Introduction
Liver Transplantation is one of the most complex surgeries in the world. There are many myths and misconceptions among patients and doctors alike regarding liver transplantation. Let us discuss these myths and see if they match with the facts.
Myth #1: Liver Transplantation is the last stage, desperate treatment for liver cirrhosis when all medicines have failed!
Fact: Liver Transplantation is the only curative option for decompensated liver cirrhosis and must be timely opted for, when indicated, to get optimal outcomes.
Liver cirrhosis is an irreversible, progressively deteriorating condition of the liver, where liver is permanently scarred. Unfortunately, medical treatment cannot reverse the condition. Over the time, the function of liver deteriorates with progressive scarring, and it affects other organs and systems of the body and the general health of the patient. There are definitive indications for liver transplant in liver cirrhosis. Once, any of these indications is met, one should go for a timely transplant, before the general health deteriorates further, to get optimal results of the transplant.
Indications of liver transplantation in liver cirrhosis:
- Refractory ascites (Repeated accumulation of fluid in abdomen, which does not respond to medicines)
- Recurrent episodes of hepatic encephalopathy (episodes of altered sensorium due to increased ammonia levels in blood)
- A single episode of spontaneous bacterial peritonitis (infection in fluid in abdomen)
- Hepatorenal syndrome (derangement of kidney function because of liver disease)
- Acute on chronic liver failure (life-threatening rapid deterioration of liver function with impact on functions of other organ systems)
- Development of liver cancer (HCC-hepatocellular carcinoma)
- Poor quality of life because of repeated hospital admissions, repeated fluid tapping, repeated endoscopies, repeated blood transfusions, generalized weakness, reduced food intake and overall poor nutrition
Myth #2: Most patients are not able to survive liver transplant!
Fact: The overall success rate of liver transplantation is 90-95%.
There have been major improvements in health care due to newer innovations in medical technology. Liver transplantation is considered a safe surgery today. The overall success rate of transplant is 90-95%. This is better than 100% risk to life in patients who do not go for transplant, despite indicated.
Myth #3: Even patients who survive the surgery, do not survive long after the transplant!
Fact: Liver Transplantation provides the best long-term survival among all the treatment modalities available for liver cirrhosis.
Liver does not have a shelf life. A transplanted liver works well for rest of the life. The estimated 1-year survival is 85-90% and 5-year survival after transplant is more than 70%. This data includes transplant done for sick patients and patients with liver cancer.
Myth #4: Quality of life after liver transplantation is poor with lot of restrictions!
Fact: One can live a normal quality life after liver transplantation.
There are no major restrictions after transplantation, barring initial post-operative period. 3-6 months after the surgery, patients can start their job. They can go to gym and take part in regular sports activities. They can marry, have sexual relation, and can have children. Female patients can get pregnant and give birth to healthy children. They can eat outside, at a hygienic place. Patients are supposed to take their immunosuppressive medications regularly (which is generally single drug) and get a set of tests done every 3-6 months, as advised by their physician.
Myth #5: Donor surgery is very risky!
Fact: Donor surgery carries minimal risk to donor.
Liver has a remarkable capacity to regenerate. The donated liver regrows and achieves original size in 2-3 months. So, donor surgery is considerably safe. There is a minimal risk of 0.2-0.5% to life in donor surgery. There are no long-term medications after surgery. The donor can go to gym and take part in regular sports after 2 months of the surgery. They can marry, have sexual relations, get pregnant, and bear children. There are no long-term dietary or physical restrictions on the donor.
Myth #6: Cadaver liver transplant is better than living donor liver transplant as the patient gets the whole liver!
Fact: There is no difference in early and long-term outcomes after living donor liver transplantation, when compared with cadaver liver transplantation.
The studies, comparing living donor liver transplantation with cadaver liver transplantation have found no significant differences in the early and late outcomes after liver transplantation. Both have their own advantages and disadvantages. There is a waiting period, involved in cadaver liver transplantation, which is quite unpredictable. There is no such waiting period in living donor liver transplantation. The organ quality of cadaver liver is not as predictable as living donor transplantation. On the other hand, living donor transplantation requires a donor from the family, which is not possible in all cases. Although minimal, there is a definitive risk to the donor in living donor transplantation.
Myth #7: Liver Transplant surgery is very costly!
Fact: The cost of liver transplantation has come down remarkably, and with support from various government and non-government organizations, liver transplantation is affordable today.
With the technological innovations and more centers doing liver transplants, the cost of liver transplant has come down remarkably. Most centers are offering liver transplants at an affordable cost. Also, if one compares the long-term cost of medical treatment of liver cirrhosis patient with cirrhosis-related complications, liver transplantation is less costly. A few Government and trust-based hospitals have also started transplant services, making it affordable to extremely poor patients. Besides, there are multiple charitable organizations and crowd-funding platforms, which are helping the poor and needy patients with arrangement of finances for the surgery. The state and central governments also provide help through resources like Chief Minister’s Relief Fund and Prime Minister’s Relief Funds to poor and needy patients.
