Cold Ischemia Time and Post-Transplant Alcohol Limits

It is a cure in that the patient's symptoms completely resolve. However, because the patient needs lifelong immunosuppressant medication, they remain in medical follow-up indefinitely even though the disease itself is gone.

Yes. Patients who develop decompensated chronic liver failure from hepatitis B or C should undergo transplant. Hepatitis B patients are kept on lifelong antivirals post-transplant to suppress the virus; hepatitis C is now completely treatable with directly acting antivirals given before or after transplant. Chronic viral hepatitis does not pose a major barrier to offering transplant.

Both donor and recipient undergo extensive two-pronged evaluation: confirming the surgery poses no major risk to the donor, and confirming the liver quality is good enough to function well in the recipient. Primary non-function occurs in under 1-2% of living donor transplants; early allograft dysfunction in about 5-10%. Donors are generally 18-55, and a younger, non-fatty liver has better quality than an older or fattier one.

Legally, the donor must be a relative of the patient. Medically, the ideal donor is blood-group compatible (A or O for an A recipient, B or O for a B recipient, any group for an AB recipient, only O for an O recipient; Rh status doesn't matter), aged 18 to 55, and free of diabetes or advanced uncontrolled pulmonary disease. An incompatible donor can still be evaluated if no compatible one exists, with longer preparation, higher cost and slightly increased risk.

Post-transplant patients who contract COVID-19 usually develop mild disease since the immunosuppressed body can't mount a severe response, though those who do develop severe COVID-19 can have poorer survival due to vulnerability to secondary infections. On nutrition: patients awaiting transplant should follow a high-protein, high-calorie diet to fight muscle loss (sarcopenia); after transplant, only freshly cooked meals, clean water, and peeled fruits/vegetables eaten immediately are advised, plus reduced red meat, due to immunosuppression and cardiovascular risk.

Up to 16 hours for a deceased-donor liver in preservative solution. Living donor transplant reduces this to just half an hour to two hours, since donor and recipient surgeries happen simultaneously in adjacent theatres.

Zero. At least six months of abstinence is recommended before transplant, and no alcohol at all is advised afterward, since the new liver cannot tolerate the metabolic stress.