Liver Transplant Facts and Myths – Donor And Recipient Risks

Learning in detail about all liver transplant facts and myths before opting for the liver transplant procedure can help you make an informed decision.

Most people are scared at the very mention of the word surgery, let alone the concept of getting someone else’s liver transplanted into their bodies. Each surgery has its share of pros and cons, and it is important to weigh the pros against the cons and then make a critical decision and not just give into misconceptions.

Basic Liver Transplant Facts

If there is something wrong with a kidney, a dialysis unit can help in preventing further problems from occurring and if there is something wrong with the heart, a pacemaker will supply enough electrical impulse to help it pump your blood for you.

This way, the functions of these two organs can be replaced temporarily using modern science and technology. The liver, however, is different from these two organs and cannot be replaced by an artificial unit or device, unlike the kidneys and the heart. A liver transplant is inevitable in cases where acute liver failure occurs. Simply put, the liver is irreplaceable.

Liver Transplant Facts

People who opt for organ transplants face a higher risk for skin cancer

Liver Transplant Facts for Recipients

Listed below are a few misconceptions that liver transplant recipients generally harbor about liver transplants. You can read about these misconceptions to clear any doubts that you may have regarding the procedure.

  • Will I have to depend on lots of medication for the rest of my life?

If you have just undergone a liver transplant procedure, you will need to survive on medication to protect the new liver. This is because the body sometimes rejects the new organ transplanted as a foreign object. These medications however reduce both in dosage and number as time passes and the immune system gets used to the new liver.

  • I was an alcoholic and now have cirrhosis of the liver, is it possible for me to get a transplant?

The medical boards in most countries agree that an alcoholic has to be sober for at least a year before he can qualify for a deceased donor liver transplant. If you qualify under this stipulation then nothing can stop you from being put on a waiting list. If, however, you do not qualify to be put on the waiting list for a deceased or cadaver donor liver transplant, you can still opt for a living donor liver transplant.

Liver Transplant Facts for Donors

Liver Transplant Facts for Donors

Obesity, high blood pressure and diabetes are diseases recipients should watch out for

It is not only liver recipients who have doubts or misconceptions about the liver transplant facts, as even donors have their doubts. It is vital that these doubts about liver transplant donor risks are cleared before the procedure is actually carried out.

  • How will I live once they remove my whole liver out?

As it is impossible to live without a liver, your surgical team will not be doing this. The liver has an amazing ability to regenerate itself with the passage of time. This regeneration will be based on a person’s physique and natural ability to regenerate.

The transplant unit will remove only a part of your liver. According to research, it has been noted that close to 55% of your liver will be removed to transplant into the recipient’s body. This is true only for a liver that’s of average size, because for a large liver, as little as 40% can also be removed which would make the process of regeneration faster.

The transplant unit will be able to provide more information regarding the procedure right from the type of scalpel used to the type of incision made.

It is important to learn about liver transplant facts for you to take up the procedure confidently. Most doctors and medical practitioners encourage their patients and their family members to ask as many questions as possible to understand liver transplant requirements.

Liver Function Test Information – Diagnosing the Symptoms

A liver function test can be used to identify any disease that interferes with the liver’s normal processes. Most diseases that affect the liver show very mild symptoms in the initial phases and it is important for you to get tested for these liver disease symptoms before they get worse or unmanageable.

According to a survey conducted by the United States CDC (Centre for Disease, Control and prevention), there are around 3.5 million people in the US alone who are infected with the hepatitis C virus, but more than 60% of them have no knowledge of the same.

liver function test

Flowchart for Elevated Liver Function Test

A liver function test can be a liver blood test or a clinical test that’s carried out to see the stage of liver failure that the patient is going through. In other words, it is an indication of the state of a patient’s liver. These tests are usually used to:

  • See if the patient has any liver disease present (or potential).
  • Distinguish between the different disorders that cause liver damage.
  • Note the extent of damage done to the liver.
  • Set a course for the treatment based on the diagnosis.

Standard Panel for a Liver Function Test

Albumin

Albumin is the primary constituent of protein which is produced by the liver. It can be measured in an inexpensive manner. The secondary constituent of protein is Globulin, inclusive of immunoglobulin. The levels of Albumin recorded for patients suffering from chronic liver diseases are relatively low, like in the case of Cirrhosis.

In diseases like Nephrotic Syndrome, albumin is lost through the urinary tract and hence leads to a marked decrease in levels. If nutrition is poor or protein catabolism is impaired, which is the case in Ménétrier’s Disease, it leads to hypoalbuminaemia.

