The liver is one of the most crucial organs for the body's blood purification and digestive systems. It is a large organ that weighs between 1200 and 1400 g in an adult woman and 1400 to 1500 g in an adult man. It is a delicate organ protected by the rib cage.

The liver and the intestines work together to digest all the food that enters the body. The liver filters out and detoxifies the blood coming from the digestive tract. It is responsible for metabolising the food that enters the body. The liver also secretes bile, essential for the intestines, and proteins, which are important for blood clotting.

If you suffer from any liver disease for a prolonged period, it may lead to liver failure. Liver failure is when the liver (or a significant portion of it) is damaged beyond repair. It starts affecting the liver function and is a condition that requires urgent medical care. In this guide, you'll understand the warning signs, symptoms and risk factors of liver failure and learn how to prevent or treat it proactively.

Types of liver failure:

1. Acute Liver Failure

When liver function is affected within a few weeks or days, it is called acute liver failure. Patients who suffer from acute liver failure may not have exhibited any signs of liver disease in the past. The failure is abrupt and not progressive.

2. Chronic Liver Failure

This type of liver failure builds up gradually with time, and it causes the liver to stop functioning eventually. In these cases, the symptoms of liver disease are apparent and go from bad to worse without timely intervention.

Symptoms of liver Disease and liver failure

The symptoms of liver failure are pretty familiar to those of any liver disease, so it becomes difficult to diagnose liver failure in the earlier stage. A few of the symptoms are as follows:

Nausea
Loss of appetite
Fatigue
Diarrhea

And as the damage to the liver progressively increases, the symptoms become serious and they need immediate medical intervention.

Jaundice
Constant fatigue or sleepiness
Profuse bleeding in case of cuts or bruises
Swollen belly
Hepatic encephalopathy (mental confusion)

Possible Causes and Risk Factors That Lead To Liver Failure

The causes of liver failure can be divided into two types by the failure type.

1. Acute liver failure causes

Large doses of acetaminophen can damage your liver rapidly and cause liver failure.
Hepatitis A, B, and E, Epstein-Barr virus, and herpes simplex virus can cause liver damage or cirrhosis.
Consumption of certain poisonous mushrooms, such as Amanita phalloides, can damage liver cells as they contain certain toxins, which eventually lead to liver failure.
In cases such as Autoimmune hepatitis, your body attacks your liver and causes acute liver failure.
Genetic diseases like Wilson's disease, which affects the removal of copper from your body, may lead to liver damage.
Excess fats accumulated in the liver during pregnancy may cause liver damage.
An overwhelming infection like septic shock damages and stops the liver from functioning.
Budd Chiari syndrome, which causes the blood vessels in the liver to develop blockages, may lead to acute liver failure.
Toxins like carbon tetrachloride, degreasers, and cleaners have been found to cause liver damage.

2. Chronic Liver Failure Causes

The liver swells up in Hepatitis B and prevents it from functioning as it should.
Long-term Hepatitis C causes liver cirrhosis.
Excessive alcohol consumption over a long period leads to cirrhosis.
The inherited disorder Hemochromatosis makes your body accumulate iron in great quantity, which causes liver failure.

Other conditions causing Liver Failure

1. Primary sclerosing cholangitis

The bile ducts are damaged
Mostly observed in young men

2. Oxalosis

Kidney cannot remove the calcium oxalate from your body through urination; this may lead to liver damage.

3. Liver adenoma

When there are benign liver tumours
Mostly affects women from 20 to 44

4. Alcoholic Hepatitis

Liver inflammation from a prolonged period

Disease And Conditions That Cause Liver Failure

Alpha-1 antitrypsin deficiency

A genetic disorder causing liver or lung disease.

Liver cancer

People suffering from chronic Hepatitis B or C for an extended period may develop liver cancer.

Alagille syndrome

Genetic disease where people suffer due to a fewer number of bile ducts than usual in the liver. It leads to bile buildup that causes scarring and damage.

