Much has been said and written about end-stage liver disease in the past few weeks. Health24 separated fact from fiction.
Cirrhosis of the liver
Cirrhosis is a chronic, progressive and irreversible disease of the liver. It has a number of different causes:
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In South Africa, the most common cause of cirrhosis is chronic alcoholism. Alcoholic liver disease develops after more than a decade of heavy drinking (a factor which varies between individuals).
Chronic hepatitis B, C and D are other causes. Hepatitis B is the most common cause of cirrhosis worldwide and, like hepatitis C, causes inflammation of the liver. Hepatitis D also affects the liver, but mostly in people who already have hepatitis B.
Autoimmune hepatitis occurs when the immune system attacks the liver. Inherited diseases such as Wilson’s disease can also affect the way the liver works.
Other lesser causes include:
non-alcoholic steatohepatitis, which is associated with diabetes;
blocked bile ducts, often caused by primary billary cirrhosis in which the ducts become inflamed, blocked and scarred;
drugs, toxins and infections (e.g. severe reactions to prescription drugs, prolonged exposure to environmental toxins, or parasitic infection such as bilharzia); and
repeated heart failure accompanied by liver congestion.
Symptoms
Patients with cirrhosis often don’t display any symptoms in the early stages of the disease.
However, as scar tissue replaces healthy cells, liver function starts to fail. The following symptoms may occur:
exhaustion;
fatigue;
loss of appetite;
nausea;
weakness;
weight loss;
abdominal pain; and
spider-like blood vessels that develop close to the surface of the skin.
Diagnosis
If cirrhosis of the liver is suspected the doctor will perform a number of tests to confirm this. Tests may include blood tests, X-rays, and often a liver biopsy.
Treatment
As cirrhosis is irreversible, treatment is generally aimed at ensuring that the disease doesn’t develop any further. For example, if the cirrhosis is caused by alcoholism, the patient must stop drinking alcohol completely.
However, in cases where the cirrhosis is extreme and the liver is under threat of failing, the doctor may suggest a liver transplant.
How long is the waiting list for transplants in SA?
In South Africa, the Organ Donor Foundation (ODF) claims that there is no way of predicting how long a patient could be on the waiting list for an organ.
The Foundation says that there are a number of issues to consider, such as the severity of each specific condition. Patients can jump the queue if their condition is life-threatening.
When is a transplant the only option?
If the deterioration of the liver is so extreme that it cannot function properly anymore, a transplant is the best viable option available.
Who qualifies?
There are a number of different reasons why certain patients may be refused a liver transplant. If the transplant is needed due to alcoholism and the patient refuses to give up alcohol, for instance, they are unlikely to take priority in the queue.
Where do the livers come from?
Usually, a liver is donated by an organ donor who has just died. This type of donor is called a “cadaveric donor”. When a healthy person donates part of their liver to a particular person, he/she is known as a “living donor”.
Testing is done to determine whether the donated liver is a match to the receiver’s blood type. It also has to be a healthy liver and must be the right size.
The surgical procedure
Surgery can take anything up to 14 hours.
The surgeon will disconnect the diseased liver from the bile ducts and blood vessels before removing it. The blood that flows into the liver will be blocked or sent through a machine to return to the rest of the body during the procedure.
The surgeon will put the healthy liver in place and reconnect it to the bile ducts and blood vessels.
After surgery
Patients usually stay in hospital for a period of one to three weeks. They are only released once the new liver is functioning properly.
Transplant patients take anti-rejection medication (immunosuppressants) for the rest of their lives to ensure that the immune system doesn’t damage the organ, leading to it being rejected by the body.
The downside to taking immunosuppressants is the increased chance of infection as they weaken the immune system.
Increased blood pressure, a rise in cholesterol, susceptibility to diabetes, weakened bones, and kidney damage are also side effects of the medication.
What are the signs of rejection?
Between 80% and 90% of transplanted livers still function one year after the transplant procedure.
However, if rejection starts taking place, liver enzymes will show up in the blood, and the transplant patient will experience symptoms such as nausea, pain, fever or jaundice.
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