Alanine Transaminase

ALT is also known as Alanine aminotransferase (ALAT) or Serum Glutamic Pyruvate Transaminase (SGPT). It is an enzyme which is present in the liver cells called hepatocytes. When these cells are damaged, this enzyme leaks into the blood where its level is measured.

In case of acute liver damage the level rises exponentially. This happens in the case of paracetamol overdose or viral hepatitis. These elevations are measured to narrow down the possible list of causes behind liver damage.

liver function test abnormalities

Liver Function Test Abnormalities

Aspartate Transaminase

AST is also called Aspartate Aminotransferase (ASAT) or Serum Glutamic Oxaloacetic Transaminase (SGOT). Like ALT, it is just another enzyme present in the parenchymal cells of the liver. It is not specific only to the liver as it is also present in skeletal and cardiac muscle and also in red blood cells.

Its levels are increased in cases of acute liver damage. As AST levels are not related only to the liver, its elevation does not always help in diagnosis. The ratio of AST to ALT however, is useful in determining the different causes.

Alkaline Phosphatase (ALP)

ALP is an enzyme present in the cells which line the bilary ducts of the liver. The levels of ALP in plasma are high when there is a large obstruction of the bile duct, infiltrative diseases of the liver or intrahepatic cholestatis. ALP is an enzyme which is also present in placental tissue and bones. As children’s bones undergo a lot of changes with time, its levels are generally higher in children.

Total Bilirubin

Bilirubin is a byproduct of the breakdown of hemoglobin, which is present in red blood cells. One of the liver’s functions is also to remove the Bilirubin from the blood.

An increase in total Bilirubin generally causes Jaundice and some other problems, namely:

  • Pre-Hepatic

Increase in production of Bilirubin pointing to internal hemorrhage and hemolytic anemia. 

  • Hepatic

Deficiency in the metabolism of Bilirubin, which points to Viral Hepatitis and Cirrhosis 

  • Post-Hepatic

Shows reduction in Bilirubin because of obstructions in the bile ducts.

Direct Bilirubin (Conjugated)

The patient’s diagnosis can be further narrowed by taking a look at the direct Bilirubin levels during the liver function test.

  • If it is normal, then unconjugated Bilirubin is in excess and the exact location is before the excretion of Bilirubin. The suspects are Cirrhosis, Viral Hepatitis or Hemolysis.
  • If there is an elevation in the level of direct Bilirubin, then the conjugation of Bilirubin will be normal, but the liver will be unable to excrete it. This happens in the case of either cancer or if gallstones obstruct the bile duct.

Gamma Glutamyl Transpeptidase

It is possible for GGT levels to get elevated due to a minor dysfunction from the liver’s part. This is generally raised when there is a high level of alcohol toxicity which points to Alcoholic Liver Disease.

Other tests that can be considered if liver function tests are not accurate are:

  • 5 nucleotidase test
  • Coagulation test
  • Serum glucose
  • Lactate dehydrogenase

If any of these symptoms of liver failure are observed, it is recommended that you seek medical recourse immediately. Opting for a liver function test before any major symptoms of liver damage occur can be a good call as a liver transplant surgery or any other major medical recourse can be avoided this way.

Liver Disease Symptoms – Identifying the Need for a Liver Transplant

If you have started showing early liver disease symptoms, it is recommended that you seek the expert opinion of a medical practitioner to confirm the same and seek medical recourse. The symptoms of liver problems are not too subtle, and you’ll be able to identify them over the course of a few weeks.

Liver symptoms can range from mild and intermittent headaches and nausea to polyuria (frequent urination). Listed below are some of the most prominent liver disease symptoms.

liver disease symptoms

Jaundice is one of the primary liver disease symptoms

Liver Disease Symptoms

Jaundice

Jaundice is the most prominent symptom of liver disease as it’s the basic indication if there is anything wrong with either the liver or the gall bladder. Jaundice can be commonly observed, as the skin generally sports a yellowish orange color. The sclera (white part in the eye) displays a shade of yellow too.

The cause behind jaundice is the improper or insufficient production of bile in the liver. Bile helps in processing old blood and when bile is not properly produced, the problem results in jaundice. Sometimes, jaundice can be accompanied by other symptoms such as flu or joint aches.

This can be a result of an infection in the gall bladder or a contraction of acute hepatitis. It is better to visit a hospital or a medical facility to get the symptoms thoroughly checked in this case. As per traditional oriental medicine, two types of jaundice exist:

  • Yang Jaundice

Constipation, palpitation, thirst, urinary problems, yellowing of the tongue as well as abdominal distention are a part of the symptoms that are highlighted in this form of whole body jaundice. The body color changes to tangerine and this is generally brought on by moist heat and excessive dampness.

