Dr Ankur Vagadiya

Dr Ankur Vagadiya

FAQ

Liver Failure

Liver failure is clinical condition which leads to fluid in tummy , repeated vomiting of blood , repeated infection in tummy fluid , altered senses and extreme weight loss.

 

Definative treatment of liver failure is liver transplantation

When we will remove your diseased cirrhotic liver and replaced with healthy liver.

There are two types of liver transplantation

  • Deceased donor liver transplantation where liver donated from brain dead donor is transplanted to patient
  • living donor liver transplantation where family member donate part of liver to patient like son to father , daughy to father etc

The liver is a vital organ that plays a crucial role in filtering toxins and waste products from the blood, producing bile to aid in digestion, and storing glucose and other nutrients. In general, liver damage can be reversible if detected and treated early. However, in some cases, when the liver is severely damaged, a liver transplant may be the only option.

A liver transplant is considered when other treatments have failed to manage liver disease, or the liver has been damaged beyond repair. Some common reasons for liver transplant include:

Liver failure or end-stage liver disease caused by chronic liver diseases such as cirrhosis, hepatitis B or C, or non-alcoholic fatty liver disease.

Liver cancer that cannot be treated by other means.

Certain inherited metabolic disorders that affect the liver, such as hemochromatosis or Wilson’s disease.

Acute liver failure caused by drug toxicity, infection, or autoimmune disorders.

The decision to undergo a liver transplant is made by a medical team that evaluates the patient’s overall health, medical history, and severity of liver damage. In most cases, the liver transplant is a life-saving procedure and is reserved for patients who have a high risk of dying without it.

Pre-transplantation work up

A series of tests will help determine if you have medical issues such as significant heart or lung disease that may influence the outcome of a transplant.

  • Blood tests: To look at the liver and kidneys, test for infection, and A/B/O blood typing.
  • Urine tests: Check for kidney diseases, illicit drugs/tobacco.
  • Chest X-ray: Looks at the heart and lungs.
  • Liver imaging: Examines the liver and abdominal organs for tumors and sees if the major blood vessels in the liver are open.
  • Dobutamine Echocardiogram or 2D Echocardiogram: Looks for heart diseases that may prevent transplantation. If your dobutamine stress test is abnormal or inconclusive, you may need a nuclear stress test or PET Scan. You must abstain from all caffeinated products for 24 hours before a cardiac PET scan.
  • Dental Clearance: Determines health of teeth and gums.
  • Mammogram: Checks for breast masses in patients over 40 or those with a family history of breast cancer.
  • Pelvic Exam with Pap Smear: Checks for cancer of the reproductive organs and Sexually Transmitted Diseases (STDs).
  • Colonoscopy: Checks for colon cancer and bleeding from the colon.

 

You will also attend the Liver Transplant Education Counselling : this is a 1-hour class designed to explain the entire liver transplant experience, from the initial evaluation to discharge from the hospital after surgery. You cannot be placed on the liver transplant list until you and your caregivers have attended this class.

While You Are On List

Every person’s case is discussed at our selection conference within 2 weeks of their initial evaluation. The committee will determine whether there is any additional testing required.

To be placed on the waiting list, you must:

  • Attend the Patient Education Class along with your caregiver
  • Complete all the required pre-operative testing
  • Be approved by the Transplant Evaluation Committee
  • Be authorized by your insurance company to undergo liver transplantation at Michigan Medicine

Once your case has been reviewed and accepted for listing, the transplant coordinator will place you on the waiting list. You will be notified of your listing status via phone and letter.

The MELD score attempts to assess the person’s risk of dying before the liver transplant. The higher the MELD score, the sicker you are. The MELD score is assigned when you are listed and periodically updated thereafter.

The labs used for calculation include: bilirubin (liver function), INR (liver synthesis), sodium and creatinine (kidney function).

The score ranges from 6 to 40. If the MELD score is above 24, weekly labs are required to remain listed.

Click here to calculate your MELD score with the US Department of Health & Human Services MELD Calculator.

Usual waiting time is unpredictable but chance of getting liver is more once MELD score reach above 24

  • Exercise- Do your best to stay active before transplant. Reduced activity can lead to decreased endurance and energy levels, a declining mood, and poorer outcomes after surgery.
  • Eat a well-balanced diet
  • Restrict your sodium intake (less than 2,000 mg/day) so you aren’t holding onto extra fluids.
  • Eat enough protein (more than 60 grams of protein/ day) to avoid muscle wasting.
  • Eat freshly cooked meals with fruits and vegetables.
  • Avoid prolonged periods of fasting and try to eat small, frequent meals throughout the day instead of 1 or 2 large meals a day
  • Keep your immunizations up to date
  • You should receive an annual flu shot – no nasal vaccination.
  • You should be vaccinated against both Hepatitis A and B if not already immune.
  • People over 50 with cirrhosis should receive the Shingrix vaccine to prevent shingles.
  • All vaccinations may be done through your primary care physician’s office.

To remain active on the list, you must:

  • Provide blood and urine samples to monitor your liver and kidney function
  • Go to your clinic visits at Michigan Medicine at least every six months
  • Keep your regular visits with your local doctors
  • Have a yearly cardiac stress test and dental clearance
  • Have a liver ultrasound with Doppler every 6 months
  • Have a mammogram, if requested by your doctor in the 12 months prior to listing and every 2 years after the age of 40.
  • Have a pap smear (or pelvic exam if you’ve had a total hysterectomy), if requested by your doctor in the 12 months prior to listing and periodically after that (depending on age-related guidelines).

If you do not meet these requirements, you may be placed “on hold” and be unable to receive a transplant.

If you are on hold you cannot be offered donated livers. It is your responsibility to make sure testing is completed and the results are sent to our office.

You may also be placed on hold for:

  • Medical reasons such as infection, stroke, heart attack, other new serious illnesses or surgeries
  • Non-medical reasons such as a change or loss of insurance, social support, compliance concerns, or getting better
  • Violation of our substance use policy.

You may be removed from the waiting list for several reasons:

  • Complications that make you too sick for liver transplantation
  • Non-adherence to the substance use policy
  • Non-adherence to medication regimens, clinic appointments, or lab testing
  • Improved liver disease

Call if:

  • You have been admited to the outside hospital
  • Your medical condition changes or another doctor changes your medications or prescribes a new medication
  • Your telephone number or address changes
  • When you need to travel out of town
  • You and your family have questions or concerns

 

When you are added to the waiting list, please prepare for when a liver bcomes available by doing the following:

  • Keep the transplant coordinator informed on how to reach you (i.e. cell phone numbers and contact information for your caregivers as a back-up). They will only have 1 hour to notify you when a liver becomes available.
  • Make arrangements for a safe driver to bring you and your family to the hospital.
  • Make a plan for someone to care for your children and pets.
  • Identify a spokesperson (someone consistently involved in your care) to communicate with the transplant team before, during, and after surgery.

You will have adequate time to travel to the hospital. Your travel time will be considered while we are making arrangements for your surgery. Do not speed to the hospital and please wear your seatbelt.

Your Liver Patient Education Guide

  • Personal items including glasses, hearing aids, and loose fitting clothes to wear after the surgery
  • Current medications
  • Medical devices used at home such as a CPAP machine, insulin pump, diabetic testing supplies, canes, or other walking devices
  • Money for parking and meals for your family

 

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