Primary Biliary Cholangitis (PBC)

Destroys smaller bile ducts
Also known as Primary biliary cirrhosis

Galactosemia

Galactose digestion problem, which eventually damages the liver.

Lysosomal acid lipase deficiency (LAL-D)

The body cannot produce enzyme-like lysosomal acid lipase, which helps break down cholesterol and fats.
The fats remain in the body, causing damage to the liver.

Liver Disease : Understanding stages and Progression

Inflammation (Stage 1)

It is the first stage of any liver disease. In this stage, the liver gets inflamed, tender and enlarged. Inflammation happens when the body is fighting off an injury or infection. But if the inflammation is prolonged, it may damage your liver permanently. In this, the person suffering from liver disease cannot feel the inflammation. And so, it's challenging to identify the disease at this stage. If the disease is diagnosed at this early stage, the doctor can successfully treat the person with medications and minimal lifestyle changes.

Fibrosis (Stage 2)

If the inflamed liver is left untreated, it starts scarring. This scar tissue replaces healthy liver tissue as it proliferates tremendously. The scar tissues cannot process liver functions such as blood purification or metabolisation. This puts an excessive strain on the healthy tissue, which tries to compensate by working at an unhealthy rate. If liver disease is diagnosed at this stage, there is still a chance of the liver healing itself over time with the right kind of treatment.

Cirrhosis (Stage 3)

Once a large portion of the healthy tissue in the liver is replaced by scar tissue, it is called cirrhosis. If cirrhosis is left untreated, it leads to liver failure, and the liver ceases to function. Several complications arise due to cirrhosis, which can cause liver cancer. In many people, liver disease only starts exhibiting symptoms at this stage.

Bleeding and bruising may occur easily
Building up of water may occur in the legs and stomach region
Yellow colouration of the skin eyes is observed (Jaundice)
Intense itching of skin might occur
Blood vessels that are blocked in the liver might burst
You may exhibit hypersensitivity to medicines
You may develop type 2 diabetes
You may develop problems concentrating, sleeping or performing any mental functions due to toxin buildup in the brain.

End-Stage Liver Disease (ESLD or Stage 4)

It is the final stage of liver disease, where other courses of treatment are impossible; at this stage, only a liver transplant surgery can save the patient. At this stage, the liver starts showing signs of decomposition. And this includes variceal bleeding, kidney impairment, hepatic encephalopathy, and lung issues.

Liver Transplant Criteria and Requirements

Choosing a liver transplant hospital

If the doctor suggests a liver transplant surgery, then you must do your research before choosing a hospital for your procedure. Since it is a significant procedure, you must ask the following questions before choosing your healthcare provider.

Number of liver transplants they perform per year.
Enquire about the survival rates of liver transplant surgeries at the hospital.
Make note of costs involved in treatment before, during and after the transplant.
Also consider the additional services the centre provides for support groups and travel arrangements as it is a major operation that may require an extended stay.
Appraise the commitment of the centre with regards to updating to the latest technology and techniques.

Patient evaluation

After choosing a hospital, the doctor will evaluate your general health to check if you are a suitable candidate for liver transplant surgery. To be eligible for the liver transplant, you should be:

Overall health must be adequate to sustain a serious surgical procedure.
Must be able to cope with a long period of post-transplant medication
Must be clear of any medical conditions that could interfere with the success of the transplant.

A few specific tests, procedures, and consultations the patient will have to undergo:

Blood and urine tests to assess liver health.
Ultrasound of the liver.
Routine general health exam to screen for liver cancer as well as to evaluate the overall health.
Counseling with a dietitian to recommend the nutritional intake before and after transplant.
Assessment of the psychological health of the patient.
Counseling for alcohol, drug, or tobacco addiction.
Financial counselling to manage the transplant cost.