  • Yin Jaundice

Severe fever, poor appetite, nausea, fatigue, lassitude, loose stools, hypochondriac pain, palpitation, cold feet and hands, breaking breath, and edema are the most common symptoms of Yin Jaundice. The face, eyes and skin turn yellowish in this type of jaundice.

Appetite and Digestion

Another very common symptom that goes hand in hand with liver disease is loss or change in appetite. This is why liver disease causes weight loss in some cases. The weight loss can further trigger incorrect metabolism of the fats, proteins and carbohydrates present in the body, worsening the condition of the pre-existing liver problem.

This loss of appetite soon kick starts a chain of events which begins with anemia as the hepatocytes, cells in the main tissue in the liver, keep degrading.

At the onset of diarrhea, vomiting and nausea, the body becomes weaker and the presence of even a single gastric ulcer in the body can cause bouts of blood vomit. The gastric ulcers grow faster due to the reactions between the nitrogen, bile acids, gastrin, mucus membrane and the histamine that line the walls of the stomach.

Coloration of the Stool

The stool also shows initial signs of discoloration as it becomes lighter in color and pale. This is brought on if there is a problem with the secretion of the bile pigments, which is caused either due to a blockage in the bile ducts or because of a stop or drop in the level of bile secretion.

signs of liver disease

Polydyspia (excessive thirst) ranks among the main liver disease symptoms

Almost all liver and gall bladder diseases cause irritable as well as irregular bowel movements. The bile gives the stool its natural dark color, but due to the blockage in the bile duct or the improper secretion of bile, the stool takes up a lighter color, which is an indicator that something is wrong with either the duct or the liver itself. The ducts are generally blocked because of stones, inflammation or scarring.

Distention and Bloating

Another symptom is distention of the abdomen. This occurs near the lower part of the right side of the rib cage, and this is caused because of ascites or hepatomegaly. As the distention takes a turn for the worse, there is an applied pressure on the diaphragm which results in pain during breathing.

Polyuria and Polydyspia

Polyuria means excessive and very frequent urination and polydyspia means excessive abnormal thirst. These are common symptoms among many diseases, but they are also noticeable in people suffering from liver diseases.

When doctors pen down reasons for liver transplant, these are the other minor liver disease symptoms they look for:

  • Skin problems
  • Allergies
  • Headaches
  • Nausea
  • Seizures
  • Eye irritation
  • Itching skin
  • Mood swings
  • Back aches
  • Strokes

If any of these liver disease symptoms are manifested together and persist over a period of time, it is recommended that you consult your medical practitioner immediately. Liver failure generally requires a liver transplant surgery as treatment. This can be determined in a liver function test.

Research has shown that among a group of ten patients who died because of a lack of compatible livers for transplants, at least five of them were ignorant to the symptoms of transplant rejection that they were facing till it was too late. This is one of the main reasons why you’ll need to monitor your health regularly through medical checkups to ensure that your body doesn’t spring a surprise from the blue.

Causes of Liver Failure – The Reasons Behind Liver Transplants

Liver transplant surgery is performed when acute liver failure occurs and all other modes of treatment are ruled out. Since the liver is an integral part of the human anatomy, it is pivotal to the maintenance and proper functioning of the human body.

When the liver ceases to perform its functions like fighting infections and breaking down food to convert it into energy, it leads to the slow degradation of other organs as well.

Liver Failure Causes - Hepatitis B

Hepatitis B is one the main causes behind liver failure

If the liver is not in a condition to perform the necessary metabolic and synthetic functions that keep the human body functioning, the condition is called liver failure in medical parlance.

Types of Liver Failure

The types of liver problems and the reasons behind liver failure are listed below:

  • Chronic Liver Failure 

    This is caused over long durations of time. The damage can occur for a period of anywhere between months and years. The damage caused is sometimes irreversible because of the long duration of its decay. 

  • Acute Liver Failure 

    This is caused in a very small period of time because of extensive damage to the liver and its tissues. 

  • Liver Cancer 

    Cancer cells that multiply in the liver and cause cancer can also lead to liver failure.

Causes of Liver Failure 

Liver Failure Causes - Alcoholic Liver Disease

Roughly around 25000 Mexicans and Americans die every year due to Alcoholic Liver Disease

A more detailed explanation about the liver failure causes has been given below:

  • Alcoholic Liver Disease

Alcohol contains a number of toxins. The function of the liver is to filter out these poisonous toxins from the bloodstream. Some of the liver cells are lost in the process of filtration. In the initial stages, this does not pose a problem as the liver has the ability to create new cells when old ones die.

