Liver cancer is the condition characterized by uncontrolled growth of cells in the liver. Hepatocellular carcinoma is a common liver cancer that initiates in hepatocytes.

What Are The Types Of Liver Cancer?

Liver cancer is broadly divided into two main types:

Primary liver cancer: Primary liver cancer is cancer that starts within the liver. The most common primary liver cancer is hepatocellular carcinoma. Primary liver cancer is found in those people who are at significant risk of developing this cancer such as patients of hepatitis or cirrhosis.

Secondary liver cancer: Secondary liver cancer is cancer that spread to the liver from another organ through the bloodstream. This condition is also known as liver metastasis.

What Are The Symptoms Of Liver Cancer?

The time of occurrence of symptoms primary and secondary liver cancer varies. While symptoms of primary liver cancer are experienced at an early stage, the secondary liver cancer is not detected until a considerable part of the liver is under attack by cancerous cells. Following are some of the symptoms of liver cancer:

 

What Are The Risk Factors For Liver Cancer?

Following factors increases the risk of liver cancer:

How The Diagnosis Of Liver Cancer Is Done?

Following are some of the tests that are performed to diagnose liver cancer:

What Is The Treatment Of Liver Cancer?

The treatment of liver cancer is done according to the stage of diagnosis. More advanced stages require a more aggressive treatment strategy. Following are some of the treatment options for liver cancer:

What Is The Prognosis For Liver Cancer?

Prognosis of liver cancer depends upon the stage. If the liver cancer has spread to nearby organs, the prognosis is poor. However, with the advanced diagnostic techniques, the cancer is detected at an early stage. With the advanced treatment like liver transplant, the survival rate of the patient has been increased.

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What Is A Liver Transplant?

The liver is one of the most vital organs of the human body. Proper liver function is required to sustain a healthy life. In liver diseases, the capacity of the liver cell gets reduced. Most of the diseases can be treated by non-invasive treatment methods while some diseases require surgery. Liver transplant is the last option when all the other treatment options do not provide adequate relief from the symptoms of the patient. Liver transplant is a surgical procedure of replacing a damaged lived with a healthy liver. People whose liver fails to perform the physiological functions require a liver transplant. It is also to be noted that the liver has the capacity to regenerate itself shortly after the surgery. This unique characteristic has made the living donor liver transplant as an alternative to deceased donor liver transplantation.

Which Patients Require Liver Transplant?

Liver transplant is the last resort for the people suffering from end-stage irreversible damage to the liver. There are various causes of liver failure. These include Hepatocellular CarcinomaCirrhosis, Cryptogenic Cirrhosis, Primary Biliary Cirrhosis, Primary Sclerosing Cholangitis, Wilson’s Disease, Non-Alcoholic Steatohepatitis (NASH), Acute Liver Failure, Primary Hemochromatosis, Hepatitis B & C, Budd- Chiari Syndrome, Primary Sclerosing Cholangitis, Alcoholic Cirrhosis, and Autoimmune Hepatitis. Before transplanting the liver to such patients, comprehensive health evaluation is done.

What Are The Risks With Liver Transplant?

The risk associated with liver surgery can be divided into two parts. The first part comprises of the risk due to liver transplantation surgery itself while the other part includes the risk and side effects due to potent medications.

The risk associated with liver transplant surgery: These risks include:

 

Side effects of medications: Potent anti-rejection medications are administered to the patient to avoid the risk of rejection. These medications have side effects such as:

 

What Is A Rejection Of Liver?

Various cells in the body protect us from external pathogens and other substances. These cells are known as immune cells and form a systematic and organized immune system. These immune cells spare our body cells as they are able to identify them through a specific mechanism. However, these immune cells also identify any foreign cell and start the immune reaction in order to damage those cells.

The liver which is transplanted is a foreign organ comprising of foreign cells. The immune system of recipient initiates an immune reaction against the transplanted liver. If the liver gets damaged by the immune system, it is known as a rejection of the liver. In order to avoid this rejection, various anti-rejection medications are administered to the patient.

What Is The Success Rate Of Liver Transplant?

With the advancement of technology and new and potent anti-rejection medications, the success rate of a liver transplant is drastically improved in recent years. The survival rate of liver transplant varies from patient to patient and depends upon the other health conditions along with liver failure. Age also plays a major role in liver transplant success.

