Complications from hepatitis C are the front cause of liver transplantations worldwide.In this article, Dr. Gaurav Gupta, among Mumbai’s leading Liver Transplant surgeons, will discuss what people should know about liver transplants for hepatitis C. Liver transplantation is a life-saving procedure in which the diseased liver is removed and replaced with a healthy liver from a living or deceased donor. Hepatitis C virus (HCV) is a virus that causes liver inflammation. HCV infections can be acute (short-term) or chronic (long-term/lasting). Symptoms of acute hepatitis can last for up to six months.
The infection becomes chronic if the body is unable to clear the virus. According to Dr. Gaurav Gupta, a counselor, and leader of the Fortis Mulund Liver Transplant and HPB Surgery Department, more than half of all cases progress to a chronic condition, which often damages the liver and causes it to stop functioning correctly. Dr. Gaurav Gupta from Mumbai estimates that 5–25% of people with persistent HCV disease will form extensive scarring, or cirrhosis, within 10–20 years. Cirrhosis patients have a 1–4% annual risk of developing liver cancer.
HCV infections are a common reason for liver transplants, according to evidence. While antiviral drugs can usually treat HCV infections, some people may need a liver transplant. However, due to screening and antiviral therapy, the number of liver transplantations for hepatitis C-associated liver conditions decreased to 18.7% in 2019 compared to 44.5 percent in 2010.
Transplantation criteria for the liver
According to Dr. Gaurav Gupta, the head of the Fortis Mulund Liver Transplant and HPB Surgery Department, a person must meet the following criteria to receive a liver transplant:
- have irreversible liver disease that would be fatal without a transplant
- pass an extensive transplant evaluation process
- have no contraindications for the transplant surgery
Chronic HCV infection can lead to chronic liver disease and liver cancer complications, necessitating a liver transplant. Cirrhosis develops when scar tissue gradually replaces healthy liver tissue. This prevents the liver from performing its normal functions.
According to Dr. Gaurav Gupta, HCV is responsible for about half of all liver cancers. According to evidence, HCV causes roughly 700,000 deaths per year due to cirrhosis or liver cancer.
Liver transplant contraindications
Hepatitis C patients must be in good enough health to undergo liver transplant surgery. If you have any of the following contraindications, you are not eligible for a liver transplant:
- severe heart and lung disorders, such as chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF)
- cancer that has spread outside the liver
- cancer in the bile ducts
- the persistent refusal of medical care
- uncontrolled sepsis
- acquired immune deficiency syndrome (AIDS)
- lack of help or social support
- an abnormality in internal anatomy that makes transplant impossible
Other circumstances may preclude a person from receiving a liver transplant. These conditions may be taken into account by transplant centers on a case-by-case basis. Here are some examples:
- a person with a human immunodeficiency virus (HIV) infection
- individuals ages 65 years and over
- a person with class 3 obesity, which refers to a body mass index (BMI) higher than 40
Evaluation of a transplant
Each person is put through a battery of tests to see if they are healthy enough for the surgery and post-transplant care. The following items may be included in the evaluation:
- a careful analysis of the individual’s current liver condition to manage their diagnosis without a transplantation
- a complete history and physical exam to determine other existing medical concerns
- screening and treatment for any bacterial, viral, and fungal infection
- vaccination updates, if necessary, for pneumonia, flu, DPT, and human papillomavirus (HPV)
- bone density testing
- screenings for any liver disease complications, such as esophageal varices and hepatocellular carcinoma
- thorough heart and lung evaluations
- blood work
- cancer screenings
- anesthesia evaluation
- mental health and social support screening
- nutritional evaluation
A person will work with their healthcare team to treat any underlying conditions and ensure they receive adequate HCV infection treatment before undergoing a liver transplant to avoid any potential complications.
For example, a person with an alcohol or substance use disorder may be required to have clean time before the procedure.
A doctor may schedule surgery 4–6 weeks before receiving a living donor’s liver, according to Dr. Gaurav Gupta.
When a person is placed on the national waiting list for a deceased donor’s liver, they must be prepared to go to the transplant center for surgery as soon as a liver matches.
The diseased liver is removed and replaced with the donor’s liver during liver transplant surgery. The procedure can last up to 8 hours, but it is more likely to last 12 hours or longer. The surgeons must reconnect several structures to the new liver to ensure blood flow and allow bile to drain from the liver.
The inferior vena cava, portal vein, hepatic artery, and bile duct are among them
A person will most likely be taken to a recovery room for a few hours after surgery before being transferred to an intensive care unit (ICU).
For several days, the transplant recipient will be closely monitored by the medical team. Most transplant recipients will spend about two weeks in the hospital.
Taking care of a newly transplanted liver
After receiving a new liver, a transplant recipient requires lifelong outpatient follow-up.
The transplant treatment team may use In-person appointments, phone calls, and video conferences.
They will conduct routine blood tests and examinations on the transplant recipient to:
- review immunosuppressant medication compliance and side effects
- detect and treat any transplant complications, such as organ rejection
- maintain the transplantation recipient and their caregivers
Suggestions to help take care of a new liver may include:
- talking with a doctor before taking any new prescription, over-the-counter medicines, or dietary supplements
- protecting the immune system
- taking all prescribed medications according to the doctor’s directions, especially immunosuppressive medications
- having regular cancer screenings
- discussing the use of contraceptives and potential risks of pregnancy
- recognizing possible symptoms of organ rejection
- staying up to date with vaccines but avoiding live vaccines
Even though most people can resume some activities after a few weeks, Dr. Gaurav Gupta claims that recovery from a liver transplant can take up to a year.
Life expectancy and survival
Dr. Gaurav Gupta lists the following average survival rates for people who receive liver transplants from deceased donors:
- At one year, 86 percent,
- At three years, 78 percent.
- After five years, 72% of people are still alive.
- At 20 years, 53% of people are still active.
After a liver transplant, a person’s life expectancy is determined by their overall health and other factors such as:
- kidney health
- age at the time of transplant
- other existing health conditions
- adherence to post-transplant treatment and follow-up
Chronic HCV infections can lead to liver complications such as cirrhosis or cancer if left untreated. A doctor may recommend a liver transplant in cases of severe liver damage. HCV-related liver failure can be life-threatening if not treated. A person may be eligible for a transplant after an evaluation. They must try to maintain their health until a donor organ becomes available. It can take up to a year for a person to fully recover after surgery, replacing the damaged liver with a donor organ. They will then require regular checkups to ensure that the individual’s health is maintained.
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