Liver transplant

The liver is a vital organ that carries out essential functions such as detoxifying the blood, producing proteins and storing energy. When it stops working properly due to severe disease, liver transplant becomes the only viable therapeutic option for restoring the patient’s health.

Who is it aimed at?

Liver transplant is indicated for patients with clear signs of deteriorating liver function, certain liver tumours and certain metabolic diseases.
Symptoms suggestive of liver failure include:

• Jaundice: yellowing of the skin and eyes caused by the build-up of bilirubin.
• Ascites: build-up of fluid in the abdomen, which can cause swelling and difficulty breathing.
• Hepatic encephalopathy: cognitive alterations such as disorientation, confusion and behavioural changes.
• Extreme fatigue: a persistent feeling of tiredness and weakness.
• Digestive haemorrhage: gastrointestinal bleeding caused by varices (oesophageal, gastric, rectal) due to portal hypertension.
• Intense pruritus: persistent itching due to a build-up of toxins.

The procedure is performed in patients with severe liver failure, due either to chronic liver disease, such as cirrhosis or fulminant hepatitis, or metabolic disorders. In the case of paediatric patients, the most frequent cause is biliary artresia.

How is it performed?

Prior assessment

Before being considered for a liver transplant, patients must first undergo a number of medical examinations to determine whether they are suitable candidates. This phase includes blood tests to assess liver function and detect possible infections or immunological disorders. Imaging studies such as ultrasounds, MRIs and CT scans are also carried out to examine the condition of the liver and other organs. In some cases, a liver biopsy may be required to obtain detailed information on damage to the liver. In addition, assessments by other specialities (such as cardiology, nephrology, pneumology and anaesthesia) are carried out to ensure the patient can withstand the surgery, along with consultations with specialists in nutrition, psychology and social work to assess the patient’s general preparedness.

Types of liver transplant

• Deceased donor transplant: the transplant of whole or part of a liver from a donor who has died. A donated liver can sometimes be divided into two parts to be transplanted into two patients, normally an adult and an infant (split).
• Living donor transplant: a relative or compatible person donates part of their liver.

Surgery

• Extraction and preparation of the implant: in the case of a deceased donor, the organ is extracted and prepared for transplant. In the case of a living donor, a partial hepatectomy is performed to obtain a portion of the liver from the donor.
• New liver implantation: once the diseased liver has been removed, the vascular structures (hepatic artery, portal vein and hepatic veins) and bile duct of the new liver are connected to the recipient.

After surgery, the patient is admitted to the intensive care unit (ICU) for the first few days for thorough monitoring, after which they start their recovery on the ward with regular follow-up from the medical team.

Risks

As with all types of major surgery, liver transplant involves risks such as:

• Rejection of the transplanted organ.
• Infections due to immunosuppression.
• Vascular or biliary complications.
• Need for further transplants should the transplanted organ fail.

Subsequent follow-up

After surgery, the patient requires close follow-up with:

• Immunosuppressive therapy to avoid rejection.
• Regular check-ups to analyse liver function.
• Lifestyle changes, including a balanced diet and preventative measures against infections.
• Adequate hydration to help liver function.
• Avoiding consumption of alcohol and fatty foods to reduce stress to the transplanted liver.
• Regular physical activity, adapted to the patient’s condition, to help recovery and general well-being.
• Avoiding exposure to infections through good hygiene and avoiding contact with sick people.
• Attending all medical follow-up visits to ensure that the new liver is working properly.