Insights on Liver Transplant: Interview with Dr. Sanjay Goja

The impact of alcohol consumption on liver health varies significantly, making it difficult to provide a definitive answer. While it's commonly understood that consistent intake of approximately 4-5 standard drinks over a prolonged period can lead to fatty liver disease, occasional binge drinking can also contribute to this condition.

A standard drink typically contains 14 grams of alcohol, though this measurement can vary. Individuals may consume alcohol over many years without developing liver issues, while others may develop complications.

There are numerous causes of liver failure. Alcohol consumption is a significant factor, alongside the rising prevalence of

1. Lifestyle-related liver diseases such as Non-Alcoholic Steatohepatitis (NASH) which is associated with obesity. 

2. Viral causes like hepatitis B, C, A, and E infections also contribute, with acute liver failure occurring in hepatitis A and E infections. 

3. Additionally, drug-induced liver damage, notably from antitubercular drugs, is common.
   

The spectrum of liver diseases in adults varies widely, encompassing a range of etiologies.

People with chronic liver disease are at high risk when they get COVID-19. Even though liver enzymes and functions can be affected by COVID-19, there isn't enough evidence to say that it alone leads to liver failure.

Yes, individuals with varying genders and ages can be affected differently by liver failure. While factors like gender and age play a role, other variables such as underlying health conditions, lifestyle choices, and genetic predispositions also influence how liver failure manifests and progresses in different individuals.

Whether a deceased donor or a living donor, organ transplants are governed by strict legalities and some ethics. The Organ Transplant Act has guidelines that must be strictly followed.

1. Donation after brain death is practised in India as well as abroad.

2. Donation after cardiac death is not legal in India.

Liver donation doesn't have long-term effects on sexuality or fertility. Liver function usually returns to normal afterwards, and there's no evidence of a lasting impact on fertility or marital life. The only concern is the risk of hernia formation around the time of surgery due to the incisional scar, but this is temporary. Beyond a few months, there are no lasting effects on family or sexual life from donation.

There's no definitive cutoff. It depends on the severity of the liver disease and the individual's likelihood of recovery.

Globally, children undergoing liver transplantation have a 95% post-survival rate, leading to excellent outcomes. Many children who receive liver transplants go on to live everyday lives and transition into adulthood successfully. 
For kids with end-stage liver disease, paediatric living donor liver transplantation (LDLT) has emerged as the gold standard. Patients' survival rates and long-term results following LDLT have greatly improved because of advancements in organ preservation immunosuppressive, surgical, and anaesthetic procedures. 
Close monitoring and meticulous follow-up are essential for maintaining these excellent results in children.

Eat small, frequent meals throughout the day and include protein with every meal. The nutritional build-up and control diet form an essential part of the journey towards liver transplant; even after the transplantation, the person can have anything on any diet. Fatty food and drinking alcohol should be avoided.

Both recipient and donor can lead a normal life after transplant. Preventive precautions should be followed, like not coming in contact with someone who already has an infection and not drinking.

Post liver transplant, the patient usually stays in the hospital for around 10-15 days; after that, for three months, he has to take absolute precautions against infection because this is a very highly susceptible time when he starts getting an infection.
It can take up to a year to fully recover, although you'll usually be able to start gradually building up your activities after a few weeks.

The liver transplant offers a lifelong organ solution. Thus, it's uncommon for individuals, including the elderly, who have undergone liver transplants to later die from liver failure. Globally, the majority, if not all, of liver transplant recipients pass away from ailments unrelated to liver complications.

To lower your chance of liver rejection, you will need to take immunosuppressive medications. Usually, two or three different medications are included. The doses of these medicines generally reduce over time, but some immunosuppressant medication will be needed for the lifetime of the liver transplant.

Following discharge from the hospital, it typically takes about three months for the patient to resume their normal lifestyle safely, minimising the risk of infection, especially in a workplace environment. Around the 3-month mark, the patient can consider working from home. 
However, returning to a physical workplace is usually recommended after six months, provided it's a clean, dust-free environment to reduce the risk of infection. 

After the transplant, individuals can resume normal activities, including exercise and gym. However, heavy weight lifting should be avoided for the first 3 to 6 months due to the risk of hernia development at the incision site. After this period, they can gradually return to regular exercise routines without concerns.

No, cirrhotic patients often experience decreased sexual desire due to hormonal changes, including elevated oestrogen levels in males. However, after surgery, this hormonal imbalance is typically reversed, leading to a return of sexual function for transplant recipients. For donors, there's no impact on sexual life.

You should never drink alcohol again if you have undergone liver transplant since it could damage your newly transplanted liver. This holds true even if alcohol was not the primary cause of your liver disease but was deemed to have had a role.

Yes, it's possible for the body to reject a transplanted liver after surgery. The liver is highly immunocompatible compared to other organs like the kidneys or lungs. While liver transplantation is less prone to rejection, it's not entirely risk-free. This happens when the immune system sees the new liver as foreign and attacks it. However doctors can usually treat rejection with medications.

For the first three months, rigorous follow-ups are necessary. It can be conducted virtually unless physical intervention is required. However, lifelong follow-up is essential, with the frequency of investigations increasing over time, typically ranging from monthly to once every three months. Regular, consistent follow-up is crucial for post-liver transplantation care.

Individuals who donate a portion of their liver can live healthy lives with the remaining liver. The liver is the body's only organ that can replace damaged or lost tissue (regenerate). After surgery, the donor's liver will rapidly grow to its natural size.

After a liver transplant, the liver starts regrowing. It gets nearly 90% of its normal size in about three weeks. Then, the regrowth slows down for the next three months. But within 90 days, the liver returns to its normal size.

A study by Wong et al. (2019) found comparable survival rates (72.2% vs 81.5%) between matched LDLT and DDLT groups. LDLT often offers advantages over DDLT, like shorter waits and potentially better long-term outcomes.