Liver transplant: Symptoms, Classification, Diagnosis & Recovery

Liver transplantation is a complex medical procedure that involves several diagnostic tests and evaluations to determine a patient's eligibility and suitability for the procedure. The specific tests and assessments may vary among healthcare institutions, but here are some common diagnostic procedures conducted before a liver transplant:

• Medical History and Physical Examination: A detailed medical history is obtained to assess the overall health of the patient.
• Liver Function Tests (LFTs): These tests assess the health of the liver and may include measurements of liver enzymes, bilirubin, and other markers.
• Blood Typing and Crossmatching: To match the donor and recipient blood types to minimize the risk of rejection.
• Abdominal Ultrasound: This helps evaluate the structure of the liver, blood vessels, and nearby organs.
• CT (Computed Tomography) Scan or MRI (Magnetic Resonance Imaging): These imaging tests provide detailed pictures of the liver, helping to assess its size, structure, and the presence of any abnormalities.
• Viral Screening: Tests for viral infections, particularly hepatitis B and C, are crucial to assess the overall health of the liver and to determine the appropriate treatment plan.
• Cancer Screening: Screening for any signs of cancer is important, as certain cancers may impact the decision to proceed with a liver transplant.
• Endoscopy: An endoscopy may be performed to assess the health of the gastrointestinal tract and to identify any issues such as varices (enlarged veins) that may need to be addressed before transplantation.

• It is very crucial to match both the liver of the donor as well as the recipient based on blood group and the size of the organ. A database is maintained to match all these aspects but the transplant team may reject a donor's liver on different grounds. For example, they may refuse to transplant the donor liver in case the patient’s condition improves by itself or if there are chances of rejection or improper functioning of the donated liver after the transplant.
• The doctor refers the patient to a transplant center where recipients are carefully assessed by a team of liver transplant surgeons. They make a note of the medical history of the patient and blood, X-ray, and physical examination results. The functionality of the kidneys, heart, and lungs is also checked.
• The surgery is scheduled as soon as a suitable donor, whether living or deceased, is identified. The patient undergoes the last set of tests and is prepared for the surgery. The liver transplant procedure is quite long and it takes around 12 hours for it to complete.
• The patient is given general anesthesia before the surgery. It is administered through a tube inserted into the windpipe. A catheter for fluid drainage and an intravenous line are also placed for the administration of medicines and other fluids.
• The liver transplant surgeon makes an incision in the upper abdomen and the injured or the diseased liver is gradually detached from the common bile ducts and the connecting blood vessels.
• The team clamps the duct and the vessels and then removes the liver. This common bile duct and the related blood vessels are now attached to the liver of the donor. The donated liver is placed in the same location as the diseased liver after the latter’s removal. Some tubes are placed near and around the newly transplanted liver to aid in the removal of fluids and blood from the abdominal region.
• Another tube may be used to drain out bile from the transplanted liver into an external pouch. This helps surgeons assess whether the transplanted liver is producing enough bile or not.
• In the case of a living donor, two different surgeries are performed. In the first surgery, a portion of the healthy liver is removed from the donor’s body. In the other surgery, the diseased liver is removed from the body of the recipient and the donor’s liver is placed in its position. The liver cells multiply further during the coming months to form the entire liver from the piece of the donor's liver.

• After completion of the surgery, the patient is taken to the anesthesia recovery room and then finally to the intensive care unit. After the condition of the patient stabilizes, the breathing tube is removed, and the patient is shifted to a normal room.
• Multiple monitoring lines are attached to the body of the patient to keep in check the stability of vital organ systems in the body. Liver transplant recovery time varies from one to eight weeks and the patient may be required to stay in the hospital during this period.
• Initially, the patient is required to visit the hospital once a month after discharge to undergo a check for transplant compatibility and other health-related issues. Later, the frequency can be decreased to once a year.