Understanding The Liver Transplant Procedure

Before the procedure

Being placed on the waiting list:

To determine your place on the waiting list for a liver transplant, the doctors make use of the tests and another prognosis of the liver function. The prognosis is called a Model for End-Stage Liver Disease (MELD), or for children who are below 12 years old; it is known as Pediatric

End-Stage Liver Disease (PELD). The score range of MELD is from 6 to 40. These scores calculate the risk of death without the transplant—the more dire your chances of liver failure, the higher your score. People with a higher MELD score receive a higher priority on the waiting list. Adults having acute liver failure are placed higher on the waiting list, and timely intervention is critical for survival.

Waiting for a new liver

The wait varies significantly for each liver transplant patient. Few may wait for days, while some stay for months and may not receive the deceased donor's liver. As the patient waits for the liver, the doctor treats the complications and makes the patient as comfortable as possible. Patients suffering from end-stage liver failures are frequently hospitalised. So, their MELD score is updated as their liver deteriorates further.

Staying Healthy

It is essential to stay healthy whether your surgery is scheduled or you are still waiting for the donor. A transplant can only be performed if your body can sustain such a major medical procedure.

Points to note:

Ensure proper intake of medications as prescribed
Follows proper diet and exercise routine as prescribed
Never miss out on appointments with your doctor
Ensure that you stay active with your day-to-day routine
Make sure to update your doctors about any changes in your health
Give your correct address and your contact number so that the doctors can contact you immediately in case a donor's liver is found
Always be prepared with a packed hospital bag and ensure transport arrangements to the transplant centre are made in advance.

During the Procedure

Once you are notified that the deceased donor's liver is available, you must immediately make arrangements to visit the hospital. The surgeons make sure you're healthy for the operation and you can undergo the surgery. General anaesthesia is used for liver transplant surgery. A long incision is made across your stomach for the transplant surgery. The location and size may vary according to the patient and the surgeon's approach. The surgery may take up to 12 hours and differs from case to case based on complexity. Once the new liver is in place, the surgeon may use stitches or staples to close the incision, and later, the patient is transferred to the intensive care unit so that they may start the recovery process.

Living-donor liver transplant

In such cases, first, the donor is operated on to remove a portion of the liver for the transplant, and then the surgeons remove the diseased liver and replace it with the donated liver portion. After that, they connect the blood vessels and bile ducts to the newly transplanted liver portion. The healthy liver portion is transplanted into your body, and the donor's body regenerates rapidly to reach the average volume within a couple of months.

After the Procedure

The doctors test your liver function frequently and monitor for any symptoms of complications.
You may have to stay in the intensive care unit for a few days.
You may be asked to come in for frequent checkups
You may be prescribed medications, some of which may be life-long

You may resume normal activities after six months or more after the procedure. The time for full recovery depends on the individual complications and general health before the procedure.

Finding a Donor

Living Liver donors

A small percentage of liver transplants are done annually, employing a portion of a liver from a living donor. At first, the living-donor liver was used for children below 12 needing a liver transplant due to the non-availability of proper-sized deceased-donor organs. It has now become an important alternative explored by end-stage liver disease adults.

The determination of access to the deceased donor's liver depends on the severity of liver disease (MELD score). In the case of a living-donor liver transplant, it is done by identifying a healthy living donor who can undergo the major surgical procedure safely and the suitability of the donor organ. Close family members or friends are the most likely living liver donors of the liver transplant candidate.

Living donor transplants are said to have similar survival rates as those using livers from deceased donors. However, the probability of finding an appropriate donor is low as there are few restrictions, such as the donor's age, blood type, liver size, and health condition.

Domino liver transplant

In a domino liver transplant, the patient receives the liver from a living donor having familial amyloidosis. It is a disorder in which the protein deposits accumulate, eventually damaging the body's internal organs. The patient suffering from familial amyloidosis receives a liver transplant, and later, this liver is transplanted to another patient because the liver functions quite well. The patient may develop the symptoms of amyloidosis eventually, but it takes at least a few decades to build.

The candidates selected by the doctors for such transplants are those who are 60 or above, so they do not develop these symptoms before the end of their natural life expectancy.

