World Liver Day: Life after liver transplant

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Sumary of World Liver Day: Life after liver transplant:

  • Compared to other organ transplants (kidney, heart, lung, pancreas, intestine, face, hands), liver transplant has higher success rate, long term survival and needs the lowest quantum of medicines for follow up in the long run..
  • The path–resurrecting from the stage of End Stage Liver Disease (ESLD) to a new life through liver transplant with good quality of life–can be perilous, embedded with severe complications of ESLD, facing life- death situations often..
  • Those who undergo liver transplant have many queries and worries, regarding their long term health, quality of life, longevity, possible complications, social and financial concerns as well..
  • There is a popular misconception that even after transplantation life span is constricted and the quality of life may not be that great..
  • Those who have a work from home arrangement, I have seen patients going back to work, working on their laptop from the second month after transplant..
  • The chance of a person living after transplant in the first year is 90 per cent, five years it is 85 per cent and 10 years it is somewhere between 60 to 75 per cent..
  • Let not these statistical figures misguide into thinking that due to liver transplantation the lifespan has come down..
  • In fact, a patient age at the time of transplant, the diseases which the patient had other than liver disease at the time of transplant are the additional factors other than success of transplant surgery which determine lifespan after liver transplantation..
  • At this age, all other diseases which can happen in a person who has not undergone transplant would happen in the transplanted patient as well..
  • 30 to 40 per cent liver transplantation is done for a disease condition called Non Alcoholic Fatty Liver Disease (NAFLD)..
  • So, those who develop liver cirrhosis due to NAFLD and undergo liver transplant, obviously their diabetes, BP and cholesterol levels have to be controlled in a stringent manner..
  • If there are no major surgical complications after transplant surgery, generally the new liver would survive throughout the lifespan of an adult who underwent liver transplant at 50-60 years..
  • This is the background of why it is said everything depends on a very systematic and scientific follow-up under a trained liver transplant physician who would monitor health of the grafted liver as well as health of other organ systems..
  • There is another way of emailing blood tests to the transplant units and continuing medicines, which is a wrong follow up choice to make..
  • Infection control measures – During Covid times measures for Transplanted patients are similar to what we observe– maintaining hygiene of food and water, wearing an N 95 mask..
  • Obesity and its associated conditions like BP, cholesterol and diabetes (collectively known as METABOLIC SYNDROME) are the basic reason behind shortened lifespan after liver transplantation..
  • Thus, maintaining ideal body weight by following a healthy diet and regular aerobic exercise go a long way in ensuring long term lifespan post liver transplant..
  • Two or three decades back when liver transplantation was initiated in India, transplant surgeons were learning this new technology and historically if you look back, the success rate was low, death rate was high and complication rates were much more..
  • Since the learning curve has been crossed by many transplant centres, death rate/surgical failure has come down tremendously..
  • Moreover, instead of liver transplant surgeon, handling the entire clinical activity, conjoint effort by liver surgical team along with liver medical team and Liver critical care team have certainly contributed to the high success rate and long-term outcomes in best of centres..
  • 10 or 20 years back, transplant surgeons had no other choice but to do the entire medical and surgical activity on their own..
  • Now, like in the western world we have various subsections or clinical specialities handling liver transplant patient..
  • It is, however, reassuring to note that chances of rejection in liver transplant are very less compared to other organ transplants..
  • They are administered only in the initial months after transplant, beyond which lifestyle measures to control infection control are indicated..
  • When the new liver is attached to the patient body, various tubes are joined and complications are possible at these joining sites..
  • If blood supply to the new liver is compromised, this can lead onto a serious condition called Hepatic Artery Thrombosis (HAT) which mostly occurs in the initial days and weeks after transplant..
  • Blood vessels like portal vein and Hepatic vein also may get damaged very rarely -blood clot can form inside these vessels, rarely narrowing can occur at the joining sites..
  • Many a time the complications listed above need not give any difficulties or symptoms to the patient and hence regular blood tests as well as scanning are needed to identify this..
  • The policy of giving paracetamol for a few days and then attending a hospital if that doesn’t work is a wrong decision when it comes to a transplanted patient..
  • The immune system is weak due to anti rejection medicines and a transplanted patient body may not handle fever or infection efficiently on its own..
  • hence if significant generalised itching is present it has to be brought to the notice of liver transplant physician..
  • Some cells in our body undergo stealthy changes called mutations and if these mutated cells are allowed to grow, they evolve into cancer..
  • Because of anti-rejection medications given after liver transplant, the mutated cells get inefficiently tackled by the immune system and certain cancers can occur because of this..
  • Since anti-rejection medication dose is much less in liver transplant as compared to other organ transplant, the chance of cancer incidence is also fortunately quite low..
  • After many years from liver transplant, it is prudent to look for any signs or symptoms of cancer and that is where the importance of performing screening tests on transplanted patients lies…

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