The liver is the largest internal organ in our body which performs multiple functions and it is the only gland that can regenerate quickly when it is healthy. The main role of the liver is to clean and filter blood coming via digestive tract previous to it flows to remaining body parts. Liver failure results in reduced ability of blood clotting, thereby causing severe problems in case of injuries. Apart from that, alcohol and viruses are also significant factors that stop the liver from functioning properly.

Liver Transplantation
Liver Transplantation enables even the people at the final stage of liver failure to lead longer and happier life. The success rate of Liver transplantation has increased drastically due to advanced surgical techniques. Liver transplant is the best option when the liver is damaged partially or entirely. It is a surgery that involves replacing a failed liver in a recipient with a healthy liver of a donor.

Who should go for it?
The main cause of liver failure in infants is Biliary Atresia. This occurs when bile ducts are absent or partially/fully blocked. Whereas in adults, liver disease is caused due to Cirrhosis - a condition in which liver is scarred and becomes dysfunctional in the worst case. Most common reasons for Cirrhosis are Hepatitis B and C, genetic disorders, alcohol consumption, toxic metals and obesity. One should immediately seek advice from a doctor when he/she suffers from following symptoms:

Fatigue
Nausea
Weakness
Weight loss
Jaundice
Fever
Abdominal Pain
Itchy Skin
Liver Transplantation Surgery
Two kinds of the liver transplant are available: 

Deceased donor transplant 
Living donor transplant
There are not enough deceased donor livers available to match all the liver transplant needs. Any living donor with a matching liver can donate a part of their organ to the person undergoing the liver transplant. As the liver can regenerate itself to its normal size in healthy people within a few months, there are no side effects of donating a part of the liver. A thorough physical and mental health examination will be performed for both the donor and the recipient to ensure that they can cope with the process and are aware of the risks involved. This includes psychological tests and blood tests. Patients are added to a waiting list as per their priority score. The score is assigned to a patient based on three blood samples creatinine, bilirubin and INR.

The priority score is termed as MELD (model of end-stage liver disease) in adults and PELD (pediatric end-stage liver disease) in children. The patient cannot undergo liver transplant if he/she has contracted cancer in any other part of the body or is suffering from heart disease or severe infections.

During the liver transplantation procedure, the surgeon removes some part of the liver from a donor and replaces damaged liver in the recipient with it. Both recipient's and donor's liver re-grow rapidly and reach normal size within months. As per statistics, recipients who receive the liver from living donor have a higher survival rate than those who receive it from deceased donors.

After surgery, both donor and recipient should maintain healthy and clutter-free life and follow strict diet rules and get vaccinated as per the chart provided by the doctor. They also need to avoid consumption of alcohol entirely and talk to a medical practitioner before taking any medications.

Liver Transplant Surgery - Who Should Go For It?

The liver can be transplanted either from the living-donor or from the deceased donor. Liver transplant surgery includes the transplantation of a part of the liver from the donor to the donee who has a damaged liver and does not function well. Living-donor liver transplant is more common especially among children as the number of liver donee are more than the available deceased donors of the liver.

Living liver donors are the alternative for the donee waiting for a liver transplant from a deceased person. The remaining liver of the living donor, after the transplant, regenerates itself and reoccurs to its usual capacity and volume within a few months post the surgery. The donated part of the liver to the donee also regenerates and restores to its normal functioning.

Most often, the living-donor of the liver is a close relative or friend. Everyone or anyone cannot donate a liver but only those can who have the matching liver depending on age, organ size, blood type, and other health and medical factors. Both the donor and the donee have to go through a thorough medical examination before the transplant to know the potential outcome and risk involved.

Procedure-
For the transplant, the donor is first operated and the required part of his/her liver is removed. The donee s damaged liver part is then replaced by the healthy liver part of the donor. Both the donor s and the donee s operated liver is then attached with the bile duct and the blood vessels. Both the patients are kept under observation for some days for the medical team to know if they are having any health issue due to the transplant. The operated liver regenerates itself within certain months and starts functioning normally.