Over a long duration of time however, the more the liver has to filter the blood, the more cells die. The liver gradually loses its ability to produce new cells and the dead, decaying cells will end up scarring the liver. This condition is known as Cirrhosis. If the scarring of the liver is left untreated for long, it will finally reach a stage of liver failure.

  • Hepatitis C

This is a virus that is transferred through an affected person’s blood. It is also possible for this disease to be transferred through sharing bodily fluids. For instance, most drug abusers tend to share their needles. If one of them is affected by Hepatitis C, it is highly likely that the others will share the same fate. Sexual intercourse with an affected partner is yet another cause for the spread of Hepatitis C.

Hepatitis C results in the swelling and scarring of the liver, which is likely to cause long term liver damage. Studies show that at least one out of seven people who suffer from Hepatitis C will subsequently also suffer from liver failure, even though the person might have contracted the infection more than 20 to 30 years previously. As of today, no vaccine for Hepatitis C has been invented.

In the United Kingdom, surveys conducted by the UK Healthcare Centre have shown that there is 15 to 25% chance of the liver being rejected because of Hepatitis C resurfacing.

Liver Failure Causes - Hepatitis C

MAC Granulomatous Hepatitis can cause abnormal liver function

  • Primary Biliary Cirrhosis

The buildup of bile in the liver is the cause for a chronic liver disease called PBC. Bile is a greenish liquid secreted inside the liver and its main function is to help digest fats. Bile ducts are passages present in the liver, and these aid in the flow of bile out of the organ.

PBC is caused when the body’s immune system attacks the liver, causing a buildup of bile inside the organ. This is a rather rare condition. Studies in the field show that one among every 8000 people suffers from PBC. A transplantation unit has recorded that one out of four-five liver transplantation cases has a background of PBC related issues, making it the most common cause behind liver transplants.

  • Hepatitis B

Like Hepatitis C, Hepatitis B is caused by the spread of the Hepatitis B virus either during unprotected sex or through sharing an affected needle. It is not very rampant in the western hemisphere as only one in every 1000 people in the UK is said to be affected by this virus. The initial symptoms include vomiting, nausea and headache.

Around 2-10% will suffer from chronic liver damage, as the virus stays in the host cells for a long time though they may not show any symptoms apart from the initial symptoms. Another 20% will face liver failure. Hepatitis B can be countered with the help of vaccines. 

  • Primary Sclerosing Cholangitis

This is a chronic liver disease which affects people in the age group of 30-50. It is a rare condition and only one in 16,000 to 17,000 people is known to be affected by it. As is the case with most chronic liver diseases, it can cause liver failure after many years. 

  • Autoimmune Hepatitis

This is characterized by chronic inflammation of the liver, and the liver is attacked by white blood cells. The reason for this condition has not yet been discerned. The condition leads to liver failure if the inflammation festers over long periods of time. It is extremely rare as only one person in 100,000 is diagnosed with it. 

  • Biliary Atresia

Biliary Atresia is a condition in which a child is born without a bile duct. This is similar to Primary Biliary Cirrhosis, but in children. Around one in about 18,000 children is known to be born with Biliary Atresia. If the scarring of the liver is too much, it leads to liver failure and the child will need a liver transplant.

  • Drug Overdose

Statistically, one in 300,000 individuals in a year is affected by this condition. Acute liver failure generally occurs in teenagers and young adults. The primary reason is a drug overdose, and this can be either deliberate or accidental. For example, most people suffering from this condition in UK were found to have overdosed on paracetamol, which when taken in high doses will take its toll on the liver leading to liver failure.

  • Liver Cancer

Cancer that starts in the liver and spreads elsewhere in the body is known as primary liver cancer. This is a very rare but extremely aggressive type of cancer and studies have shown that most people suffering from liver cancer are generally well over 60 years of age. Almost 3,000 cases of liver cancer in England are diagnosed every year.

Liver transplants are carried out in hospitals and healthcare clinics on an everyday basis and the procedure is an expensive one. It is recommended that you enquire about liver donors and other options regarding liver transplants at your nearest hospital in order to get the practitioner’s perspective. Your doctor will recommend a liver transplant after conducting a liver function test to identify the liver disease symptoms. Your practitioner will also educate you on some liver transplant facts, living donor liver transplantsliver transplant complications, and transplant rejection.

