Liver Transplant Criteria: An Overview

Introduction:

In the United States in 2016, decompensated liver disease and liver cirrhosis ranked as the ninth most common cause of death in males. In terms of treating patients with acute and chronic end-stage liver diseases, liver transplantation is a life-saving intervention. It recovers normal health and lifestyle and adds fifteen years to life expectancy. When all other medical treatments for various liver illnesses have failed, liver transplantation has emerged as a safety net.

What Is Liver Transplantation?

Liver transplantation is a life-saving procedure for patients whose livers cannot function due to severe damage or disease. It is a surgical procedure that replaces a failing liver in patients with liver failure (recipient) with a healthy liver from someone recently dead or from a living person (donor). The transplanted liver in the recipient and the remaining portion of the liver in the donor can both regenerate to full size. Liver transplantation is usually performed as a last option in individuals with severe liver disease.

Who Is a Candidate for Liver Transplantation?

Liver transplantation is an option for individuals with severe liver disease where the liver fails to function and when other treatments are no longer effective. Liver failure can result from a variety of conditions. A score known as MELD (Model of End-Stage Liver Disease) helps to decide who needs a liver transplant. A high MELD score above 15 is indicative of liver transplant evaluation. The following are some of the most typical causes of liver transplantation:

• Graft Failure: A condition in which the liver transplant fails to work properly. This indicates that the recipient's new liver is not functioning well enough to sustain their life. If graft failure occurs, doctors attempt re-transplantation, but the outcome is not good.

• Chronic Hepatitis C: This viral infection can cause serious liver damage.

• Hepatitis B infection: This is also a viral infection caused by hepatitis B virus that can cause severe liver infection.

• Primary Biliary Cirrhosis (PBC): A liver condition that damages the bile ducts that pass through the liver.

• Primary Sclerosing Cholangitis (PSC): This chronic liver illness causes the bile ducts to become inflamed, scarred, and blocked both inside and outside the liver.

• Alcohol-related Liver Disease: Heavy drinking of alcohol can damage the liver and eventually lead to liver failure.

• Acute Liver Failure (ALF): This is a serious condition where the liver suddenly stops functioning normally and cannot keep up with its vital function.

• Hepatocellular Carcinoma (HCC): Thisis a primary cancer of the liver. Individuals with cirrhosis are at increased risk of developing HCC.

• Cholangiocarcinoma: Bile duct cancer.

• Nonalcoholic Steatohepatitis (NASH): This is a severe form of nonalcoholic fatty liver disease brought on by the buildup of fat in the liver.

• Wilson Disease: This is an uncommon hereditary disorder that results in an accumulation of copper in multiple organs, including the liver.

• Hereditary Hemochromatosis (HH): A genetic condition that can result in serious liver damage.

Who Is Not a Good Candidate for Liver Transplantation?

• MELD score less than 15.

• Severe heart and lung problems.

• Active AIDS and uncontrolled infection.

• Ongoing alcohol and substance abuse.

• Advanced cancer.

• Intrahepatic cholangiocarcinoma (bile duct cancer within the liver).

• Hemangiosarcoma (liver cancer).

• Severe mental health issues.

• Severe pulmonary hypertension (high blood pressure in lungs).

Relative contraindications;

• Overall, poor health.

• Old people.

• Multiple previous abdominal surgeries.

• Blood clots in the portal vein.

What Are Liver Transplant Donor Criteria?

There are two categories of liver transplant donors: living donors and deceased donors. The criteria for each type of donor are different.

For deceased donor

• Blood group compatibility with donor and recipient.

• Having a good body size between donor and recipient helps the new liver to function properly.

• Young donors are often preferred.

• The deceased donor must be brain dead, but their other organs, including the liver, must be functioning.

For living donors

• An individual must be between 18 and 60 years old and willing to donate a liver.

• Donors must be in good overall health and should have no history of liver diseases, uncontrolled high blood pressure, cancer, or infections like HIV.

• Donors should not be engaged in active substance abuse.

• Donors should have a healthy weight with a BMI of less than 32.

• Donors and recipients must have matching blood types.

• Donors must have healthy liver and kidney function.

How Is Liver Transplant Surgery Performed?

Liver transplant surgery is a complex operation lasting between six to 12 hours. General anesthesia is given to ensure the patient is unconscious throughout the procedure. Various tubes are inserted to perform specific functions while the patient remains unconscious. These include:

• An IV (intravenous) catheter is inserted into the vein in the arm or hand to deliver fluids and medications.

• An extra IV catheter is inserted in the neck or thigh vein to take blood pressure readings and collect blood samples.

• A tube connected to a mechanical ventilator is passed through the mouth and into the windpipe. This ventilator mechanically inflates the lungs to maintain breathing during surgery.

• Drainage tubes are inserted into the abdomen to drain fluid and blood from the area surrounding the liver.

• A nasogastric tube is used to drain stomach secretion. The tube is inserted through the nose and into the stomach. The major gastric tube will stay in place for a few days or until then, until then, regular bowel movements.

• A catheter is placed in the bladder to allow urine drainage.

The surgery starts with a long incision made across the abdomen to reach the liver. The surgeon will then carefully remove the current liver and clamp the bile duct and blood arteries connected to it. The patient's bile duct and blood arteries will be connected to the newly transplanted liver. The patient will be transferred to the intensive care unit once the wound has healed.

What Is the Risk of a Liver Transplant?

There is a considerable risk of serious complications with liver transplant surgery. Both the surgery itself and the medications used to keep the donor's liver from rejecting the transplant have risks.

The risk from surgery:

• Bile duct complications.

• Bleeding.

• Blood clots.

• Failure of donated liver.

• Infection.

• Rejection of organs.

The risk from anti-rejection medications:

• Bone thinning

• Diabetes.

• Diarrhea.

• Headaches.

• High blood pressure.

• High cholesterol.

Conclusion:

For patients with end-stage liver disease, liver transplantations provide a lifeline, increase their chances of survival, and improve their quality of life. However, liver transplantation needs careful consideration that the candidate must meet specific criteria, including a high MELD score, donor compatibility, and overall good health is important.