Precautions for the Donor-
Although the donor can go back to normal life routine a few months after the transplant there are a number of precautions that should be taken into account to avoid any health issue or liver damage.
  Avoid smoking.
  Avoid consumption of alcohol.
  Eat on time or do not starve or overeat.
  Avoid having heavy meals.
  Avoid heavy exercise or weight lifting or physical work.

Take Away-
Liver transplant is a surgery conducted to remove the damaged or injured liver of the patient with the healthy liver of the donor. The donor of the liver can either be deceased or living depending upon the availability of the donor and the severity of the donee.

Various lab tests and examinations are conducted on the donor and the donee to confirm their match and assess potential complications before the transplant. The donor is usually someone close to the patient or the donee whose liver has been matched depending upon various factors. As the liver regenerates within a few months, the donor can lead a normal life after the transplant.

Know How To Choose A Liver Donor For Liver Transplant! 

When there is too much accumulation of fat cells in the liver, the healthy tissue gets replaced by the fat cells resulting in fatty liver. The liver colour changes to yellowish greasy one. More than half of liver related diseases are caused due to fatty liver. Some of the common symptoms of fatty liver include excessive sweating, nausea, excess abdominal fat, itchy eyes, gallstones and fatigue. Luckily, though, a fatty liver is a reversible condition. 

Here is a list of 5 effective ways to avoid fatty liver:

Cut down on carbohydrate: Too much consumption of carbohydrate can result in fatty liver. Some of the biggest culprits are white flour and sugar related products. Since, the liver converts excess carbohydrate into fat, over consumption of food items such as pasta, potatoes, rice and breakfast cereals should be checked. A diet consisting of low carbohydrate and low fat should be designed and followed for cutting down fat in the liver.
Cut down on alcohol: Chronic alcoholism is the second biggest reason of a fatty liver. Alcohol results in damage and inflammation of the liver cells, thus infiltrating a lot of fat cells into the liver. Alcohol also restricts the process of healing. Restricting alcohol is an essential towards cutting down fat in the liver. Low-fat alcohol such as red wine and brandy can be consumed twice or thrice in a week. If a person is suffering from a chronic liver condition, a doctor should be consulted before alcohol.
Protein consumption: Breakfast should have an adequate amount of protein. It balances the blood sugar level of body, helps to fight cravings and helps the liver to detoxify foreign objects. Some good sources of protein include eggs, nuts, chicken, seeds and fish. The serving size should not be more than 4-6 ounces per day. Proper intake of protein will slowly reduce fat in the liver.
Fresh fruit and vegetable: Fresh fruits and vegetables are some of the most powerful agents in cleansing liver toxins. They have the capacity to repair liver filters and remove excess fat. Even juice of vegetables fetches excellent results in getting rid of excess fats. Fruits, on the other hand, possesses vital mineral and vitamins that are used by the liver to eradicate fat cells.
Get moving: If the endeavour is to remove fat from the liver, running and daily exercise has a pivotal role in achieving it. If a person has never worked out, a good way to start is to spend half an hour in a day running and doing free hand exercise. One can also get into a gym and try extensive cardio exercises to cut down liver fat. It is not safe to perform any high-intensity training should without an expert supervision.

Fatty Liver - 5 Ways You Can Prevent It!

Just like the name suggests, Non-Alcoholic Fatty Liver Disease (NAFLD) is a set of diseases that can affect the liver due to excess accumulation of fat. One common disease that arises from this condition is known as nonalcoholic steatohepatitis. This can lead to cirrhosis as well. NAFLD is very common in the Western Countries affecting close to 100 million people annually. Although it can occur in any age group, the most affected age group being the one between 40-50 million. With this condition, the risk of getting other diseases such as cardiovascular problems and type 2 diabetes increases considerably.