Liver Transplant Surgery – An Introduction To Liver Transplant Procedures

A liver transplant surgery can be a viable option for a person with a liver that has failed beyond repair. In a typical liver transplant procedure, the damaged liver is replaced by similar but non-identical liver tissue. The diseased liver is removed from its location and replaced by a part of the donor organ.

Liver transplant procedure

Liver Transplant Surgery in Progress

An Introduction to Liver Transplant Surgery

To gain a better understanding of the liver, it is essential to learn about some of the basic functions it performs:

  • Controls the levels of glucose, amino acids and fats in the blood
  • Manufactures bile which is useful in processing lipids in the small intestine
  • Neutralizes and destroys toxins and drugs
  • Stores vitamins, iron and other such important chemicals
  • Regulates hormones including sex hormones like testosterone and estrogen

Information on Liver

Here’s some more information on the liver, and the processes that it helps in:

Liver Function #1 – Production of Instant Energy

The liver’s main function is to break food down into smaller components and release energy in the process when there is a need for it. Carbohydrates are converted to glucose and stored in the muscles and in the liver as glycogen. As and when there is a need for energy, the liver simply converts the glycogen back to glucose to be used by the body.

Liver Function #2 – Removal of Waste

Not all of the body’s wastes are removed by the kidneys. Waste matter in the body which cannot be expelled by the kidneys is absorbed by the liver from the blood. The waste matter then proceeds through the bile ducts into the bowels.

Liver Function #3 – Protection Against Infections

The liver also fights infections that ravage through the body’s defense system, especially infections that are prone to arise in the bowels. The liver does this by activating a defense mechanism present in the body called the Machrophage System. This system contains ‘Kuppfer Cells’ which destroy all the bacteria that harm the body. The liver’s ability to fight off these infections is lost if there is any damage to the liver.

Why Liver Failure Occurs

Liver failure can occur owing to reasons ranging from genetic disorders and commonly known diseases to irresponsible lifestyle choices. The most common causes of liver failure include:

1. Hepatitis

This is basically an inflammation of the liver. This is brought on by both viral and non-viral modes. The non-viral causes for Hepatitis include excessive drug or alcohol use.

  • Hepatitis A:

    This is generally observed in countries with poor levels of hygiene and low standards of living. Hepatitis A infection is caused by contamination of drinking water and edibles. Vaccination is recommended in case you intend to travel or stay in such places.

  • Hepatitis B:

    Exposure to infected blood is the primary reason for the spread of Hepatitis B. The infection is generally transferred from a mother to her child. But, in certain countries, sharing of needles and sexual intercourse with affected people are the main causes for the spread of Hepatitis B.

  • Hepatitis C:

    This disorder is transmitted through the blood.

2. Alcoholic Liver Disease

There is no conclusive evidence to indicate that only heavy drinkers are affected by this. It can be a combination of different factors that may lead to it including genetics. In more serious cases, it causes alcoholic hepatitis or permanent scarring of the liver, known as Cirrhosis.

Liver Disease Statistics

Statistics show that 40% of men and 30% of women consume more than 5-6 units of alcohol each day

A liver transplant procedure is used for liver treatment in cases where the patient is suffering from acute liver failure or liver diseases which are in their final stages. Such liver transplant procedures may not be recommended for people whose livers have mild swelling, or whose livers are affected by conditions that can be cured using pharmacological interventions or drugs. Pre-liver transplant preparation will help you make an informed decision based on information about liver transplant complications and transplant rejection.

Types of Liver Transplants

There are three types of liver transplant surgeries – Living Related Liver Transplantation, Cadaveric Liver Transplantation and Auxiliary Liver Transplantation.

  • Cadaveric Liver Transplantation

In this type, the liver that is transplanted is taken from the body of a brain dead individual, once the family members of the concerned individual provide their consent.

  • Living Related Liver Transplantation

In this type, a part of the liver from a living relative is transplanted to the affected person. There are certain conditions involved in such a transplant, as only a first degree relative or spouse will be allowed to donate a liver.

  • Auxiliary Liver Transplantation

In this type of transplant, some parts of the donor’s liver will be implanted near the recipient’s native liver. In case there’s graft failure, the native liver will be able to kick in, or it can be used for development of gene therapy.

Once you’re diagnosed with a liver disease, your physician will be able to determine whether or not you require a liver transplant using a liver function test that will identify the liver disease symptoms. The type of transplant that you should undergo will also be decided based on the condition of your liver. Some liver transplant facts will also educate you on whether you should opt for it.