The procedure known as a liver transplant involves removing a liver that has failed to function correctly and replacing it with a healthy liver from a donor. In the event that your liver fails for any reason—cirrhosis, hepatitis, cancer, overdose, etc.—a liver transplant may be your last chance to survive. A liver transplant is a significant, intricate procedure that needs to be carefully planned and followed up on. The causes, signs, diagnosis, course of therapy, prophylaxis, and avoidance of liver failure and liver transplantation are all covered in this article.
Liver failure can be acute (sudden) or chronic (gradual), and it can lead to life-threatening complications, such as bleeding, infection, coma, and death. Liver failure can have various causes, such as the following:
Viral hepatitis, such as hepatitis A, B, C, D, or E, which are infections that inflame and damage the liver
Alcohol abuse, which causes damage to the liver due to excessive alcohol consumption
Drug overdose, especially of acetaminophen (Tylenol), which can cause severe liver damage or death if taken in large doses
Medications, such as antibiotics, antifungal drugs, anticonvulsants, or statins, which can cause liver toxicity or allergic reactions
Herbal supplements, such as kava, comfrey, or pennyroyal, which can contain harmful substances or interact with other drugs and damage the liver
Toxins, such as mushrooms, industrial chemicals, or environmental pollutants, which can poison the liver and cause necrosis (cell death)
Autoimmune diseases, such as autoimmune hepatitis or primary biliary cholangitis, which are conditions where the immune system attacks the liver and causes inflammation and scarring
Metabolic diseases, such as Wilson’s disease, hemochromatosis, or alpha-1 antitrypsin deficiency, which are genetic disorders that affect the metabolism of copper, iron, or protein and cause accumulation of these substances in the liver
Cancer, such as liver cancer or bile duct cancer, which can grow and spread in the liver and impair its function
Shock, sepsis, or ischemia, which are conditions that cause a sudden drop in blood pressure, blood flow, or oxygen supply to the liver and result in tissue damage or death
The symptoms of liver failure may vary depending on the cause, type, and stage of the disease. Some common symptoms include:
Jaundice, which is a yellowing of the skin and eyes due to the buildup of bilirubin, a waste product of red blood cells, in the blood
Ascites, which is a swelling of the abdomen due to the accumulation of fluid in the abdominal cavity
Varices, which are enlarged veins in the esophagus or stomach that can rupture and bleed due to the increased pressure in the portal vein, which carries blood from the digestive organs to the liver
Hepatic encephalopathy, which is a mental confusion, mood changes, or coma due to the accumulation of toxins, such as ammonia, in the brain
Coagulopathy, which is a bleeding disorder due to the reduced production of clotting factors by the liver
Edema, which is a swelling of the legs and ankles due to the retention of fluid in the tissues
Pruritus, which is an itching of the skin due to the accumulation of bile salts in the skin
Fatigue, weakness, loss of appetite, nausea, vomiting, or weight loss
A patient's medical history, physical examination, blood tests, and imaging studies can all be used to detect liver failure. The patient's symptoms, risk factors, medicines, and family history will all be questioned by the doctor. Additionally, the physician will look for symptoms of liver injury including as encephalopathy, varices, ascites, or jaundice. The results of the blood tests will indicate if autoimmune antibodies or viral hepatitis are present, as well as the amounts of liver enzymes, bilirubin, albumin, clotting factors, and ammonia. The size, shape, and structure of the liver as well as any tumors, cysts, or abscesses will be visible on imaging tests like ultrasound, CT, or MRI. To confirm the diagnosis and identify the source and degree of liver damage, a liver biopsy—a technique that entails extracting a tiny sample of liver tissue and analyzing it under a microscope—may also be performed.
The treatment of liver failure depends on the cause, type, and stage of the disease, as well as the patient’s condition and preferences. The treatment options may include:
Medications, such as antibiotics, antivirals, steroids, or diuretics, to treat infections, inflammation, fluid retention, or hepatic encephalopathy
Intravenous fluids, blood transfusions, or plasma exchange, to correct dehydration, bleeding, or electrolyte imbalance
Liver dialysis, which is a machine that filters the blood and removes toxins, similar to kidney dialysis
Liver transplant, which is a surgery that replaces the damaged liver with a healthy one from a donor
Palliative care, which is a type of care that focuses on relieving the symptoms and improving the quality of life of patients with terminal illnesses
The only effective treatment for liver failure that cannot be prevented or managed with conventional therapies is a liver transplant. A liver transplant is a significant, intricate procedure that needs to be carefully planned and followed up on. Before being considered for a liver transplant, the patient must go through a comprehensive assessment. Tests for tissue type, blood type, and crossmatch compatibility with the donor liver may be part of the examination. To make sure they are psychologically and emotionally prepared for the transplant and the lifetime requirement of taking immunosuppressive drugs to avoid organ rejection, the patient must also go through a social and psychological evaluation. A strong network of relatives and friends who can assist the patient both before and after the transplant is also essential.
Depending on the severity of their illness and the availability of donor livers, the patient is put on a waiting list for a liver transplant. The duration of the patient's wait for a liver transplant might range from months to years, contingent upon the availability and demand of donor livers. A liver from a living or deceased donor may be given to the patient. An individual who has passed away and given their organs for transplantation is known as a dead donor. A living donor is someone who is willing to give the patient a portion of their liver while they are still alive. A stranger, acquaintance, or relative who is a good fit for the patient can serve as a live donor. There are a few benefits to living donor liver transplantation over liver transplantation from a deceased donor, including reduced organ rejection risk, better quality donor liver, and shorter waiting period.
The entire damaged or diseased liver will be removed during the liver transplant procedure and replaced with the donor liver. The procedure necessitates general anesthesia and might take several hours. The patient will be connected to tubes and machines that monitor their vital signs and deliver fluids and medications. Following surgery, the patient will be sent to an intensive care unit (ICU) to recuperate and be monitored for any indications of problems, including bleeding, infection, or organ rejection. Immunosuppressive drugs will also be administered to the patient in order to stop their immune system from attacking the new liver. Depending on their health and rate of recuperation, the patient may need to spend one or two weeks in the hospital. Regular blood and imaging tests will be performed on the patient to assess the health and function of the replacement liver. The transplant team will also schedule regular follow-up appointments with the patient to assess their progress and modify their medication regimen. To avoid organ rejection, the patient will require immunosuppressive medicine for the remainder of their lives.
Some cases of liver failure may be prevented or delayed by taking some preventive measures, such as the following:
Avoiding alcohol abuse or limiting the intake of alcohol to moderate amounts
Avoiding or limiting the use of medications that can harm the liver, such as acetaminophen, and following the doctor’s instructions and dosages
Avoiding or limiting the exposure to toxins that can damage the liver, such as mushrooms, chemicals, or pollutants
Getting vaccinated against viral hepatitis, especially hepatitis A and B, which are preventable with vaccines
Practicing safe sex and avoiding sharing needles or other personal items that may carry blood-borne infections, such as hepatitis B, C, or D
Eating a healthy and balanced diet that is low in fat, sugar, and salt, and high in fiber, fruits, and vegetables
Maintaining a healthy weight and exercising regularly to prevent obesity, diabetes, and nonalcoholic fatty liver disease
Seeking medical attention promptly if there are any signs or symptoms of liver disease or failure
