What is a liver failure?
When the liver is irreversibly damaged and loses its ability to carry out its normal functions, it is called liver failure.
Acute Liver failure, wherein the liver fails to work all of a sudden, is usually caused as an after-effect of certain medication or infection.
Chronic liver failure or complete damage of the liver is a life threatening condition that sets in gradually, over many years. The causes can be cirrhosis or cancer of the liver.
What causes chronic liver failure?
Liver cirrhosis is a slowly progressing disease in which scar tissue replaces healthy liver tissue, causing permanent and irreparable damage to the liver.
The reasons for liver cirrhosis can be:
- Hepatitis B or C infection
- Alcoholic liver diseases
- Non-alcoholic fatty liver disease (fat build-up in the liver cells)
- Genetic and auto immune disorders
- Congenital birth defects
According to the National Institute of Health, liver cirrhosis is the 12th leading cause of death by disease in India.
What are alcoholic liver diseases?
Alcohol is a toxin that can cause irreversible damage to your liver. Every time you drink, your liver does its best to break down the alcohol and expel the toxins from your body. However, if the alcohol content is beyond what the liver can handle, it will gradually start losing its ability to function, which in turn leads to several complications.
What are the different types of alcohol-related liver diseases?
The three major liver diseases induced by alcohol are alcoholic fatty liver disease, alcoholic hepatitis and alcoholic cirrhosis.
Alcoholic Fatty Liver
Excess alcohol consumption leads to accumulation of extra fat in your liver.
The first stage of alcohol-related liver disease, this condition usually goes unnoticed as there might be no symptoms at all. However, some patients do present symptoms like unexplained fatigue and weakness. The fat accumulation in the liver will mostly go away by itself if you stop drinking alcohol at this stage. Those who are overweight and have diabetes will need to be extremely careful, for the risk of permanent liver damage is way higher in them.
This is a condition that causes the liver to swell, in turn damaging it. The symptoms of alcoholic hepatitis include loss of appetite, vomiting, abdominal pain, fever, and jaundice. It is estimated that one out of every three heavy drinkers develops alcoholic hepatitis. Alcoholic hepatitis can either be mild or severe. Mild liver damage can be reversed; all you need is to quit drinking. However, if one continues to consume alcohol despite having mild alcoholic hepatitis, the liver will slowly start becoming dysfunctional. According to reports, more than 50% of patients with severe alcoholic hepatitis do not survive.
Alcoholic cirrhosis is permanent scarring of the liver caused due to excessive alcohol consumption. A life-threatening condition and the most serious alcohol-related disease, the liver fails to function normally as healthy liver tissue gets replaced with scar tissue. The damage caused to the liver is usually irreversible.
Though stopping alcohol consumption may help prevent further damage, related complications are not curable.
In addition to the symptoms of alcoholic hepatitis the patient may develop severe bouts of jaundice, vomit blood, suffer from fluid accumulation in the abdomen and feet, get mentally disoriented or worse, slip into a coma.
Estimates say that almost 20% of heavy drinkers develop liver cirrhosis.
How do alcohol-related liver diseases progress?
Heavy drinkers usually progress from fatty liver to alcoholic hepatitis to alcoholic cirrhosis over time. However, one may develop alcoholic cirrhosis without getting alcoholic hepatitis first. Besides, obesity, diabetes, and chronic Hepatitis C infection increase the chance of liver diseases substantially.
What are the complications that arise from alcohol-related
The complications of liver diseases start showing very slowly, over many years. Symptoms usually aggravate with time and become life threatening. The patient may suffer from
- Build-up of fluid in the abdomen (ascites) and legs (edema)
- Vomiting blood due to rupture of veins in the food pipe or stomach
- Deliriousness or confusion (Hepatic Encephalopathy)
- Kidney failure
- Liver cancer
How is alcohol-related liver disease diagnosed?
Your doctor can diagnose whether you have any alcohol-related disease based on your medical history, physical examination, blood tests and radiological investigations such as Ultrasound or CT scan.
