Multiple liver dysfunctions, collectively known as cirrhosis, produce a permanent scarring of the liver that often goes unnoticed, as symptoms don’t typically appear until the disease is in its advanced stages.
“There is a lot of reserve in the liver function,” says Dr Lee Kang Hoe, respiratory physician at Gleneagles Hospital. “Even if 50% of your liver doesn’t work, you could live normally.”
The only way to detect liver dysfunction early is to do a blood test or a liver imaging study like an ultrasound or CT scan. In the Asia-Pacific region, hepatitis B is the most common chronic liver disease that leads to cirrhosis. Those who carry the condition are encouraged to undergo frequent examinations to monitor their liver function.
“Hepatitis B carriers would need regular follow-ups because they can develop cirrhosis and liver cancer, even if they don’t experience any symptoms,” says Dr Lee.
If left untreated, liver cirrhosis may lead to liver failure or liver cancer, which in turn may require a liver transplant.
“When the liver fails, the patient will die quickly because liver dialysis is still quite inefficient and cannot replace the liver for a long time.”
Living donor liver transplant an option for patients with liver failure
The good news, however, is that the liver is a unique organ as it can regenerate itself. This allows surgeons to graft one portion of a healthy liver from a living donor into a patient who is suffering from liver failure.
“After being separated, the 2 lobes of the liver will grow back to the original size in both the donor and the patient,” says Dr Lee.
According to Dr Lee, the key challenge is keeping the patient in good condition until the operation takes place. Liver dysfunction carries a number of complications, like fluid accumulation in the abdomen or an increased risk of infections. Doctors have to carefully manage these complications by draining the water and administering antibiotics to keep infections at bay.
“As for any operation, the better the condition of the patient going into the operation, the better the recovery,” says Dr Lee.
If the procedure is devoid of complications, such as extensive blood loss, patients usually recover smoothly due to the new functional liver. In addition, anti-rejection medication isolates transplant failure to less than 1% of all cases, shares Dr Lee.
Since these drugs weaken the immune system, however, patients need to be vaccinated against multiple conditions – such as yearly flu, pneumococcal disease, herpes zoster in the elderly, and hepatitis B – before they can enter the operating theatre, explains Dr Lee.
“The good thing about the liver is that it is a tolerant organ that doesn’t need that much immunosuppression.”
Article reviewed by Dr Lee Kang Hoe, respiratory physician at Gleneagles Hospital