Why a cirrhotic liver needs to be replaced with a transplanted liver.

Often during conversations that transplant surgeons have with potential candidates for liver transplantation procedure, it can take a while to reach an understanding of exactly why the whole liver needs to be replaced. Particularly as this will involve major surgery along with waiting for a suitable liver from an organ donor. Also there are currently no other types of medical treatment which can reverse end stage liver disease once it is diagnosed.

With the liver being hidden from view under the right lower rib cage at the top of the abdomen as described in this British Liver Trust post, it can be hard for any individual with liver disease to know exactly what is going on. Plus many types of liver disease in the early stages do not usually lead to specific symptoms such as abdominal pain or the development of yellow jaundice.

So by the time the symptoms of chronic liver disease do occur there is often already a significant amount of liver scarring present, i.e. there is cirrhosis.  This means that the underlying disease process in the liver can already be well advanced. Cirrhosis affects the whole liver and the scarring process turns the liver from being a slightly soft triangular shaped organ into being a far harder, scarred organ with lots of nodules. This can be seen in the image below or via watching this video What is cirrhosis of the liver?  

 

Cirrhosis can also lead to other significant changes occurring within the abdomen which also tend not to be visible until this type of liver damage is well advanced. Changes like the accumulation of fluid lead to abdominal swelling and this is otherwise known as ascites. Increased pressure within certain veins in the abdomen cause a condition known as portal hypertension which can lead to major bleeding from the junction of the oesophagus with the stomach.  In advanced cirrhosis yellow jaundice and problems with kidney function may also occur. Further information on liver disease and cirrhosis can be obtained via the MedLine Plus WebMD or the American Liver Foundation sites.

Hence this is why in the advanced stages of many of the chronic liver diseases which lead to cirrhosis, liver transplantation is currently the only long lasting effective treatment, because the whole diseased liver must be replaced. As yet other therapies such as stem cells and bio engineered organs are nowhere close enough to being considered effective therapies for this condition.

If you are a patient receiving treatment for liver disease or a relative you should always check with your doctor that any information you source online is appropriate for your circumstances.

 

Why ‘every tablet every time’ is so important for transplant recipients

No conversation about an organ transplant surgical procedure is complete without mention being made of one other important topic. That is the absolute necessity for additional medicines to be given post transplant, otherwise known as the ‘immunosuppressive medications’. So why are these types of medicines needed? Why do transplant recipients need to understand the importance of the saying “every tablet every time”?

Well it is all about the fact that our ‘immune system’ is designed to protect us by repelling anything from entering our bodies that is not made up of our own tissue. This includes bacteria, viruses and yes vital transplanted organs. A very general overview of how our immune system works can be obtained via this YouTube video.

Hence these white blood cells (lymphocytes), and other related factors need to be kept suppressed by medications as summarised in this article via  News Medical This prevents the newly transplanted organ from being ‘rejected’.

These extra medications will commence in most cases around the time that the organ transplant surgical procedure occurs. Initially quite high dosages are usually required and as a result side effects may occur, as summarised via this article from the National Kidney Foundation 

 

In order to limit the long term consequences of all of the possible side effects from these medications, many transplant recipients will ultimately be managed on the lowest dose that is possible. Hence why taking “every tablet every time” is essential. Skipping medications can allow the immune system to be triggered, which then contributes to premature loss of the vital transplanted organ. No one wants this outcome.

General information on ‘immunosuppressive medications’ can also be obtained via web sites maintained by legitimate professional organisations for e.g. eMedicine Medscape or Up to Date

NB: Immunosuppressive medication regimens do vary markedly, as there are many factors which go into the decision making as to which medications are suitable for each recipient. Hence this is why all transplant recipients if they have any concerns over their medications, need to also seek advice from their treating doctor.