Top Common Indications for Liver Transplant

When standard medical treatments don't work for severe liver diseases, like cirrhosis, liver transplantation is considered. If patients experience serious complications such as hepatic encephalopathy or variceal haemorrhage, they receive medical care, but those for transplantation undergo an evaluation.

About 80% of liver transplants are done for advanced cirrhosis cases where the liver can't function properly. The severity of cirrhosis is often assessed using the Child-Turcotte-Pugh score. Various factors, like albumin levels and bilirubin levels, are considered. 

Common Indications of Liver Transplant in Adults

1. Acute Liver Failure: When the liver suddenly stops working, a transplant may be needed to save a person's life, as medications may not be sufficient. There is severe liver damage, which occurs rapidly, leading to hepatic encephalopathy (confusion), bleeding, and other life-threatening complications.

2. Alcoholic Liver Disease: In cases of advanced liver damage due to long-term alcohol abuse, a transplant may be the only viable option for survival.

3. Viral Hepatitis: If chronic viral infections like hepatitis B or C lead to severe liver damage or cirrhosis, a transplant may be recommended. It is when antiviral medications fail to control the progression of viral hepatitis, and liver function declines.

4. Non-alcoholic Fatty Liver: In cases where non-alcoholic fatty liver disease (NAFLD) progresses to cirrhosis and causes liver failure, a transplant may be necessary.

5. Liver Cancer: If liver cancer reaches an advanced stage or is unresponsive to other treatments, a transplant may be recommended.

Rare Indications of Liver Transplant in Adults

Polycystic Liver Disease: A liver transplant may be considered in rare cases of polycystic liver disease, where extensive cysts impair liver function and cause severe symptoms. The liver results in numerous fluid-filled sacs, leading to pain and complications.

Hereditary Hemochromatosis: It is a genetic disorder causing excessive iron buildup in the liver, leading to organ damage. When iron overload becomes severe, a transplant may be necessary to address the life-threatening consequences.

Familial Amyloid Polyneuropathy (FAP): In cases of FAP, a rare genetic disorder causing abnormal protein accumulation in the liver, transplant may be considered to halt disease progression.

Hepatic Adenomas: In rare cases of hepatic adenomas, noncancerous liver tumours can cause bleeding and other complications. A transplant may be considered if other treatments are ineffective.

Liver Transplant in Children Indications

For children needing a liver transplant, the most common reason is biliary atresia. For metabolic liver conditions, it is Wilson's disease. The indications of paediatric liver transplant are:

1. Biliary Atresia: A liver transplant may be recommended for infants with biliary atresia, a condition where bile ducts are blocked or absent, leading to liver damage. When kasai procedure to correct the bile duct is not successful, transplant becomes a critical option for children with biliary atresia.

2. Wilson's Disease: It is a rare genetic disorder causing copper buildup in the liver, leading to organ damage. When medications fail to control copper levels and prevent liver damage, a transplant becomes a potential solution for children with Wilson's disease.

3. Budd-Chiari Syndrome: In rare cases of Budd-Chiari syndrome in children, where blood flow out of the liver is obstructed, a liver transplant may be recommended to restore normal liver function. Untreated Budd-Chiari syndrome may result in liver failure, potentially causing death within a span of 3 months to 3 years after diagnosis.

4. Crigler-Najar Syndrome: For children with Crigler-Najar syndrome, a rare genetic disorder causing severe jaundice. It is due to a lack of an enzyme. When conventional treatments are insufficient to manage the excessive bilirubin levels causing jaundice, a transplant becomes a life-changing option for pediatric patients.

5. Glycogen Storage Disease (GSD):  A rare genetic disorder affecting the storage of glycogen in the liver, leading to organ dysfunction. It results in liver enlargement and impaired function. A liver transplant may be considered for children with glycogen storage diseases for better long-term health outcomes.

Your first step is to get a referral from a liver specialist (hepatologist) who can guide you through the transplant process. This referral is crucial as it ensures that you're directed to the right experts for advice on the necessity of a transplant.

The preliminary evaluation by the transplant team includes:

1. A thorough medical history assessment to understand the overall health and the specifics of your liver condition.

2. They will then perform diagnostic tests and imaging to gather detailed information about your liver function and identify potential challenges.

3. The transplant team will have a detailed conversation with you about the potential benefits of liver transplantation, such as improved quality of life and increased life expectancy.

4. They will also discuss the associated risks, ensuring you clearly understand both the positive outcomes and potential challenges.

5. You'll receive comprehensive information about the transplant process, including what to expect before, during, and after the surgery.

6. Post-transplant care details will also be provided, ensuring you are well informed about the recovery period and the steps needed for a successful recovery.

7. It is important to seek a second opinion to confirm the necessity of a liver transplant and to explore different perspectives on your condition and potential treatment options. A second opinion helps you make an informed decision and ensures you are comfortable with the recommended action.

