Liver transplantation is a major undertaking both for the patient, family as well as for the health care provider, therefore the option of subjecting a patient to this major procedure is only considered when all other treatment options have been exhausted. All decisions in choosing a treatment modality in medicine is based on the premise of the ‘risk benefit calculation’, which means that a treatment option is suggested for a patient only when the risks of the disease outweighs the risks of undergoing the suggested medical procedure. This calculation is probably most relevant to a complicated procedure like liver transplantation, which according to experts is the most complex among the commonly performed surgeries. Having said this, patients whose livers have failed to the point of requiring a transplantation, detoriate at a rapid pace and eventually a failing liver starts affecting the other vital organs of the body. Once the other organ systems start getting affected transplantation becomes a risky proposition. Therefore we advise our patients that once the need for a liver transplantation has been established they should not wait too long to get listed for a transplantation because the success of a transplantation is largely dependent on severity of their liver disease and how early or late in their disease they get the liver transplantation done. In the following passages I have tried to explain the various parameters that can help in deciding what the right time is to consider a liver transplantation.
1- MELD score- MELD or model for end stage liver disease score is a complex score based on the results of your blood test. It is freely available on the internet and can be easily calculated by a patient. The score ranges from 6 to 40 and denotes the severity of liver disease. Once the score reaches a figure of more 12 the risk benefit calculation gets tipped in favour of a liver transplantation, because the chances of a patient dying because of their liver disease is far more than the risks of a transplantation beyond a score of 12. What is also important is that the success of a liver transplantation starts worsening as the MELD score progresses beyond a score of 15-20.
2- Complications of liver disease- Very often we have patients who come and ask us as to how much percentage of their liver has been damaged? It is a fact that about 20-25% of healthy liver is enough to support the body, therefore when patients start developing features of liver disease like, vomiting of blood, water accumulating in the body, bleeding problems etc a point has already been reached where the reserve capacity of the liver has been exhausted. If we speak about medical facts then once a liver patient develops vomiting of blood there is a 50% chance of death in 1 year, for patients with kidney damage because of the liver the chances of death in 1 year are as high as 80-90%. Therefore the development of complications like bleeding, fluid accumulation, altered consciousness etc in a patient with liver disease are immediate reasons to get evaluated for a liver transplantation.
3- Liver Cancer- Liver cancer is very different from the other cancers that occur in the body, because of the fact that cancer in the liver usually arises in a liver that has already been damaged because of other reasons. Liver transplantation is considered the most comprehensive treatment of the cancer because it deals both with the disease in the liver and the cancer. The feasibility of doing liver transplantation is a complicated decision and best left to the discretion of experts.
4- Genetic diseases- The liver is responsible for the production of more than 500 essential substances in the body. Some genetic conditions might be a reason for a liver transplantation even in the absence of complications of liver disease, when the patients liver cannot produce one of these essential products in the body.
The above information is a guide to help patients with advanced liver disease make an informed decision, it is in no way a substitute for expert advise.