Liver Treatment

Preventative measures, including medications, to delay or stop the progression of liver diseases will be explored as the first step. However, when such measures are no longer possible, patients with liver diseases may have to seek invasive treatments such as the following:

What is liver resection?

Liver resection is a procedure for patients who have small tumours in their liver which have not yet caused severe liver damage. The procedure involves the surgical removal of tumours that are around 3cm or smaller. It can be done with minimally invasive techniques using a laparoscope, also known as a 'keyhole' surgery. However, this procedure is rare as the conditions for a liver resection are very specific. For one, the cancer must not have invaded the internal blood vessels of the liver. Secondly, the remaining portion of the liver must be sufficiently healthy so that function can be maintained. If the remaining portion of the liver is damaged, eg. due to cirrhosis, then liver failure may still occur despite the operation. 

When is a liver resection done?

A liver resection is more commonly performed when the patient is suffering from metastasised cancer, that is, cancer that began in another organ and has spread to the liver. Chemotherapy or radiation therapy may be used after the operation to ensure that cancer cells do not regenerate in the liver. 

What is the success rate for liver resection?

Due to the many limitations of a liver resection, the 5-year survival rate of a liver resection is around 40%. This means that only 4 or fewer patients out of every 10 who undergo a liver resection survive for at least 5 years. Liver resection is often performed as a bridging procedure to keep the cancer from spreading while the patient waits for a liver transplant.

What is radiofrequency ablation?

Like liver resection, radiofrequency ablation (RFA) is another procedure used to treat small tumours in a patient with liver cancer. A special needle electrode is inserted into the body at the site of the tumour. Radiofrequency waves are used to heat up the electrode, which in turn burns the tumour cells. 

Unlike liver resection, RFA causes less bleeding in the liver as the high heat also closes up blood vessels. It can be done using minimally invasive techniques, either with the use of laparoscopes or percutaneously, where the needle is inserted through the skin into the stomach. RFA is often used as a bridging procedure for liver cancer patients awaiting liver transplant, as it can help to keep the cancer from spreading in the interim period.

What is liver dialysis?

Just like how dialysis is used as treatment for patients with kidney failure, liver dialysis is used as treatment for patients with liver failure. A special machine is used to act as a temporary external filtration device that replaces the liver. It removes substances such as bilirubin, fatty acids and bile acids that are normally discharged from a healthy liver. 

Just like how radiofrequency ablation (RFA) is used as a bridging procedure for liver cancer patients, liver dialysis is used as a bridging procedure for patients awaiting a liver transplant. Unlike kidney failure patients who can rely on dialysis over many years, liver dialysis is not sustainable for long periods of time, and is often only used for a matter of days or weeks.

Liver dialysis is available at the Parkway Asian Transplant Unit (PATU) at Gleneagles Hospital. Hepatopancreatobiliary (HPB) specialists will assess patients who may require this before their liver transplant.

What is a liver transplant?

In cases where there is liver failure, or substantial damage to the liver due to fibrosis or end-stage cancer, a liver transplant is usually the recommended procedure. The American Liver Foundation states that about 75% of patients who receive a new liver will live at least 5 years after surgery. The result is even better for children, with 82% of them living at least 10 years after surgery. 

What is a living donor liver transplant? (LDLT)

A living donor liver transplant is one where a living donor donates part of the healthy liver to the patient. The liver is capable of regenerating itself to 100% functionality within 4 – 6 weeks despite the removal of up to 70% of its mass.

How do you recover from a liver transplant?

After a successful transplant, patients will need to take anti-rejection medication, which suppresses the immune system to prevent the body from rejecting the new organ. Find out more about the recovery process for liver transplant patients.

Where can I get a liver transplant?

The liver transplant programme in Gleneagles Hospital is headed by Dr Tan Kai Chah and the Asian American Liver Centre. Dr Tan performed the first living donor liver transplant in Singapore in 1996, and he is one of the leading experts of liver transplant in the region. He and his team has performed more than 200 liver transplant procedures since.

Patients should take note that the living donor liver transplant programme in all Singapore hospitals is subject to approval by the Transplant Ethics Committee, as required by the Human Organ Transplant Act, to safeguard against human organ trade.

Gleneagles Hospital is also home to the Parkway Asian Transplant Unit (PATU), a dedicated transplant ward for transplant patients, with a team of nurses who are specifically trained to care for liver transplant patients and help them to a full recovery. Find out more about the Gleneagles Hospital transplant ward and its team of nurses.

Benefits of a living donor liver transplant (LDLT)

The current waiting period for a cadaveric donor liver is often too long to benefit patients with these rapidly progressive diseases. Without an LDLT, it is highly unlikely that these patients will receive a transplant before they develop fatal complications.

Besides being an alternative source of donor livers, the other advantage of LDLT over cadaveric liver transplantation is that it allows scheduling of the procedure. As such, the patient with greatly reduced liver function can be prepared before the transplant surgery. In addition, the quality of the liver graft is better as it is retrieved from a healthy donor, and the cold ischaemic time (the time the donated liver has no blood supply) is much shorter. The biggest disadvantage of LDLT is the potential for complications or even death of a healthy donor. There are drawbacks with LDLT, the main one is finding a suitable compatible donor who has the same blood group and is fit to undergo the surgery. The donor can be the next of kin, a relative or even a close friend.

Living donor liver transplant at the Asian American Liver Centre (AALC)

At the Asian American Liver Centre (AALC), LDLT for adults and children is performed by an experienced team of specialist doctors. For patients who have suitable donors, extremely strict investigations for the donor and recipient are carried out to ensure the safety of both the donor and the best graft for the recipient.

Since performing its first living donor liver transplantation (LDLT) in 2002, AALC has successfully performed more than 230 LDLTs to date with consistently good clinical outcomes – the first private medical centre in Asia to achieve this milestone. Today, it is one of Southeast Asia’s largest private liver centres, with a direct link to one of the world’s most recognised transplant programmes through the University of Pittsburgh Medical Center.

Since the 1990s, LDLT is an accepted treatment method for hepatocellular carcinoma (HCC). The Asian American Liver Centre has expanded the indication criteria of LDLT for HCC due to the many patients **beyond the *Milan criteria (small or few tumours) with long-term survival after LDLT.

*Milan criteria – 1 tumour less than 5cm or up to 3 tumours less than 3cm (NEJM 1996; 334)

**Beyond Milan criteria for AALC are:
No extra hepatic disease
No limitation on number or size.

Results

Among all patients transplanted since 2002 at AALC, there were 69% male and 31% female patients. Survival outcomes for living donor liver transplants in patients between 2008 – 2012 for 1 year, 3 years and 5 years were 88%, 75% and 69% respectively. Patients transplanted for acute liver failure and malignancy were included in this analysis.

Outcomes for hepatocellular carcinoma (HCC) recipients

At least 98 LDLTs were performed for patients with HCC. Survival outcomes were compared for patients transplanted for HCC within and beyond the Milan criteria. Overall survival rates for HCC patients for 1 year, 3 years and 4 years were 86%, 72% and 64% respectively. For Milan criteria patients, the rates were 89%, 82% and 82% respectively.

AALC’s highly successful LDLT Programme is complemented by the Parkway Asian Transplant Unit (PATU) – a dedicated ward with Intensive Care Unit (ICU) facilities and state-of-the-art medical equipment including liver dialysis machines and monitoring devices. This ensures that every patient receives the best treatment for their specific liver condition.

You can learn more about liver transplants at the Asian American Liver Centre.

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