In a general sense, the immediate rate of success of liver transplant is between 90-95%. For five-year survival is around 75%. This implies that almost 75% of the patients who have undergone liver transplant are able to survive for more than 5 years.

It is also to be noted that patients getting the liver from a live donor have more chances of survival as compared to a patient who gets a liver from a deceased donor.

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Which Children Are Eligible For Liver Transplantation?

Liver transplant is advised in the children with liver failure. It is recommended in those cases where the child may not be able to sustain life without liver transplantation. The common condition in children that results in liver transplantation is biliary atresia. Biliary atresia is the condition occurring in infants that results in the blockage of bile ducts inside and outside the liver. This results in the accumulation of bile in the liver resulting in scarring and liver damage. Other diseases in children that may require liver transplantation include Wilson’s disease, Alagille’s Syndrome, hepatitis, alpha-1-antitrypsin deficiency, and hemochromatosis.

What Are The Tests Conducted Before Transplantation Process?

A comprehensive evaluation of the health of the child is done before liver transplantation. Blood tests hold primary importance in successful liver transplantation because of risk management from rejection. Following are some of the tests conducted on the child before liver transplantation:

Blood tests: Various blood tests of the child are conducted to evaluate the emergency of liver transplantation. Tests conducted include bilirubin tests, liver function tests, level of proteins such as albumin and globulin and total protein levels, and clotting time.

Imaging tests: Imaging techniques such as ultrasound is needed to analyze the health of the liver, and associated blood vessels. This helps in determining the gravity of liver failure.

Liver biopsy: Liver biopsy can be done to identify the cause of liver failure. It is also done to determine the progression of the disease. 

Tests for successful transplants: For successful liver transplantation, various other tests are done. These include Blood group tests, function tests of vital organs such as kidney, heart and lungs and test for identifying the presence of viral antibodies that may also increase the risk of rejection.

What Is The Duration Of Liver Transplant Surgery?

Liver transplantation is a complex and major surgery. A team of medical and paramedical staff conducts the liver transplant surgery in almost 8-12 hours and the child is provided enough care before and after the surgery by this team. Team of overall liver transplant care includes Transplant surgeons, Transplant nurse coordinator, anesthesiologists, cardiologists, respiratory therapist, child specialists, nephrologists and hematologists.

What Is The Risk Related To Transplant Surgery In Children?

As with adult liver transplantation, the transplantation of liver in pediatric patients also has risks. These risks include bleeding, clotting, infection, and respiratory problems. Further, there is a risk of rejection of the liver.

What Is The Recovery Process After Transplantation Surgery?

The child is shifted to ICU from operation theatre after surgery. On average, the duration of hospital stay is around 3 weeks, however, it depends upon the speed of recovery. During the recovery period, the child should be kept away from doing strenuous exercise for at least one month after surgery.

What Are The Medications Administered After Transplant Surgery?

Various medications are prescribed to the child after surgery. The important medications include anti-rejection medications such as tacrolimus, antibiotics to prevent infection, and multivitamins for a speedy recovery. In case the dose is missed, contact immediately to your doctor.

What Are The Lifestyle Changes Done In The Child After Surgery?

The child may recover within six months after surgery. The exposure to people should be limited to reduce the risk of infection. Further, a healthy diet speeds up the recovery process. Strictly adhere to the prescription and take medications on time.

What Is The Liver Transplant Success Rate In Children?

Survival depends upon the overall health of the child and underlying medical conditions. The survival rate after a liver transplant is approximately 90%.

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There are various types of liver transplant depending upon the source of the liver to be transplanted. Following are the different types of liver transplantation:

Living donor liver transplant: Living donor liver transplantation is the process in which a healthy person donates a portion of his liver for the patient whose liver is completely damaged. This type of transplantation uses the feature of liver regeneration. The remaining liver gets regenerated in the donor while the transplanted liver portion grows into a complete liver in the recipient. The liver is divided into various segments and grafting of a segment is done depending upon the requirement of the patient. Such type of liver transplant reduces waiting time, flexibility in the schedule of surgery and increase the survival rate. Research indicates that people who have a liver from a living donor have a high survival rate as compared to people who get the liver from a deceased donor.