Click on Liver Transplant Guide to know the step-by-step procedure of transplant.

Deciding to go ahead with a liver transplant involves a thorough evaluation of the causes and stage of liver disease, complications from cirrhosis, potential obstacles, and a detailed psychosocial assessment. 

The criteria of liver transplant depends on the severity of liver disease, measured using the following: 

1. Model for End-Stage Liver Disease (MELD) Score: The MELD score is a numerical measure that assesses the severity of liver disease. It predicts the three-month mortality of individuals awaiting a transplant based on specific lab values such as creatinine, bilirubin, and INR.
   
   A higher score indicates a greater need for transplantation. Liver transplant consideration often involves monitoring the MELD score. If it reaches a critical level, indicating advanced liver disease, transplantation becomes a viable option.
   
   
2. Severity of Liver Disease and Complications: The decision for liver transplantation considers the overall severity of liver disease, including factors like cirrhosis and the presence of complications such as ascites or hepatic encephalopathy.
   
   When liver disease becomes advanced and complications affect daily life, transplantation is contemplated as a means to improve both the quality and duration of life.

While liver transplantation is a transformative option for many, certain conditions may limit its feasibility. Understanding these contraindications is crucial for individuals considering this life-changing procedure.

Absolute Contraindications

These conditions or factors completely rule out a specific medical treatment or procedure, making it too risky. These includes:

1. Active Alcohol Abuse: Ongoing alcohol abuse is an absolute contraindication, as it can jeopardize the success of the transplant and pose additional health risks. People with alcohol addiction should consider seeking psychological and psychiatric support before a liver transplant.
   This precautionary step is crucial to ensure at least six months of alcohol abstinence, mitigating the risk of relapses that might result in removal from the liver transplant waiting list.

2. Uncontrolled Systemic Infections: Severe, uncontrolled infections affecting the entire body may preclude liver transplantation due to the heightened risk of complications.

3. Uncontrolled Extrahepatic Malignancy: The presence of uncontrollable cancers outside the liver is an absolute contraindication, ensuring a focus on successful transplantation outcomes.

4. Existing Medical Conditions: Medical conditions that are uncontrolled or significantly limit overall health may be absolute contraindications. It can include conditions like impaired kidney function. This impacts the feasibility of a successful liver transplant.

Relative Contraindications

These factors may pose some concerns but don't entirely prevent the treatment. It requires careful evaluation of risks and benefits before proceeding. It includes:

1. Psychosocial Conditions: Certain psychosocial conditions, such as lack of support or coping mechanisms, may be relative contraindications, requiring careful evaluation before considering transplantation.

2. Advanced Age: While not an absolute barrier, advanced age may be a relative contraindication, considering overall health and the potential impact on post-transplant outcomes.

3. Severe Hepatopulmonary or Hepatorenal Syndrome: Conditions affecting the lungs (hepatopulmonary syndrome) or kidneys (hepatorenal syndrome) may be relative contraindications, necessitating thorough assessment before transplantation.

4. Severe Obesity: Extreme obesity may be considered relative contraindications, as they can impact the success of the transplant and subsequent recovery.

For patients receiving liver transplants from deceased donors, the 1 -year survival rate is 86 per cent. The goal is to identify individuals who may benefit from a liver transplant due to the failure of medical treatments in managing their liver disease.

But, delaying a liver transplant can significantly impact the patient's quality of life, affecting their daily activities and well-being. It can be life-threatening. Untreated liver conditions can have issues like:

1. Progression of Liver Disease: With time, liver diseases can progress. It potentially reduces the chances of a successful transplant, complicating the surgical process.

2. Worsening Health Condition: Delaying a liver transplant can lead to a deterioration in the patient's overall health, increasing the risk of complications.

3. Limited Donor Compatibility: Delay may result in a reduced pool of compatible donors, making it harder to find a suitable match for the transplant.

4. Impact on Transplant Success: Timely transplantation often results in better outcomes, and delays can affect the overall success rates of liver transplant surgeries.

5. Longer Recovery Period: The recovery process post-transplant may be prolonged if the surgery is delayed, potentially affecting the patient's return to normal activities and overall recovery experience.

6. Financial Strain: Extended delays may lead to increased medical expenses, as the patient may require additional treatments or interventions to manage the progressing liver disease.

In India, many people suffer from liver diseases, with 22.2 deaths per 100,000 people linked to cirrhosis, according to the World Health Organization. 

Adults in India face common causes of chronic liver disease, like alcohol-related issues and viral hepatitis. 

Additionally, the rising diabetic population, possibly due to insulin resistance, is making nonalcoholic steatohepatitis a significant concern for liver health in the country. 

We, at HexaHealth are committed to offering high-quality and budget-friendly liver transplant surgeries in India. If you have questions about the procedure, costs, possible side effects, hospital stay, financing options, or post-surgery recovery, don't hesitate to contact us.

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