Alcoholic liver disease
Alcoholic liver disease

The liver is an organ in the right side of the abdomen. It is called the ‘chemical factory’ of the body as it produces enzymes for most of the chemical reactions occurring in the body. The liver also detoxifies the body to a certain extent and metabolizes drugs into more absorbable forms.

The liver can fail due to many reasons. Usually, the liver has the ability to regenerate, if some parts are damaged. We can survive without any problem even if 10-20% of the liver is functional. However, some conditions can do irreparable damage to the liver, resulting in cessation of liver function, known as liver failure.

Alcoholic Liver Disease (ALD) is the most common liver disorder. This includes three conditions: fatty liver, alcoholic hepatitis, and cirrhosis. These conditions damage the liver and may lead to an end-stage liver disease. The only known cure for an end-stage liver disease is a liver transplant.

Relationship between liver and alcohol

The liver metabolizes alcohol, which is considered a toxin by the liver cells. These cells convert alcohol into acetaldehyde by secreting some enzymes. Acetaldehyde is a more toxic compound and can damage not only liver but also the other organs.

Why has liver transplantation become more common in alcoholics?

The liver is vulnerable to alcohol-related damage. Heavy alcohol consumption even for a few days can lead to ‘fatty liver’, or ‘steatosis’. It is characterized by an excessive buildup of fat inside the liver cells. This condition is the earliest stage of ALD and one of the common alcohol-induced liver disorders.

Steatosis is a reversible condition once you stop drinking. For this medical condition, you may not require any liver transplantation. However, heavy alcohol consumption for a prolonged period may lead to severe and potentially fatal conditions such as alcoholic hepatitis (i.e. inflammation of the liver cells). This condition can further worsen to alcoholic cirrhosis if you don’t stop drinking. Cirrhosis is marked with the replacement of healthy liver cells by scar tissue (fibrosis) thereby costing the liver its functionality. Liver cirrhosis is the major cause of death among those diagnosed with liver disorders. Alcohol can also increase the risk of liver cancer, which can be life-threatening.

Determining eligibility for liver transplantation in alcoholics

The only treatment available for severe (end-stage) liver failure with complete loss of functionality is ‘liver transplantation’. It can improve survival rate significantly if performed in appropriately selected patients with liver failure.

Before undergoing liver transplantation, ALD patients must undergo a thorough evaluation to determine their eligibility for transplant. These evaluation tests determine any coexisting medical problems (cancer, heart damage, pancreatitis, and osteoporosis) which might influence the outcome of the procedure. This procedure also requires strict abstinence from alcohol and compliance with the medical regimen following the procedure. Regular psychiatric evaluations before undergoing liver transplantation help to identify those who may not be able to meet the eligibility criteria for the surgery.

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