Deceased donor liver transplant: It is the most common liver transplant process. In this type of transplantation, the liver to be transplanted comes from a deceased donor. The donor may either have cardiac death or brain death. Strict guidelines are followed to certify a patient as brain dead. Braindead patients do not have any brain function but the other organs including liver are in good condition. Sometimes the patient has low brain function and is not fulfilling the criteria of brain death, however, with the consent of the relatives, the life support system of such patients can be removed. In such a case, the death is not considered as brain death rather a cardiac death. Livers obtained from the cardiac death patients are at increased risk of organ dysfunction, biliary complications, and thrombosis of the hepatic artery.

Split liver transplantation: Split liver transplantation involves splitting the liver obtained from a deceased donor to two patients requiring liver transplantation. Split liver transplantation increases the number of cadaveric grafts.

Who Can Donate A Liver?

A healthy person can donate a liver. A comprehensive evaluation of the health of a living donor is conducted before certify him as a donor. The donor should be a good match for the patient to reduce the risk of rejection. The living donor should not have any underlying medical condition. He should avoid smoking 1-2 months before surgery to limit the complications. Other tests that are performed on the living donor are Ultrasound, X-ray and Electrocardiogram.

What Are The Risks For The Donor?

With the advancement in technology, donating a liver is safe. However, it is major surgery and like other major surgeries, it has some inherent risks. The donor may have a risk of bleeding, infection, clotting, allergic reactions and complications in nearby organs. The living donor has increased risk of hernia or bile leakage. In very rare cases, the liver stops functioning normally.

In Which Patients Liver Transplant Cannot Be Done?

Whether liver transplantation should be done in the patient is decided by the transplant surgeons. Following are some of the conditions in which living transplant is no recommended:

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Bile ducts are the tube-like structure carrying bile from the liver and gall bladder and drain it into the intestine. Bile helps in digestion of fats and helps in their absorption. It also helps in detoxification of the body. The biliary disease involves the bile ducts and gall bladder along with the disorders in other organs that manages the production and transportation of bile. The biliary disease includes various diseases such as Gallbladder Stone disease, Choledochal cyst, Biliary Cirrhosis, acute acalculus cholecystitis, biliary tract malignancies, Mirizzi syndrome, and Bile duct stone. The symptoms and treatment are different for different types of diseases.

What is The Causes Of Biliary Disease?

Following are some of the probable cause of the biliary disease:

Inflammation of bile ducts:Inflammation in the bile duct may cause biliary disease. The condition is known as cholangitis. The bacterial infection is the most common cause of cholangitis.

Complications after liver surgery: Complications after liver surgery may also lead to biliary disease. Biliary leakage is the most common complication of liver resection.

Injury or surgery of gall bladder: Abnormality in the gall bladder after injury or during surgery may lead to biliary disease. Further, hypomotility of gall bladder and bile stasis increases the risk of formation of gall stones.

Biliary stricture: Abnormal constriction of the bile duct leading to biliary disease.

Inflammation in the pancreas: Biliary diseases also include pancreatitis.

What Are The Symptoms Of Biliary Disease?

Symptoms depend upon the type of biliary disease. In some case, the symptoms are acute while in other cases, the disease gradually progresses over years before presenting symptoms. The common symptoms of biliary diseases are:

What Are The Risk Factors For Biliary Disease?

People with certain factors have an increased risk of developing biliary disease. Following are the risk factors for biliary disease:

 

How The Diagnosis Of Biliary Disease Is Done?

Diagnosis of the biliary disease is done through various techniques. The patient with symptoms of biliary disease undergoes a comprehensive physical evaluation and may be advised for the following diagnostic tests:

What Are The Treatment Of Biliary Disease?

Following are the treatment option available for biliary diseases:

Lifestyle changes: Healthy diet, a diet with low fat and weight management may help manage the symptoms of biliary diseases.

Antibiotics: Common cause of cholangitis is a bacterial infection. Antibiotics are used to curb the infection.

Hepatoportoenterostomy: When bile ducts are blocked, excess bile damages liver cells. Hepatoportoenterostomy is done to drain the bile from the liver. 

Cholecystectomy: In case of gall bladder stones, cholecystectomy is done. This procedure involves the removal of the gall bladder. 

Endoscopic retrograde cholangiopancreatography (ERCP): This technique is used for the diagnosis of stones in the gall bladder. It also helps to remove the gall stones.

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