Why Liver Transplant is necessary ?

Liver transplantation is necessary when the liver functions are damaged beyond the body’s capacity to regenerate. In children and adults with liver failure due to long standing liver disease, primary liver tumors or generalized diseases, a liver transplantation may be potentially curative. 1-7

The reasons for liver transplant again vary with the patient’s age and severity of the disease.

Reasons for liver transplants in children

In children, a common reason for liver transplantation is biliary atresia in which the bile ducts that transport the bile from the liver to the gall bladder and help in digestion are under developed. In the initial few months of life a reconstructive surgery may be undertaken to correct this condition. However, some children go on to develop deep jaundice and finally liver failure.

Reasons for liver transplants in adults

In adults, the most frequent causes of liver disease that leads to a need for a liver transplant is chronic infection with hepatitis C virus. Other conditions in adults that commonly necessitate a liver transplant include:

• hepatitis B virus
• Non Alcoholic Fatty Liver Disease
• Primary Biliary Cirrhosis
• Primary Sclerosing Cholangitis

Among tumors, hepatoblastoma (in children) and hepatocelllular carcinoma (in adults) are the most common forms that necessitate a liver transplant.

Rarer causes include drug overdose (either accidental or suicidal) with medications that damage liver like paracetamol or acute liver failure due to viral hepatitis A or B.

Some common and rare conditions that may lead to liver failure and need for a liver transplant include complications of liver cirrhosis; Primary biliary cirrhosis and so forth.

Complications of liver cirrhosis

Liver cirrhosis results due to long term liver disease and liver scarring. This in itself may not cause liver failure at the outset but over time the liver gradually loses its functions and may require to be replaced by transplantation.

Complications include:

• ascites (accumulation of fluid within the abdomen)
• encephalopathy (affliction of the brain due to liver failure)
• variceal haemorrhage or bleeding
• loss of blood due to portal hypertension, etc.

Cirrhosis may be caused by:

• long term hepatitis C infection or long term hepatitis B infection (rarer than cirrhosis caused by Hepatitis C infection)
• long term excessive alcoholism
• autoimmune liver diseases
• fatty liver disease
• hereditary liver diseases

An estimated 1 in 7 people who contract hepatitis C will have liver failure, often 20 to 30 years after contracting the initial infection.

Primary biliary cirrhosis

Primary biliary cirrhosis is a type of chronic liver disease that necessitates liver transplant. There may be build-up of bile inside the liver. This happens because of the immune system attacking the bile ducts within the liver.

PBC is a relatively rare condition, affecting around 1 in every 8,300 people in the UK. However, this remains one of the most common reasons why a person requires a liver transplant.

Primary sclerosing cholangitis

Primary sclerosing cholangitis in another chronic inflammation of the liver that needs transplantation. It usually results, after many years, in liver failure. This condition affects about 1 in 16,000 people between ages 30 and 50.

Liver cancer

Liver cancer is another condition when liver transplant is necessary. In England, an estimated 2,750 new cases of liver cancer are diagnosed annually and most occur in older adults aged 65 or above.

Autoimmune hepatitis

Autoimmune hepatitis occurs when the body fails to identify the liver as its own and attacks the liver tissues. This can lead to liver failure. The reason for this reaction is not known. Only 1 in 100,000 people develop this condition in UK each year.

Metabolic diseases

Metabolic diseases based on the liver including:

• Primary oxaluria
• Familial amyloidosis
• 1-antitrypsin deficiency
• Wilson’s disease
• Urea cycle enzyme deficiencies
• Tyrosemia
• Familial hypercholesterolaemia
• Criggler Najar syndrome urea cycle defects
• Glycogen storage disease

Biliary atresia

In children, the most common reason for needing a liver transplant is biliary atresia. Biliary atresia affects only 1 in every 18,000 births.

Other conditions in new borns and children include:

• Idiopathic neonatal hepatitis
• Cholestatic liver disease
• Alagille’s syndrome
• Familial intrahepatic cholestasis (FIC)
• Non-syndromic biliary hypoplasia
• Inherited metabolic liver disease

Sudden liver failure

Sudden liver failure that required transplantation includes drug over dose with drugs like Acetaminophen.

Exposure to anaesthetic gas called halothane may also lead to acute liver failure. This type of liver failure affects younger people and only 1 in 300,000 people are affected by it each year.

Other conditions

Other generalized conditions such as Hepatopulmonary syndrome and Portopulmonary hypertension.

Reviewed by April Cashin-Garbutt, BA Hons (Cantab)