By Ana Theresa Williams,BSN,RN
In the recent years, more people have become aware that liver transplant can prolong life significantly, even in the case of liver cancer. Thus, there has been an increasing demand for liver transplantation.
Stephen Chang Kin Yong,MD, medical director of Liver Transplant Program at Mount Elizabeth Hospital in Singapore, said there has been exponential rise in the number of patients undergoing living donor liver transplant (LDLT) with improved surgical techniques and better understanding of the liver regenerative process.
Dr. Chang was the invited speaker during the CME update for medical doctors last Friday at San Pedro Hospital Medical Arts Building.
The liver has great regenerative ability. Both the donor and recipient’s liver portion will grow to its full functionality within just a few months given adequate nutrition, he said.
“Since the remaining liver will be able to regenerate to its original volume within a few months after the liver donation, there should not be any consequences to the donor’s liver function or health after the donation,” Dr. Chang said.
After a transplant, the medical expert said the recipient will need to take lifelong immunosuppressants to avoid their body from rejecting the transplanted liver. Other than that, the recipient is expected to have a normal life after the transplant. Most transplant recipients return to productive and fruitful lives after their transplant.
On the other hand, the donor need not be on any long-term medication after the transplant. They will be followed up with to ensure that they are well. The frequency of the follow-up will subsequently decrease to only once a year.
Dr. Chang said a donor should not donate again after they have already donated their liver once. Their example of sacrificial kindness as a previous donor will be an encouragement to future potential donors.
Liver transplant is increasingly being recognized as the best treatment for many disease arising in the liver, as well as for some diseases that affect the whole body. Some common conditions for which a liver transplant is recommended include various cancers, various causes of cirrhosis or liver hardening and loss of function like Hepatitis B or Hepatitis C, biliary diseases and primary metabolic diseases.
A living donor liver transplant involves the removal of part of the liver from a healthy donor with a good liver and transplanting it to a recipient who is often a relative. The recipient’s diseased liver will have to be removed from them before the donor’s liver graft can be implanted. Both the donor and recipient operations will be conducted simultaneously.
In Singapore, Dr. Chang said the outcome of every LDLT is reported to the Ministry of Health and the results are strictly monitored. The safety of the donor is of foremost importance, he said.
If there is any doubt that the remnant liver may not be sufficient for the donor, the candidate will automatically be excluded from being a donor, Dr. Chang noted.
The criteria for donor selection is very strict. Before selecting the donor, a panel of blood tests and liver scans will be done to assess the candidate’s overall fitness for the surgery and the suitability of the liver for donation. The donor’s liver will be assessed for its function and quality. The estimated volume of remaining liver will then be computed to ensure that it be enough for the donor’s own health. Finally, the anatomy of the liver or the structural pattern of the blood vessels and bile ducts within the liver will be analyzed by the transplant team to ensure that the surgery will benefit the patient as well as be safe for the donor. A psychiatry assessment will also be required.
When the quality and function of the liver are normal, the remaining liver will be able to regenerate to its original volume within a few months after the liver donation. As the donor’s liver has the ability to regenerate itself, there should not be any consequences to the donor’s liver function or health after the donation.
At Mount Elizabeth, Dr. Chang said the risk of a liver transplant is minimal to both the donor and the recipient. An extensive donor evaluation process is done to minimize risk and ensure the safety of both the patient and the donor. Before the liver transplant, the recipient and donor will be assessed by the transplant team to confirm their suitability to undergo a liver transplant surgery. For foreigners, blood and other imaging tests will be repeated in Singapore to confirm the disease condition, he said.