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Monday, July 14, 2008

About Liver Transplantation

Who Needs a Liver Transplant?

Patients with acute or chronic liver failure.

Chronic liver failure is cirrhosis due to hepatitis B or C, chronic alcohol use, some inherited disorders like Wilson's disease and Hemochromatosis, exposure to certain toxins, fatty livers etc. In some cases the cause of cirrhosis cannot be found out and these cases are referred to as cryptogenic cirrhosis. Signs of decompensation include accumulation of fluid in the abdomen, bleeding from the oesophagus or stomach, effect on the brain in the form of changes in sleep pattern, drowsiness and eventually coma, failure of the kidneys etc

Acute liver failure is often due to Hepatitis A and E, rarely due to Hepatitis B, exposure to toxins such as poisonous mushrooms and high doses of paracetamol. This can kill very fast and a liver transplant is needed as an emergency within a few days at most. Signs of a failing liver include changes in mental status in the form of drowsiness, confusion and eventually coma and abnormalities of blood clotting. Acute liver failure has a very high mortality unless liver transplantation can be done.

What are the Risks to the Donor?

Like every operation the donor hepatectomy carries a certain risk. Our priority is always to reduce the risk to the donor. There is a 10 to 15% chance of a complication that would require treatment or prolong the hospital stay (normally a week or less). The most common complication is development of some fluid around the lung. Usually this requires no treatment other than breathing exercises but occasionally it may need to be drained under ultrasound guidance. Sometimes there may be leakage of bile from the cut surface of the liver or elsewhere. Usually this too does not require anything more than keeping the abdominal drain longer than usual. Sometimes it requires ultrasound guided drainage. Rarely temporary endoscopic stenting of the bile duct is required.

Like any operation, there is a small risk of death as a consequence of the operation. All over the world the donor mortality is in the region of 0.2% (just a little higher than the risk of mortality from driving a car on the streets of Delhi). In over 150 liver transplants at Sir Ganga Ram Hospital, there have been no donor deaths.

What are the Risks (Patient)

The best centers in the world have over 90% recipient survival at one year after transplant. Results at Sir Ganga Ram Hospital also show over 90% survival. After one year the rate of complications decreases to close to that of normal people of similar age and general health and life returns to close to normal. Some precautions and some medications have to be taken lifelong.

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