Who needs a liver transplant?

Cirrhosis of the liver is a condition in which normal liver tissue is replaced by permanent scarring because of different liver diseases. If a patient is suffering from liver cirrhosis and his estimated life expectancy is less than a year or so is a candidate for a liver transplant. 

What causes cirrhosis?

Some causes of cirrhosis are:

  • long-term untreated infection with the hepatitis B or C virus.

  • Alcohol consumption over some time.

  • autoimmune liver disease.

  • accumulation of excess fat in obese people with or without diabetes.

  • hereditary liver diseases.

The most common causes of cirrhosis are – alcohol, hepatitis B and hepatitis C. Autoimmune liver diseases occur when our immune system does not recognize the liver as a part of our body and attacks it. Excess fat and uncontrolled diabetes can give rise to changes in the liver similar to alcohol leading to fat deposition and ultimately cirrhosis. Hereditary diseases are passed down from parents to children through genes and include Wilson’s disease (a disease with excess copper deposition in the liver) and hereditary haemochromatosis (excess iron deposition in the liver). Primary biliary cirrhosis is another condition that requires liver transplantation, seen mainly in females and characterized by severe itching and fatigue.

Other reasons for needing a liver transplant include:

  •  acute liver failure, most often caused by viruses (hepatitis A or E).

  • taking too much acetaminophen.

  • liver cancers are limited to liver only and not spread outside the liver.

What are the causes of cirrhosis in children?

In children, the most common disease, which need a liver transplant, is biliary atresia. In biliary atresia, the bile ducts which carry bile from the liver to gall bladder and small intestine are missing, damaged or blocked. Because of blockage bile go back to the liver and causes cirrhosis. Other diseases, which require a liver transplant in children, include Wilson’s disease, Alagille’s Syndrome, hepatitis, alpha-1-antitrypsin deficiency, and hemochromatosis.

What are the symptoms of advance cirrhosis and liver failure?

Symptoms of liver failure due to cirrhosis include:

  • blood vomiting or black stools.

  • water in the abdomen (ascites) or infection in the fluid.

  • drowsiness, forgetfulness and mental confusion.

  • spontaneous gum bleed and excessive bleeding from minor wounds.

  • jaundice.

  • decreased urine output.

When the patients of cirrhosis need a transplant?

Initially, these patients are managed with medical or endoscopic therapy but occurrence of these complications clearly indicates the need for liver transplantation. The severity of the liver disease is based on Child’s scoring (from A to C). All cirrhotic patients with Child’s grade C and most grade B patients are candidates for transplant. Cirrhotic patients who developed cancer in liver, which is confined to liver, are best managed by a liver transplant. A newly devised formula known as the MELD score.

What are the contraindications of transplant?

You may not be able to have a transplant if you have

  • cancer outside the liver.

  • serious heart or lung disease.

  • active alcohol abuse or drug abuse.

  • a severe infection.

 

Dr Shailendra Lalwani

HOD And Consultant - Liver Transplantation And Hepato-Pancreatic Biliary Surgery

Manipal Hospitals, Dwarka, Delhi

Appointment
Health Check
Home Care
Contact Us
Write to COO
Call Us