Question 1

What is the survival rate of liver transplantation?

Dr. Ashish George · Accepted Answer

More than 90% of patients are alive at 1 year, 80-85% at 3 years, more than 75% at 5 years, and 65-70% at 10 years. Liver transplant does not have an expiry date because the liver can regenerate.

Question 2

Is liver transplantation a replacement, a like-for-like graft, or a therapeutic treatment, essentially a cure versus a therapy?

Dr. Ashish George · Accepted Answer

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.

Question 3

Is it advisable for patients with chronic hepatitis to undergo liver transplantation, given the risk of the new liver becoming infected too?

Dr. Ashish George · Accepted Answer

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.

Question 4

How do factors like donor liver quality and recipient health condition impact the success and recovery process after a liver transplant?

Dr. Ashish George · Accepted Answer

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.

Question 5

Who is eligible to donate a liver?

Dr. Ashish George · Accepted Answer

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.

Question 6

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 · Accepted Answer

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.

Question 7

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?

Dr. Ashish George · Accepted Answer

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.

Question 8

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?

Dr. Ashish George · Accepted Answer

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.

Question 9

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?

Dr. Ashish George · Accepted Answer

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.

Question 10

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?

Dr. Ashish George · Accepted Answer

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.

Question 11

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?

Dr. Ashish George · Accepted Answer

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.

Liver Transplant

Questions Doctors Asked Dr. Ashish George