Liver Transplant

So, you’ve had the Varices and that’s been taken care of…. For the time being. You’ve gone through the Ascites, and that’s being drained off every few weeks. The Hepatic Encephalopathy is getting worse and is driving you and the family to despair. You’ve had five tumours, three of which have been burnt off using the ablation procedure. You’ve now got type 2 diabetes and you’re having to check your blood sugars four times a day, and inject yourself with insulin twice a day. If that wasn’t enough, your overall general health is going down-hill fast. Your life clock is now ticking, and those tiny grains of sand are seeping through the hourglass of your life. After all, you’ve gone through, there’s still one big problem you’ve yet to somehow overcome. For me, that one big problem was an immense feeling of unworthiness and guilt. After all, I was the one who caused all this to happen, no-one else. No one forced that drink down my throat. So, I had brought all this all upon myself, and I felt I had to suffer the consequences. Fortunately for us all there’s one final last chance. There is the possibility of a Liver Transplant. But even going down this road is full of uncertainties. Firstly, this is a gift and not a right. There are people out there in need of a transplant through no fault of their own i.e. Steatosis or Primary Sclerosing Cholangitis. The liver transplant list doesn’t discriminate, it goes on availability, match suitability and other factors, like how urgent your need is. But before any of this can start there are certain criteria and conditions that a person has to meet before they’ll be accepted on to the waiting list. The NHS has a very strict code of practice about this: https://www.nhs.uk/conditions/liver-transplant/who-can-have-it/ There is a strict assessment process that decides who can have a liver transplant, as donated livers are scarce, both in the UK and worldwide. Under UK regulations you are usually only considered a suitable candidate for a liver transplant if you meet two conditions: • Without a liver transplant, it is highly likely that your expected lifespan would be shorter than normal, or your quality of life is so poor as to be intolerable. • It's expected that you have at least a 50% chance of living at least five years after the transplant with an acceptable quality of life. Transplant centres use a scoring system to calculate the risk of a person dying if a transplant isn't performed. In the UK, the system is known as the United Kingdom Model for End-Stage Liver Disease (UKELD). This is based on the result of a series of four blood tests that create an average score. The higher you’re UKELD score and your risk of death, the higher up the waiting list you will be. Assessing your quality of life Assessing your quality of life can be a subjective process. However, the following symptoms represent a decline in quality of life that many people would find intolerable: • persistent tiredness, weakness and immobility • swelling of the abdomen, caused by a build-up of fluid (ascites), that doesn't respond to treatment • persistent and debilitating shortness of breath • damage to the liver that affects the brain (hepatic encephalopathy), leading to mental confusion, reduced levels of consciousness and, in the most serious of cases, coma • persistent itchiness of the skin Estimating survival rates The assessment of your likely survival rate is based on: • your age (some transplant centres say that 65-years of age is the cut off age) • whether you have another serious health condition, such as heart disease • how likely a donated liver would remain healthy after the transplant • your ability to cope (physically and mentally) with the effects of surgery and the side effects of immunosuppressant medication Tests will also be carried out to assess your health and your likelihood of survival. This can include examining your heart, lungs, kidneys and liver, as well as checking for any signs of liver cancer. Who can't have a liver transplant? Even if you meet the above criteria, you may not be considered for a transplant if you have a condition that could affect the chances of success. For example, it's unlikely that you will be offered a liver transplant if you have: • Severe malnutrition and muscle wasting • An infection – it would be necessary to wait for the infection to pass • AIDS (the final stage of an HIV infection) • A serious heart and/or lung condition, such as heart failure or chronic obstructive pulmonary disease (COPD) • Serious mental health or behavioural condition that means you would be unlikely to be able to follow the medical recommendations for life after a liver transplant • Advanced liver cancer – by the time cancer has spread beyond the liver into surrounding tissue, it's too late to cure the cancer with a transplant Additionally, a liver transplant will not be offered if you continue to misuse alcohol or drugs. Most transplant centres only consider a person for a transplant if they haven't had alcohol or used recreational drugs for at least six months. Types of liver transplant There are three main ways a liver transplant can be carried out: • Deceased organ donation – involves transplanting a liver that has been removed from a person who died recently. • Living donor liver transplant –a section of liver is removed from a living donor; because the liver can regenerate itself, both the transplanted section and the remaining section of the donor's liver can regrow into a normal-sized liver. • Split donation – a liver is removed from a person who died recently and is split into two pieces; each piece is transplanted into a different person, where they will grow to normal size. Most liver transplants are carried out using livers from deceased donors. Waiting for a liver There are more people in need of a liver transplant than there are donated livers, which means there is a waiting list. The average waiting time for a liver transplant is 145 days for adults and 72 days for children. While you're on the waiting list, you will need to keep yourself as healthy as possible and be prepared for the transplant centre to contact you at any moment, day or night. You should also keep the transplant centre informed about any changes in your circumstances, such as changes in your health, address or contact details. Life after a liver transplant Your symptoms should improve soon after the transplant, but most people will need to stay in the hospital for up to two weeks. (I was in for a total of nine days.) Recovering from a liver transplant can take a long time, but most people will gradually return to many of their normal activities within a few months. You'll need regular follow-up appointments to monitor your progress and you'll be given immunosuppressant medication that helps to stop your body rejecting your new liver. These usually need to be taken for life. Risks of a liver transplant The long-term outlook for a liver transplant is generally good. More than nine out of every 10 people are still alive after one year, around eight in every 10 people live for at least five years, and many people live for up to 20 years or more. However, a liver transplant is a major operation that carries a risk of some potentially serious complications. These can occur during, soon after, or several years after the procedure. Some of the main problems associated with liver transplants include: • Your body rejecting the new liver. • Bleeding (haemorrhage) • The new liver not working within the first few hours (primary non-function), requiring a new transplant to be carried out as soon as possible. • An increased risk of picking up infections. • Loss of kidney function. • Problems with blood flow to and from the liver. • An increased risk of certain types of cancer – particularly skin cancer. There is also a chance that the original condition affecting your old liver will eventually affect your new liver. I would also like to point out that some people can go on to suffer from mental health issues. These can include, “ Survivors Guilt” and PTSD. I suffered with “Survivors Guilt” for over ten months. There is sadly little or no help available out there within the local communities. A word of warning A person who ends up having alcohol-related liver disease has two battles going on. Firstly, there are the physical issues, like the damage being caused to the body, and then there’s the mental issue too. If a person requires a liver transplant due to alcohol abuse, and hasn’t consumed any alcohol for over six months, but continues to drink alcohol-free beers and wines as an alternative, then they still won’t be considered suitable for a liver transplant. On the 10th August 2022 a Channel 4 News story entitled, “Liver disease UK deaths soar by 400% since 1970” was broadcasted. Liver disease is the third leading cause of premature death in the UK. But unlike other deadly diseases – advances in diagnosis and treatment aren’t enough to stop that number rising. Dr Emmanouil Tsochatzis talks about the need for greater public awareness and political intervention on liver disease in this Channel 4 News report from London. According to the British Liver Trust, liver disease deaths in the UK have soared by 400% since 1970 with an average of 40 deaths per day. We know that liver transplantation remains a radical, expensive and risky option, while 90% of liver disease is in fact preventable. But much of that could be prevented by a healthier lifestyle.