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Liver Health:

The causes of liver failure can be divided into two types in accordance with the failure type.

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, 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 own liver and cause acute liver failure.
• Genetic diseases like Wilson’s disease which affect 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, degreaser, cleaner have been found to cause liver damage.

Chronic Liver Failure Causes

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

Other conditions causing Liver Failure

Primary sclerosing cholangitis

• The bile ducts are damaged
• Mostly observed in young men

Oxalosis

• Kidney is unable to remove the calcium oxalate from your body through urination, this may lead to liver damage.

Liver adenoma

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

Alcoholic Hepatitis

• Liver inflammation from a long period of time

Inflammation (Stage 1)

This is the first stage of any liver disease. In this stage, the liver gets inflamed, tender and enlarged. The 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 will not be able to feel the inflammation. And so it’s quite difficult 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 at a tremendous rate. The scar tissues cannot process the liver function such as blood purification or metabolization. This puts an excessive strain on the healthy tissue which tries to compensate, by working at an unhealthy rate. If the 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 the cirrhosis is left treated, it leads to liver failure and the liver will cease to function. A number of complications arises 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 coloration 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 in concentrating, sleeping or performing any mental functions due to toxin build up in the brain.

End-Stage Liver Disease (ESLD or Stage 4)

This 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.

Before the procedure

Being placed on the waiting list:

To determine your place on the waiting list of 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 timely intervention is critical for survival.

Waiting for a new liver

The wait varies greatly for each liver transplant patient. Few may wait for days while some wait for months and may not receive the deceased donor liver. As the patient waits for the liver, the doctor treats the complications and tries to make the patient as comfortable as possible. Patients suffering from end-stage liver failures are frequently hospitalized. And so their MELD score is updated as the liver deteriorates further.

Staying Healthy

It is important 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 liver is found
• Always be prepared with a packed hospital bag and ensure transport arrangements to the transplant center are made in advance.

During the Procedure

During the Procedure

Once you are notified that the deceased donor 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 anesthesia 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 as well as 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 he/she 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 your 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 transplanted in your body, as well as the donor's body, regenerate rapidly to reach the normal 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 couple of day.
• 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.

Risk and complications of the procedure:

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

Risks associated with the procedure:

• Bleeding
• Blood clots may develop
• Bile ducts 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 are chances of an infection developing due to the lowered immunity. Doctors usually prescribe medication for fighting 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

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 keep in mind to provide good ventilation in the home after the person returns from the hospital. Make sure to wear a mask for at least the first 3 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, in general, should contain low salt, cholesterol, fat, and sugar. Avoid alcohol to prevent damage of the new liver. Make sure to avoid consuming any alcoholic beverages or even use of alcohol in cooking.

Other important recommendations after liver transplant are as follows:

• Eat a diet rich in vegetables and fruits.
• void fruits such as grapefruit, pomegranates or seville oranges as they may affect the immunosuppressive medications.
• Include enough fiber 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 fluids every day.

3.Exercise

To improve your overall physical health it is important to follow an appropriate exercise regimen and physical activities after the liver surgery. Consult a physiotherapist to get proper information regarding exercise to avoid any complications.

Do not lift any heavyweight which and do not 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 3 months after the surgery, such as walking, bicycling, swimming, low-impact strength training in your life after surgery. Whenever you change your exercise routine, consult your doctor to make sure you aren’t delaying your recovery and healing process.

4.Regular Checkup

It is essential that the patient follow up with the hospital regularly for doctors appointments and rehabilitation.

5.Medications

Most important for the recovery process are the medicines. Make sure that you never skip the medications at any cost. It is necessary that the patient's family also be familiarized with the medicines so that they ensure that the patient has taken up the medicine or not. Sometimes, wound care is essential as the healing process is slow in liver transplant patients.