Cirrhosis – When to think about Liver Transplantation???

Cirrhotic Liver

Signs and Symptoms of Liver Cirrhosis

Yes, I was about to write about chemoembolization and radio embolization for primary liver cancer today but I got a few patients queries that forced me to write this.

There can be various causes of liver cirrhosis- hepatitis c, alchoholic , hepatitis b ,non alcoholic fatty liver disease, Autoimmune or some times you do not know cause at all. I will try to explain details about every disease but that part later.

OK you got liver cirrhosis now what to do???

Remember once you have got liver cirrhosis there is no medical cure.

Medicines at the most delay the inevitable that is end stage liver disease and liver failure.

Only treatment for liver cirrhosis is liver transplantation.

Should every body who has got liver cirrhosis should under go transplantation immediately????

Answer is no.

Then what is the way out??

Broadly there are 3 stages of liver cirrhosis (medically it is known has child A, Child B and child c)

I will point out theses stages without going in to technical details, mostly It is summarized as below.

Child A: liver is cirrhotic but still can carry out its function reasonably well. Chances of your living for another one year are 80-90%. (You are not required to under go transplant at this stage.

Child B: Liver functions started deteriorating and liver can not function optimally now but still it has not completely failed. Chances of your living for another year are 60 -80 %. (you can take your time to think about transplant but yes you need to start thinking and in country like India where brain death donors are not available at lease list your self for transplant)

Child C: Liver has failed and is no longer able to carry out its normal functions. Chances of your living one more year are just 30%. You need liver transplant as soon as possible. (in country like India with no brain dead donors, you have to find donor from your relatives who is willing to donate and decide about live donor liver transplant. You do not have luxury to wait for brain dead organ now.

So , always ask your gastroenterologist at what stage my liver disease is. For that he will require simple liver function tests.

Usually liver transplant is required in broad terms to

1.     Increase the quantity of life.

2.     Increase the quality of life.

If you have stage 3 or child c disease that liver transplant is absolutely necessary to increase your life. You cannot survive without it.

If you have stage 2 disease but your life is miserable i.e. repeated hospital admissions due to accumulation of water inside the abdomen, repeated intestinal bleeding etc. then liver transplant is necessary to increase your quality of life.

Remember one thing Liver transplant is a major and long duration surgery and you will require immunity lowering drugs after that so for optimal success of the liver transplantation you body should be in perfect shape.

i.e. your kidneys should be ok, your heart and lung should able to with stand such a massive surgical stress.

One should always remember that aim of liver transplant is to cure the patient and not just replace diseased liver with healthy liver and then telling the patient that liver is working fine but other organ were diseased from before and we can not do anything about it.

So yes, liver transplantation done in child b gives much better success rates then child c. But still in child C also success rates are 70-80% worldwide that is far better then 30% without liver transplant.

What to select cadaver liver transplant or live donor?

 In present scenario in countries like India you do not have choice. You have to select both. Once you are advised liver transplantation you need to immediately register your self for cadaver liver transplant because cadaver liver transplant is like a lottery. You never know when you are lucky and spare your dear one from risky surgery.

Another reason for listing in cadaver liver transplant is, in India by law only relatives can donate liver, that donor should be willing, should be fit for the surgery and his/her liver should be suitable for transplantation to avoid risk to the donor and recipient.

If you are child c, chances that you will find the cadaver liver in time in India are very less so think about live donor.

Cirrhosis can be cured if you and your doctor take right decision at right time.