If required, you may need to undergo a liver biopsy. This will help your doctor to understand the extent of damage caused to your liver. During the biopsy, a small portion of the liver tissue will be removed with the help of a needle and tested in the laboratory.
Remember, it is possible that a patient can suffer from multiple liver problems like Hepatitis B and Hepatitis C infection at the same time.
When does one need a liver transplant?
If the liver gets irreparably damaged and cannot be managed medically anymore, your doctor might recommend a liver transplant, depending on your health condition.
How is a patient chosen and enlisted for a liver transplant?
The first thing we do is to assess the patient as a team to determine whether transplant is the best way forward.
Secondly, his or her medical fitness for the transplant is assessed. Our team comprises hepato pancreato biliary/ multi organ transplant surgeons, hepatologists, transplant anesthesiologists, liver anesthesiologists, Intensivists, critical care experts, diagnostic radiologists, interventional radiologists, infectious diseases/ infection control physicians, psychiatrists and clinical psychologists supported by transplant coordinators, substance dependency experts to help those with a history of alcohol/drug use and social workers.
All medical records are reviewed carefully, and a comprehensive pre-transplant diagnostic and pathological investigations are done to understand the extent of liver damage, ascertain blood, heart and lung health and check for any other major infections or diseases.
If everything is acceptable, then we register the patient for a liver transplant, according to blood type, body size, medical condition and a priority score based on three simple blood tests known as MELD (model of end-stage liver disease) in adults and PELD (pediatric end-stage liver disease) in children.
Patients with the highest scores are transplanted first.
What is liver transplant?
Liver transplant put simply, is the process of replacing the diseased liver with a donated, healthy liver an extremely advanced procedure, it banks heavily on the expertise and experience of the transplant team and of course, high-end medical technology, transplant team and high-end medical technology. There are two types of liver transplant: living donor transplant and cadaveric donor (deceased donor) transplant.
When a healthy person donates part of his or her liver for transplantation, it is called living donor transplant. Living donor liver transplant has its advantages. If someone, preferably a family member is willing to donate part of their liver and the blood type matches, there is no need to wait.
The liver regenerates itself and will grow to its normal size in both the donor and the recipient in 6-8 weeks.
In case there is no live donor available, then one has to wait for cadaveric organ transplant (the liver of a donor who is brain-dead). In some cases, one donor liver can be transplanted into two people. This is called Split Liver Transplantation.
Worldwide, the success rate of a liver transplant- both live and cadaveric – is quite high.
Patients undergoing liver transplantation can expect a success rate of over 90%. We also perform pancreas transplant, which in most cases, is carried out simultaneously with a kidney transplant.
What are the possible post-surgery complications?
Like every advanced surgery, liver transplant too can have possible complications in some cases.
Your body’s immune system is programmed to destroy foreign substances that invade your body. This means your immune system may attempt to attack your new liver. This is called rejection and is seen in more 30% liver-transplant patients within the first year of transplant.
The doctors will give you anti-rejection medications to counter the immune attack.
How is it going to be after the surgery?
Post-surgery, you will need to stay in the hospital for 2 to 3 weeks, so that we ensure you recover well. However, it is different for different people, as some might need more time to recover from post-surgery complications.
Our doctors will always take time out to listen to you and to take good care of you, supported by our award winning team of CLS/BLS/ATLS/PALS certified nurses.
In order to ensure your smooth recovery even after you get back home, our nurses and transplant coordinator will prepare well in advance prior to discharge.
What you should do and what not will be explained to you in detail, along with your new medications that will help you overcome possible post-surgery complications. You will need to take these medications all your life.
Our medical team will also tell you how to keep a watch on signs of rejection and infection and when you should seek immediate medical help.
It is very important to follow-up as advised after the surgery. You should do every single health check-up as prescribed without fail. You will become a participant in your own healthcare, and we will do everything possible to ensure you remain safe and healthy.