Liver transplant is a treatment for patients diagnosed with Liver Cancer, acute liver failure or end-stage liver disease caused by conditions such as Viral Hepatitis, Cirrhosis or liver damage from alcohol or drug abuse.
Some Indications for liver transplant are:
Unless the liver damage is fairly severe or advanced, diseases of the liver are often "silent", and patients may be unaware of any issues. Different liver diseases may affect some functions more than others, resulting in variability between patients.
Some symptoms include:
Liver transplant is one of the most complicated surgeries one could undergo (hence requiring the extensive work up to ensure that your body is able to withstand a long surgery). For recipients, the total surgery time may range anywhere between 10 to 16 hours, sometimes even longer especially if you had past abdominal surgeries. This surgery involves making an incision across your mid abdomen in the shape of an inverted T. Your surgery proceeds in 2 major steps – the explantation of your diseased liver, followed by implantation of the donor’s liver.
Average length of stay is about 2 – 4 weeks depending on your recovery. SGH Liver Transplant team will work with you closely to help you towards your recovery, and you will be on lifetime follow up with us.
During this work up, various blood tests, scans and x rays will be done to assess your heart, lungs and liver, as well as assessment by a team of transplant specialists. Since the tests and assessments are extensive, they will be done as inpatient over the course of 5 - 7 days. If more tests are required, you may need to stay even longer.
After all the assessments are completed, our team will collate your reports and discussed in our Liver Transplant Meeting on the following Tuesday. Our team will discuss your tests results and determine if you are suitable to undergo liver transplant. We will contact you thereafter on your eligibility to be placed on the DDLT waiting list.
Surgical complications may include bile duct leakage, damage to the biliary tree, bleeding, formation of blood clots, infection (of wound or hospital acquired infections e.g. pneumonia), rejection of donated liver. Additional procedures/surgeries may be required if any of these complications arise.
You will be admitted to the Surgical Intensive Care Unit (SICU) immediately after surgery where the team of specialists will monitor you very closely. Blood tests and scans will be done throughout the day to ensure there is no active bleeding/rejection/infections. There will be multiple tubes and lines (including feeding tube, indwelling urinary catheter (IUC), arterial lines, endotracheal tube) attached to your body, please do not be alarmed. The average length of stay in SICU stay is around 2 - 3 days and may defer depending on your rate of recovery. Once your condition improves, we will transfer you to a high dependency single room at our transplant ward where you will spend the rest of your stay recovering. Our transplant team will work with you closely to help you towards your recovery.
Please avoid carrying heavy objects for at least the first 6 months after surgery to allow your wound to completely heal.
You will be given immunosuppressants to prevent your body from rejecting the new liver. 3 different agents will be given immediately post-transplant, namely:
Initial dosage of these medications will be high as the risks of rejection is the highest immediately after surgery. Your blood test results are indicative of how well your body is adapting to the new liver. Once your condition improves, our specialists will taper your medications down very carefully. Ideally, you will be left with only one type of immunosuppressant which you will have to take for life.
Be expected to return for multiple appointments, scans and blood tests after surgery as it is crucial for us to monitor you closely to prevent any complications/rejections from occurring. Initially, you will have to return frequently for appointments with our liver transplant specialists. However, the frequency of appointments will decrease as your condition stabilizes over time. Most of our stable patients are only on annual follow up with us with 6 monthly interim blood tests and scans.
Liver transplant is a big step forward in your life where your compliance and dedication are tantamount.
When in doubt, always consult the liver transplant care team.
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