Symptoms: Non-alcoholic fatty liver shows symptoms such as fatigue, enlarged liver, and pain, discomfort in the upper abdomen. Some other symptoms that have been witnessed in patients suffering from NAFLD include the development of breasts in men, swelling of the abdomen, red palms, jaundice, swelling of the blood vessels etc.

Causes: Experts have not been able to identify the exact causes of NAFLD. However, it is pretty evident that this condition only arises when the liver fails to produce bile which is responsible for digesting the fat cells. The fat in turn deposits in the liver cells resulting in NAFLD. Some of the possible causes include the following:

The resistance of insulin
Type 2 diabetes
High level of triglyceride in the blood
Obesity
Risk Factors: There is a wide array of risk factors that can pose a threat of NAFLD. Some of them include metabolic syndrome, high cholesterol, hypothyroidism, type 2 diabetes, hypopituitarism, obesity, polycystic ovary syndrome etc.

Complications: The major complications of NAFLD is liver cirrhosis. This is a condition that results in scarring of the liver cells resulting in fibrosis. Some other complications include fluid accumulation in the liver, liver cancer, swelling of the vein etc.

Diet: A mediterranean diet is a perfect diet suited for patients suffering from NAFLD. It includes nuts, fish, vegetables, grains, fruits and olive oil. Fat should be eliminated from the diet by a significant bit. It is important to add the right kind of fat in the diet. Omega-3 fatty acid available in flaxseed oil, leafy vegetables, and nuts fits the bill. Studies have shown that vitamin D and E helps a great deal in fighting liver diseases. Some other food items that should be included in the diet are green-tea, red grapes, Brazil nuts, raw garlic, wolfberry etc.

Treatment: Once the disease is diagnosed, a doctor s first endeavour is to ensure that the patient loses weight through a combination of diet and exercise. Vaccination against hepatitis A and B is the next step that a doctor would ideally suggest. For patients who are suffering from cirrhosis, a liver transplant is the only viable option to increase mortality.

What Are The Reasons Behind Non-Alcoholic Fatty Liver Disease?

The liver is the engine of the human body. It is basically composed of 2 types of cells (a cell is the basic building block of the human body)   hepatocytes (liver cells) and cholangiocytes (bile duct cells). It also has other supporting tissue and their respective cells. The hepatocytes are by far the most numerous cell type, not surprisingly tumours (otherwise called mass or lump.  Tumor  means lump in Latin), of this cell form the majority of abnormal growths in the liver. Abnormal growths can be benign (that is, they do not grow rapidly, spread to other parts of the organ or to other parts of the body) or malignant (grow rapidly, spread to other parts of the organ and to other parts of the body, i.e. cancer). These abnormal growths from liver cells are Focal nodular hyperplasia (FNH), Adenomas (the benign variety) and hepatocellular cancer (otherwise called Hepatoma/HCC, the cancerous type). What we need to recognize is that certain adenomas can turn into HCC, over a period of time. The other type of growths in the liver are those that have originated elsewhere in the body and spread to the liver, for example a growth of the breast spreading to the liver. These are in fact the commonest tumours of the liver. I will discuss these at a later date.

Benign growths of the liver

Common benign growths are Haemangiomas, FNH and Adenoma. Most of these are identified when a scan is performed as investigation for some other problem. Accurate diagnosis of the nature of these lumps is important to determine the type of treatment needed. This can be ascertained by a carefully selected scan like an Ultrasound, CT scan or an MRI. The technology of these scans is continuing to evolve and get better year on year. There are different types of Ultrasound, CT and MRI scans with different applications, based on whether contrast is used or not, the different phases of scanning, the type of MRI scanning sequence etc. Therefore, these scans although commonly available and used very frequently, need to be performed under the supervision of a team involving Liver doctors and radiologist who is well versed in the diagnosis of liver lumps, for accurate diagnosis without the need for unnecessary tests (Box 1).

