There are lot of myths about the life after liver transplant. Few common myths are:
a) Most of the patients don’t survive a liver transplant
b) The quality of life after liver transplant is very poor and a patient is not able to carry out normal activities after transplant
c) A transplanted liver does not last long
For addressing these important questions, one must understand the quality of life before liver transplant.
Life before transplant
If you have been advised a liver transplant by your physician, you are likely to be in one of the following situations:
1) Not able to live a normal life because of repeated hospital admissions, repeated ascitic tapping, repeated endoscopies, generalized weakness, reduced appetite, and reduced food intake and overall poor nutrition
2) One of the complications of liver cirrhosis like spontaneous bacterial peritonitis (SBP-significant infection in ascitic fluid), hepatorenal syndrome (deranged kidney function tests because of liver cirrhosis), recurrent hepatic encephalopathy (derangement of sensorium because of increased blood levels of ammonia), refractory ascites (ascites not controlled by medicines) or acute on chronic liver failure (ACLF-life threatening derangement of other organ systems because of liver cirrhosis)
3) Development of liver cancer (HCC-hepatocellular carcinoma), not manageable by medicines, other non-surgical interventions, or lesser surgeries like liver resections
So, as we understand from these points, liver transplant is generally advised either as life-saving measure and the quality of life of such patients before transplant is already not normal. Most of the patients who have been advised liver transplant, have a one-year survival chance of <10%.
Life after transplant
A patient is put on multi-drug immunosuppression after transplant. These medicines are tapered over a period and generally, after 1 year, only one drug (Tacrolimus) is supposed to be taken. This medicine must be taken lifelong in most cases.
Early post-transplant period
A patient needs to be in the hospital for 2-3 weeks after liver transplant in most cases. This includes an ICU stay of approximately 5-7 days. Patient is ambulated generally by 2nd- 3rd postoperative day. He/she is allowed liquids by 2nd- 3rd postoperative day and solids by 4th-5th postoperative day. The surgical stitches are removed generally by 2-3 weeks.
Follow-up visits
A patient needs to come for regular follow up visits post discharge. These visits are initially frequent (weekly). As the patient recovers from the surgery, the follow-up visits become less frequent. After 3-6 months, the visits are scheduled at 3–6-month interval which is to be followed life-long. Few blood tests are done during these follow-up visits and an abdominal ultrasound is generally advised at 6–12-month intervals.
Long-term survival and quality of life
The overall success rate of liver transplant is somewhere between 90-95%. The estimated 1-year survival is 85-90% and 5-year survival after liver transplant is more than 70%. A person can have a normal quality of life after liver transplant. He/she can resume the normal job activities, work out in a gym, and can pursue any sports activities. He/she can marry, can have normal sexual life, and have kids.
There is no shelf-life of a transplanted liver. If a person takes medicines regularly, carries out all tests regularly and follows the medical advice, he/she can live a long life with normal quality.
