Living donor liver transplant a viable option

Multiple liver dysfunctions, collectively known as cirrhosis, produce a permanent scarring of the liver that often goes unnoticed as symptoms don’t typically appear until the disease is in its advanced stages.

“There is a lot of reserve in the liver function,” says Dr Lee Kang Hoe, senior consultant at the Asian American Liver Centre, Singapore. “Even if 50 percent of your liver does not work you could live normally.”

The only way to early detect liver dysfunction is to do a blood test or a liver imaging study like an ultrasound or CT scan, explains Dr Lee. In the Asia Pacific region, hepatitis B is the most common chronic liver disease that leads to cirrhosis; hence those who carry the condition are encouraged to undergo frequent examinations to monitor their liver function.

“Hepatitis B carriers would need regular follow-up because they can develop cirrhosis and liver cancer, even if they don’t experience any symptoms,” says Dr Lee.

If left untreated, liver cirrhosis may lead to liver failure or liver cancer, which in turn may require a liver transplant, explains Dr Lee. “When the liver fails, the patient will die quickly because liver dialysis is still pretty inefficient and cannot replace the liver for a long time.”

Living donor liver transplant an option for patients with liver failure

The good news, however, is that the liver is a unique organ as it can regenerate itself. This allows surgeons to graft one portion of a healthy liver from a living donor into a patient who is suffering from liver failure.

“After being separated, the two lobes of the liver will grow back to the original size in both the donor and the patient,” says Dr Lee.

According to Dr Lee, the key challenge is keeping the patient in good condition until the operation takes place. Liver dysfunction carries a number of complications, like fluid accumulation in the abdomen or an increased risk of infections. Doctors have to carefully manage these complications by draining the water and administering antibiotics to keep infections at bay.

“As for any operation, the better the condition of the patient going into the operation, the better the recovery,” says Dr Lee.

If the procedure is devoid of complications, such as extensive blood loss, patients usually recover pretty smoothly due to the new functional liver. In addition, anti-rejection medication isolates transplant failure to less than one percent of all cases, shares Dr Lee.

Since these drugs weaken the immune system however, patients need to be vaccinated against multiple conditions, such as yearly flu, pneumococcal, zoster in the elderly and for those not immune to it, the hepatitis B vaccine, before they can enter the operating theatre, explains Dr Lee. “The good thing about the liver is that it is a tolerant organ that doesn’t need that much immuno-suppression.”

Dr Lee Kang Hoe is a senior consultant at the Asian American Liver Centre at Gleneagles Hospital, Singapore. In addition to liver failure and pneumonia, he also treats conditions like severe sepsis with multi-organ failure, ventilator-dependent patients and post-liver transplant care.

Gleneagles Hospital Singapore
6A Napier Road, Singapore 258500
Tel: +65 6735 5000
www.gleneagles.com.sg

Asian American Liver Centre
6A Napier Road, Gleneagles Hospital Annexe Block
#02-36A/36B/37, Singapore 258500
Tel: (+65) 6476 2088
www.aamg.co/liver