Risks Associated with Liver Surgery

Risks and complications of the procedure:

Significant complications may arise in liver transplant surgery. These risks are not only related to the procedure but also associated with the drugs used to prevent the donor's liver rejection after the surgery.

Risks associated with the procedure:

Bleeding
Blood clots may develop
Bile duct leakage or shrinkage
Failure of a donated liver
Infection
Rejection of donated liver
Mental seizures or confusion

Anti-rejection medication side effects:

Anti-rejection drugs are used to suppress the immune system and prevent rejection of the liver by the body. However, there is a chance of an infection developing due to lowered immunity. Doctors usually prescribe medication to fight infections that may develop at this stage. Anti-rejection medications may cause the following side effects.

Diarrhea
Headaches
High blood pressure
Bone thinning
Diabetes
High cholesterol

Steps to Prevent Liver Diseases

1. Moderate alcohol consumption:

It is better to avoid alcohol consumption altogether for liver health. However, if you must, then it is advisable to limit it to one drink a day for women and two drinks a day for men.

2. Avoid risky behavior:

Do not abuse any illicit intravenous drugs.
Always use protection (Condoms) during intercourse with a sexual partner.
If you opt for tattoos or body piercings, maintain hygiene and safety standards.

3. Get vaccinated:

If you're at risk of contracting the hepatitis virus or have already been infected, consult your doctor about getting vaccinated with the Hepatitis A and B vaccines.

4. Proper precautions regarding aerosol sprays:

Ventilate the room and wear a mask and gloves while spraying fungicides, paints, insecticides, or other toxic chemicals.

5. Maintain a healthy weight:

Make sure to follow a healthy diet and exercise regularly, as obesity causes non-alcoholic fatty liver diseases.

Road to Recovery and Aftercare

It is essential to ensure excellent post-surgery care to prevent organ rejection or post-transplant infection in case of liver transplant surgery. Follow these guidelines after the surgery to ensure a speedy recovery.

1. Ensure hygienic surroundings

The initial step for recovery starts from one's home. The family members should remember that good ventilation should be provided in the house after the person returns from the hospital. Wear a mask for at least the first three months after the surgery, especially if you live in a crowded place. Wash your hands after meeting any strangers. Shower every day and ensure separate bed linen and toiletries for the patient.

2. Diet and Nutrition

Your diet should generally contain low salt, cholesterol, fat, and sugar. Avoid alcohol to prevent damage to the new liver. Make sure to avoid consuming any alcoholic beverages or even using alcohol in cooking.

Other vital recommendations after a liver transplant are as follows:

Eat a diet rich in vegetables and fruits.
Avoid fruits such as grapefruit, pomegranates or Seville oranges as they may affect the immunosuppressive medications.
Include enough fibre in your day-to-day diet
Choose whole-grain foods
Consume low-fat or fat-free dairy products, as it is essential to maintain optimum calcium and phosphorus levels
Meats, poultry, and fish can be consumed in moderation
Keep your body hydrated by consuming adequate water and other daily fluids

3. Exercise

Following an appropriate exercise regimen and physical activities after liver surgery can improve overall physical health. Consult a physiotherapist for proper information regarding exercise to avoid any complications.

Do not lift any heavy weights or perform any abdominal exercises until you are fully recovered from the surgery.
To enjoy a healthy and active lifestyle after surgery, you can include low-intensity exercises as early as three months after the surgery, such as walking, bicycling, swimming, and low-impact strength training in your life after surgery. Whenever you change your exercise routine, consult your doctor to ensure you aren't delaying your recovery and healing process.

4. Regular Checkup

The patient must regularly follow up with the hospital for doctor appointments and rehabilitation.

5. Medications

Medicines are the most important part of the recovery process. Make sure that you never skip the medications at any cost. The patient's family must also be familiarised with the medicines to ensure whether the patient has taken them. Sometimes, wound care is essential, as the healing process is slow in liver transplant patients.

