Indications for Liver Transplant: Acute and Chronic Liver Disease

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.

About 70-80% of eventual growth happens in the first two to four weeks, and 95-97% of original size is reached by six months. The '10 years survival' claim is an absolute myth: once recovered, a donor's life expectancy, work, family and sexual life are completely unaffected. The donation age range is generally 18 to 55, and a person can only donate a liver once.

Viral hepatitis (A, some B), certain drugs, Reye's syndrome, autoimmune hepatitis, and Wilson's disease, assessed using the King's College criteria.

Chronic liver disease, most often from chronic hepatitis B or C, alcohol, autoimmune hepatitis, or fatty liver disease.