Principal Consultant & Unit Head, Liver Transplant, Fortis Hospital, Shalimar Bagh, New Delhi, India
Part 6 of 12 in Liver Transplant
Living Donor Evaluation: Compatibility, Safety and Liver Regeneration
August 11, 2024
Asked how donor liver quality and recipient health interact to affect outcomes, Dr. George explained that both the donor and recipient undergo extensive, two-pronged evaluation in a living donor transplant.
Evaluating the donor
The donor evaluation checks, first, that the surgery itself poses no major risk to the donor, and second, that the liver quality is good enough that the portion transplanted will function well in the recipient. The rate of primary non-function, where the transplanted liver simply does not work, is under 1-2% in living donor transplant; early allograft dysfunction, where the liver takes some time to function well, occurs in about 5-10% of cases.
What affects donor liver quality
Donors are generally considered between the ages of 18 and 55. A younger, non-fatty liver has better quality than an older donor's liver or one with more fat. Once a donor is cleared as fit for donation, both the safety and quality checks have already been satisfied.
How fast the liver regrows
In adult living donor transplant, about 60% of the donor's liver is taken, leaving 40% behind. That remaining liver grows fastest in the first two to four weeks, reaching 70-80% of eventual growth in that window, and 95-97% of original size by six months. Dr. George's own analogy: pruning 70-80% of a tree's branches, then giving it sunlight, water and manure; within months, the tree looks whole again, unlike a kidney, where the remaining nephrons simply work harder rather than growing back.
This article is based on a Jivo Masterclass session conducted by Dr. Ashish George, Principal Consultant & Unit Head, Liver Transplant, Fortis Hospital, Shalimar Bagh, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
Looking for a liver transplant consultation or a second opinion? Get in touch with the Jivo team
This guide is based on a live Jivo Masterclass: Dr. Ashish George taught doctors across Africa on August 11, 2024.
FROM THE LIVE Q&A
General Dimma
Is there research correlating liver transplant and COVID-19 survival, and what are the nutritional considerations before, during and after liver transplantation?
Dr. Ashish George
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.
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Frequently Asked Questions
How long does it take for a donor's liver to regrow after donation, is it true that a donor only has ten years of survival left, and what is the age limit to donate?▼
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.
For someone who already had a liver transplant and requires another one, what are the possibilities, and how many times is it possible to have a repeat transplant?▼
Re-transplant is needed in about 5-7% of patients, due to disease recurrence, chronic rejection, or other causes. It is technically more challenging than a first transplant but achieves equal long-term results when performed by a skilled team; some patients have undergone two, three, or even four transplants over the years.
Is it possible for a healthy person without liver disease to have a partial hepatectomy stored, so that if they develop liver disease later it can be transplanted back to them?▼
No, this has not been thought of or done. Only a very small subset of the general population ever needs a liver transplant, so removing a healthy liver segment as a major surgery isn't advisable, and there is no method to preserve a graft for years, only for hours to a few days using specialised machines.
What is the time limit for liver cells to survive outside the body before transplant, and what is the recommended alcohol limit for a patient after liver transplant given a history of alcohol use?▼
A deceased-donor liver can be preserved up to 16 hours in solution, though shorter is always better. Living donor transplant avoids this almost entirely since donor and recipient surgeries happen side by side, keeping the liver outside the body for only half an hour to two hours. The prescribed alcohol limit after transplant for alcoholic liver disease is zero, and at least six months of abstinence is recommended before transplant, and none at all afterward.
On immune monitoring and tolerance after liver transplant, there is evidence of adverse effects including cardiovascular disease, osteoporosis, infection and renal failure. How can these risks be minimised to improve outcomes for patients?▼
Post-transplant medications do carry a risk of cardiac problems, hypertension, diabetes and renal dysfunction, and a modestly elevated cancer risk versus the general population. But comparing 100 transplanted patients against 100 similar patients who are not transplanted, more of the transplanted group are alive at one, three and five years. Doses are actively managed and medications changed where complications arise to minimise risk over time.
How is a living liver donor evaluated?▼
Two-pronged: 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 cases.
How quickly does a donor's liver regrow?▼
70-80% of eventual growth happens in the first two to four weeks; 95-97% of original size is reached by six months.
In This Series: Liver Transplant
- 1.Liver Transplant
- 2.Indications for Liver Transplant: Acute and Chronic Liver Disease
- 3.Liver Transplant for Liver Cancer: HCC, the UCSF Criteria and Downstaging
- 4.Contraindications and the MELD-Sodium Score for Timing Transplant
- 5.Survival Rates After Liver Transplant, and Why It's a Cure, Not Just a Therapy
- 6.Living Donor Evaluation: Compatibility, Safety and Liver Regeneration
- 7.Who Can Donate a Liver: Eligibility, Compatibility and the Ten-Year Myth
- 8.Hepatitis B and C in Liver Transplant Candidates
- 9.Re-Transplantation: When and How Often It's Possible
- 10.Nutrition Before and After Liver Transplant
- 11.Immunosuppression After Transplant: COVID-19, Cardiovascular and Renal Risk
- 12.Cold Ischemia Time and Post-Transplant Alcohol Limits