DISEASE FAQS: ALL YOUR CONCERNS ADDRESSED

Q1. What is liver cancer?
A1. Cancer that proliferates in the cells of your liver is called liver cancer. There are three types of liver cancer, such as hepatocellular carcinoma, which happens in the hepatocyte. It is the most common type of liver cancer. The other two types, intrahepatic cholangiocarcinoma and hepatoblastoma, are very rare.

Q2. Is liver cancer curable?
A2. Liver cancer is said to be difficult to cure. The first stage is rarely diagnosed and can be treated. At the same time, the second stage is very difficult to heal as it has already metastasised at this stage. The complex network of blood vessels and bile duct in the liver makes the operation difficult.

Q3. How long does it take to recover from liver surgery?
A3. The patient may require a total of four to eight weeks to recover after the liver transplant surgery. The recovery rate differs from person to person, as does the patient's condition before the surgery.

Q4. Can you consume alcohol after a liver transplant?
A4. Generally, consumption of alcohol is strictly prohibited after the surgery esp, especially for those who have alcohol-related liver disease. You must consult with the doctor to get a detailed understanding of the contraindications and restrictions in your case.

Q5. What are the early signs of liver damage?
A5. Detect your liver problems with these early signs:

Yellowish skin and eyes (jaundice)
Abdominal pain
Swelling in the legs and ankles
Itchy skin
Dark urine colour
Pale stool colour (bloody or black stool)
Chronic fatigue
Nausea or vomiting
Loss of appetite
A tendency to bruise easily

Q6. What are the four stages of liver disease?
A6. Liven tends to damage any liver disease. There are various stages of gradual deterioration of the liver before a complete liver failure.

Stage 1: Inflammation

Liver inflammation is one of the first signs of liver disease. One of the liver's major functions is detoxifying the blood. Too many foreign substances, like toxins, cause liver inflammation.

Stage 2: Fibrosis

If not treated, inflammation causes liver scarring. The scar tissues replace the healthy liver tissues and thus reduce liver function.

Stage 3: Cirrhosis

Cirrhosis is severe scarring of the liver. At this stage, the liver loses its self-healing power. It takes 20-30 years for a liver to reach this stage. Cirrhosis can lead to several complications, including liver cancer.

Stage 4: Liver failure

Liver failure can be a chronic or acute condition where it loses all functioning ability.

Q7. How do I cleanse my liver?
A7. Limit alcohol; eat a well-balanced diet of fruits, vegetables, nuts, seeds, and whole grains; maintain a healthy body weight; exercise daily; avoid illegal drugs to keep your liver healthy. Liver Detoxification, or as you know it, liver cleanse, can't help you much if your liver is already infected. It only makes you feel better because it doesn't allow you to eat highly processed foods.

Q8. Can liver disease be cured?
A8. Among all the stages of liver disease, only the liver at its inflammation stage can be healed and cured. At the fibrosis stage, liver function can be supported by medicines and lifestyle changes, but it cannot repair and regenerate its cells. Cirrhosis is a chronic disease of the liver. There is no cure for cirrhosis, but removing the cause can slow the disease.

Q9. Where do you itch with liver disease?
A9. Pruritus or itching is one of the symptoms of chronic liver disease. As it is a symptom, it won't cure itself but can be treated with medicines. For some, it's a localised itch in a particular body part, whereas others have an all-over itch. It's most commonly associated with primary biliary cirrhosis (PBC), Primary sclerosing cholangitis (PSC), and Intrahepatic cholestasis of pregnancy.

Q10. What happens when your liver starts to fail?
A10. Liver failure is a life-threatening condition in which the liver loses all its functioning ability due to damaged tissues. There are two types of liver failure: Acute (the liver stops working within a matter of days or weeks) and Chronic (the damage builds up over time and causes the liver to stop working). At this stage, the treatment options are minimal.

Medication can reverse acute liver failure caused by an acetaminophen overdose. In the case of a virus-infected liver, only the symptoms can be treated until the virus runs its course. In such cases, the liver sometimes recovers on its own. For chronic liver failure, a liver transplant is the best treatment.