with artificial support. These organs would be of great service to humanity, however owing to the social structure of our society these organ donations are far below what is needed. It is said that “Don’t take your organs to heaven for only God knows that that there is a great need for them on earth”. Owing to the scarcity of brain dead or “cadaveric” organs, the available resource is that for a healthy individual to donate a part of his liver for the patient. Owing to the huge functional reserve of a healthy that we initially talked about, the part of the liver remaining with the donor is sufficient to maintain normal functioning and the remaining liver grows back to it’s normal size soon after donation.
When does one require a liver transplant?
Liver disease severe enough to require a liver transplant can come from many causes. In adults, the most common reason for liver transplantation is cirrhosis. Cirrhosis is a condition in which the liver slowly deteriorates and malfunctions due to chronic injury. Scar tissue replaces healthy liver tissue, partially blocking the flow of blood through the liver. Cirrhosis can be caused by viruses such as hepatitis B and C, alcohol, autoimmune liver diseases, buildup of fat in the liver, and hereditary liver diseases. Many people who develop cirrhosis of the liver due to excessive use of alcohol also need a liver transplant. Abstinence from alcohol and treatment of complications for 6 months will usually allow some of them to improve significantly and these patients may survive for prolonged periods without a transplant. For patients with advanced liver disease, where prolonged abstinence and medical treatment fails to restore health, liver transplantation is the treatment.
In children, the most common reason for liver transplantation is biliary atresia. Biliary atresia is a rare condition in newborn infants in which the common bile duct between the liver and the small intestine is blocked or absent. Bile ducts, which are tubes that carry bile out of the liver, are missing or damaged in this disease, and obstructed bile causes cirrhosis. Bile helps digest food. If unrecognised, the condition leads to liver failure. The cause of the condition is unknown. The only effective treatments are certain surgeries, or liver transplantation.
Other reasons for transplantation are liver cancer, benign liver tumors, and hereditary diseases. Primary liver cancers develop at a significantly higher rate in cirrhotic livers as compared to normal livers, particularly in patients having liver disease secondary to Hepatitis B. Liver Transplantation at an early stage of liver cancer may result in long-term survival for select patients. However, cancers of the liver that begin somewhere else in the body and spread to the liver are not curable with a liver transplant.
Is Chairman of Max Centre for Liver & Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi