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    Liver Transplant

    Overview
    Causes
    Symptoms
    Treatment
    Where to Seek Treatment
    Singapore General Hospital
    Contributed by Liver Transplant Programme

    Overview

    Liver transplant is a treatment for patients diagnosed with (1) liver cancer (Hepatocellular carcinoma), (2) acute liver failure or (3) end-stage liver disease caused by conditions such as viral hepatitis, cirrhosis or liver damage from alcohol or drug abuse.

    The Singapore General Hospital’s Liver Transplant Programme was set up in 2005. Since then, more than 60 life-saving transplants have been performed.


    Causes

    Indications for a liver transplant

    1. End- stage liver disease caused by:

    • Excessive alcohol intake – too much toxins in the liver causes inflammation
    • Viral hepatitis – chronic infection leads to repeated inflammation of the liver
    • Non-alcoholic steatohepatitis (NASH) – a severe form of fatty liver
    • Autoimmune conditions such as Autoimmune Hepatitis, Primary Biliary Cirrhosis and Primary Sclerosing Cholangitis
    • Metabolic conditions such as Wilson’s Disease and haemochromatosis

    2. Acute liver failure caused by drugs or viral hepatitis

    3. Liver cancer


    Symptoms

    Liver Transplant SurgeryMain functions of liver

    • Removes toxins from the blood
    • Breaks down proteins, sugar and fats
    • Stores nutrients absorbed from intestines

    Unless the liver damage is fairly severe or advanced, diseases of the liver are often “silent” and patients may not be aware of any problems. The signs and symptoms of liver disease are related to the various liver functions.

    Different liver diseases may affect some functions more than others, resulting in variability between patients.

    • The impaired processing of nutrients results in wasting of tissues, particularly muscle.
    • Impairment of the liver’s ability to secrete bile causes accumulation of its constituents including bilirubin pigment, responsible for the yellow discoloration of skin and urine (jaundice), and bile acids which may be responsible for the itch suffered by some patients.
    • The decreased absorption of Vitamin K and inadequate production of clotting factors cause easy bruising and bleeding, initially from the gums.
    • Massive bleeding from the gut is usually due to blood from the gut being diverted away from the liver, to the esophagus and stomach.
    • The decreased production of important proteins by the liver contributes to the accumulation of fluid in the abdomen, legs and lungs.
    • The failure of the liver to deal adequately with poisons produced in the gut can cause drowsiness, forgetfulness, lack of concentration, confusion and coma.
    • The liver is also much slower at dealing with alcohol and drugs, causing increasing sensitivity to these substances.
    • Inadequate removal of micro-organisms or “germs” from the blood coming from the gut partly explains the increased incidence of serious infections in patients with liver disease.

    Treatment

    If your liver disease is progressive and liver transplantation may be the appropriate treatment, you will be referred to the liver transplant co-ordinator. Arrangements will be made for you to meet the liver specialist (hepatologist) for an assessment. A variety of tests will be carried out to confirm the diagnosis, assess the extent of your disease and gauge your suitability for liver transplantation. The assessment period may take up to 3-5 days in hospital.

    If you’re suitable to receive a transplant, your liver transplant team will discuss the best option with you. One option is to undergo a deceased donor liver transplant. If this is the right choice for you and you are medically suitable, you’ll be added to the waiting list. As soon as a suitable donor is identified, you’ll be admitted to hospital to undergo transplant surgery.

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