Haemangiomas are by far the commonest. It is estimated that 5% of the adult population harbor this lump in their livers! They occur in both sexes and at all ages but are commonest between 30 to 50 years in women. Most of them are small, less than 4-5 cms in diameter and are are identified on Ultrasound. MRI and its various applications is the scan of choice for accurate diagnosis. This is crucial as most of them do not need treatment.

Focal Nodular Hyperplasia (FNH) are the second most common liver lumps. They are usually single and small (less than 4 cms) and occur in women between 35   50 years of age. About 2.5-3% of population harbor this lump in their livers. Special MRI techniques using special contrast agents is diagnostic and the findings are quite distinct from haemangiomas. Again treatment is not recommended apart from selected circumstances. Assessment in a dedicated Liver team is recommended for accurate diagnosis and a proper management plan to be formulated.

Hepatic adenomas (Hepatocellular adenoma, HCA) are rare lumps and occur in 0.2 to 0.3% of the population, again occurring mostly in young women during their reproductive period. They are again solitary and most usually 3-4 ms in diameter.

There are a couple characteristics which make this lump different from the previous 2, there is a strong relation between hormones the development of HCA and some of these HCA can turn into the malignant Hepatocellular carcinoma (HCC). Therefore, accurate characterization and diagnosis of these HCA is essential. Sometimes biopsy of the lump, molecular and genetic tests maybe necessary to determine if the HCA has a high chance of progressing to HCC. Imaging tests are generally adequate, contrast MRI Liver and its different techniques is accurate in diagnosing HCA and sub-typing it, however CT and contrast-enhanced Ultrasound is sometimes necessary along with MRI.

Generally, a HCA in a male is recommended for surgical resection. While in women, discontinuation of the OCP pill/ any other such hormone is recommended for a period of 6 months, if the HCA does not have any worrying features and size is less than 5 cms. IF HCA is larger than 5 cms and has features suggestive of a high risk for change to HCC, surgery is advised. Again these decisions have to be made as a part of a Multi-disciplinary team (Box 1)

Malignant growths beginning within the Liver

As mentioned earlier, usually malignant growths which are seen in the liver spread to it from elsewhere in the body. Hepatocellular cancer/Hepatoma (HCC) is the commonest malignant tumour beginning within the liver, as apposed to those that spread to the liver from elsewhere. It occurs between 40-70 years of age and occurs commonly in men. It is estimated that 17000 new patients develop this tumour every year in India. The vast majority (> 80%) of these develop in patients who have chronic liver disease (cirrhosis). Importantly the number of HCC cases is increasing year on year as cirrhosis due to fatty liver disease, Hepatitis B (3% of Indian population carry this virus, ie nearly 40 million individuals) and alcohol are continuing to increase in India. Nearly overall it is the 4th or 5th most common cause of cancer and the second most common cause of cancer-related death. This is continuing to increase too. We do not have a national policy in India to screen and diagnose these lumps in the liver at an early stage. Most patients present at a late stage when effective treatment is not possible.

Hepatitis B is a vaccine-preventable disease, there are good drugs to treat it and decrease the risk of cirrhosis and HCC in HBV patients, therefore it is important to test for this virus infection. The fatty liver disease can cause chronic liver damage and HCC, regular exercise and consuming a balanced diet can reduce the risk of fatty liver disease.

The usual mode of detection of these growths is when a scan is done for some other reason. Occasionally patients can develop pain in the abdomen or jaundice which leads to an investigation. The treatment of HCC depends on the extent of tumour, the extent of the chronic liver disease (the stage of cirrhosis) and the overall condition of the patient. These patients are best seen, assessed and treated in a team (Box 1) which specializes in the treatment of Liver disease.

The best treatment for HCC is surgery. However, this is suitable only for certain carefully selected patients. This can take the form of liver resection (where a portion of the liver with tumour is removed) or liver transplantation (where the whole liver is removed and a donated liver (full or partial) is replaced into the patient. Indeed surgical has excellent survival rates; more than 75% of patients survive for more than 5 years after resection or transplantation making treatment for these cancers one of the most satisfactory.

