The liver is the heavy industry of the human body. It produces and detoxifies everything
that we need and everything that we need and do not need respectively. Therefore, when the
liver malfunctions, eventually, every system in the human body malfunctions.
There are classical symptoms that are associated with liver damage. The most classical of those
is the one by which is yellow pigmentation, yellow colour on the skin, and the sclera of
our eyes. This is called jaundice. As the degree of the liver disease progresses, the
liver which is smooth and soft in our abdomen becomes hard and the blood that needs to go
through the liver finds significant resistance. That can lead to the build up of fluid in
the abdomen which sometimes can be quite significant and accumulate litres of fluid. We call that
ascites. Or one of the most severe complications of
the chronic liver disease which is the rupture of one of these veins inside the gastrointestinal
tract most commonly a dejection of esophagus with the stomach and the development of internal
haemorrhage. Fluid can accumulate in the ankle of our feet and higher up and it is not uncommon
that patients experience alterations in their sleep pattern or their degree of their concentration,
a condition that we call hepatic encephalopathy. The extreme manifestation of this condition
is what we call hepatic coma. All patients with chronic liver disease, we
experience fatigue and weakness that we make them unable to function as normal human being
with their daily duties. It depends on the etiology of the chronic
liver disease. These universal symptoms can sometimes be accompanied by symptoms related
to the cause of liver disease.
A liver biopsy is a small interventional procedure
by which we take a little piece from the liver in order to examine it under the microscope.
It is the most important often investigations that we perform to assess the nature but also
most importantly the degree of the liver damage. A liver biopsy is performed by most commonly
by a radiologist through a small cut in the patient’s tummy and the insertion of a needle
which removes a small cylinder of liver tissue for examination under the microscope.
Liver transplant is the ultimate and most effective treatment for patients with chronic
liver disease. When the patient’s chronic liver disease has progressed beyond a certain
state and beyond resolution is for that liver to be removed and replaced by a new liver.
This new liver most commonly comes from a deceased organ donor or less frequently by
a member, a close member of the family of the patient whereby we remove part of a liver
from a healthy individual to replace the diseased liver.
In every occasion, we remove all the diseased liver and we’ll replace it with a healthy
graft. This is a very complex operation which involves removal of the previous liver in
a very hostile environment which is often characterised by very thin and very large
vessels as a result of the chronic liver disease.
A patient with liver disease can maintain
his liver throughout his life following careful management and following instructions by specialist
doctor. There are however, situations where all medical treatment fails to halt the progress
of liver disease. The liver becomes progressively smaller, stiffer and harder and the patient
starts to accumulate complications of the chronic liver disease and as the months and
the years go by, the liver starts to fail to perform even the basic of its functions.
When a patient reach a point where the liver reserves have been exhausted, then we know
that we found the liver transplant his or her survival is limited to sometimes weeks
or months. This is the time that when the patient should be referred to a specialist
center to be assessed for liver transplantation.
We have to understand that liver transplantation
is a highly complex surgery. Since its inception in the early 60’s and its experimental almost
performance are through to the late 60’s and early 70’s has always been viewed as
formative operation. It has been said that perhaps liver transplantation is the most
complex operation ever invented. But we’ve come a long way. Today, liver transplants
can be performed safely in highly experienced centers by highly experienced surgeons with
results and outcomes that are considered to be exceptional.
There are however problems or there might be big problems and these are derived from
the complexity of the operation itself which involves removing a diseased liver in a very
hostile surgical environment characterised by very enlarged thin vessels as a result
of the chronic liver disease. And often, within a patient that has suffered the full spectrum
of manifestation of a chronic liver disease. Often the kidneys are not in the best of their
condition, the heart of the lungs might also be suffering from the chronic liver disease.
A patient that comes to transplantation for chronic disease is often characterised by
a condition by which phlebitis is very thin and not often clot satisfactory. All these
situations can sometimes provide significant problems during the transplant surgery.
And although one might have said that transplantation is a highly sophisticated re-plumbing, the
complications from the various joining that we do can sometime have detrimental effect.
In addition to all the above, we must never forget that we put in the patients abdomen
a foreign body which is the graft that has been retrieved from another human being. And
the complications that can arise from this affect alone can sometime affect the outcome
of the transplant surgery.