Other treatments which can be combined with surgery in selected patients or can be combined with patients not suitable for surgery are different types of Interventional radiological therapy   chemotherapy or radiotherapy delivered through fine catheters introduced into the blood vessels of the liver (TACE: Transarterial chemotherapy, TARE: Transarterial radiotherapy) and or heat energy delivered to the tumour area by means of carefully placed needles/probes (RFA: radiofrequency ablation, MWA: microwave ablation).

HCC is unique cancer as its treatment should be tailored to the patient, the treatments are varied and range from catheter-based non-invasive treatment to major surgery and transplantation. This necessitates that HCC patients are best managed in a multidisciplinary team which is highly skilled in and specializes in the management of liver diseases.

Box 1: A liver tumour multidisciplinary team   Integrated Liver Care team

The team should be one with expertise in the management of benign liver lesions and should include a Hepatologist, a Hepatobiliary & Transplant surgeon, Diagnostic and Interventional radiologists, Medical oncologist and a Pathologist.

Each member of the team must hold specific and relevant training, expertise and experience relevant to the management of benign liver lesions.

The team should be one with the skills required not only to appropriately manage these patients but also to manage the rare but known complications of diagnostic or therapeutic interventions.

The Increasing Problem Of Liver Tumours In India!

The liver is a key organ in metabolism and will have some amount of fat. However, excessive fat accumulation in the liver can be abnormal and is referred to as fatty liver. If the fat content exceeds anything more than 5% to 10% of the liver s weight, it would be referred to as fatty liver.

Types - There are mainly two types based on causes:

Alcoholic fatty liver: This is very common in people who consume excessive amounts of alcohol. Even a one-off instance of binge drinking can cause increased fat accumulation in the liver, but it would not produce any symptoms though. Preexisting hepatitis, pregnancy, obesity, and genetic predisposition may also lead to alcoholic liver disease.
Non-alcoholic liver disease: This is the less common type of fatty liver, and there would be no alcoholic abuse history here. However, there could be genetic predisposition, obesity, autoimmune liver disease, malnutrition, which can lead to this condition.
Symptoms

Fatty liver disease is a chronic condition with insidious onset (meaning to say, the exact time of onset cannot be pinpointed). However, as the disease condition progresses, symptoms will become evident, which can trigger a medical evaluation to identify the fatty liver. Some of the symptoms include:

Excessive fatigue and weakness
Unexplained weight loss
Loss of appetite
Nausea
Trouble focusing and concentrating
Impaired judgment
Constant, slow enlargement of the liver can cause pain in the right upper quadrant of the abdomen (where the liver is)
There could be jaundice, where the skin and the white of the eyes turn pale yellow
Symptoms of liver failure, including increased levels of proteins in the chemical tests.
Diagnosis

As noted earlier, it is not easy to identify liver disease, as there are no specific symptoms. However, the above symptoms could point to a potential fatty liver.

Blood tests, especially for liver enzymes
Ultrasound, where the liver is imaged to look for any structural changes
Biopsy, where liver tissue is extracted to confirm the diagnosis of fatty liver
Treatment

There is no specific treatment for fatty liver. It can be managed through the following, where symptoms reduce in severity, and overall prognosis improves.

Diabetes control: There is a relation between how well diabetes is controlled and severity of fatty liver. Improving diabetes control ensures fatty liver does not progress.
Alcohol: Cutting down or even better quitting alcohol, definitely helps improve symptoms. If it is alcohol induced fatty liver, alcohol should be stopped.
Weight management: Obesity and fatty liver are related, so weight management is essential.
Healthy diet: Eating a healthy diet and regular exercise regimen also helps improve symptoms of fatty liver.

Fatty Liver - Signs You Are Suffering From It!

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