Liver Transplantation and Regenerative Medicine

What is Liver Failure?

Liver failure (due to cirrhosis or acute liver failure) is a condition that arises when the liver starts losing its ability to function. Liver function is an uncommon disease and demands immediate medical attention. The disease may or may not be reversible depending upon its type and extent.

Symptoms

Symptoms of liver failure include:

  • Abdominal pain towards the right side of the body
  • Swelling in the abdomen
  • Feeling of nausea and vomiting
  • Jaundice
  • Confusion and anxiety
  • Disturbed sleep
  • Diarrhea
  • Fatigue
  • Poor appetite
Causes

In some cases, liver failure may be caused due to unknown causes. However, some known causes of liver failure are:

  • Intake of certain medications like antibiotics, non-steroidal anti-inflammatory drugs and anticonvulsants might lead to liver failure. Herbal medicines like kava, ephedra and skullcap might also cause acute liver failure.
  •   Diseases like Budd-Chiari syndrome blocks liver veins of the liver that causes liver failure.
  • Metabolic diseases like Wilson’s disease often cause liver failure.
  • An overdose of acetaminophen often leads to liver failure.
  •  Certain viruses like Hepatitis A, hepatitis B and hepatitis E may lead to acute liver failure.
  • Autoimmune hepatitis is a condition in which the patient’s immune system starts damaging the liver cells which may lead to acute liver failure.
  • Liver failure can also occur when the liver gets affected by cancer.
Risks

Some risk factors associated with liver failure are:

  • Acetaminophen: Acetaminophen is a painkiller that is often prescribed by doctors. It is the most common cause of acute liver failure.
  •   Diseases: Patients diagnosed with diseases such as hepatitis, Wilson’s disease, cytomegalovirus, Epstein-Barr virus and herpes simplex virus are at a high risk of developing liver failure.
Prevention

The disease can be prevented through the following means:

  •   Medicines like acetaminophen or other medications should be taken according to their dosage.
  •   Limiting the intake of alcohol and tobacco.
  •   Quitting smoking.
  •   Getting vaccinations for hepatitis or any other disease that may cause acute liver failure.
  •   Intake of poisonous wild mushrooms should be avoided.
  •  One should maintain a healthy weight and a balanced diet.
How is it diagnosed?

The doctor diagnosis liver failure by conducting certain blood test, imaging tests or by examining the liver tissue of the patient.

  •    Blood tests
  •     Ultrasound
  •     Liver biopsy
How is it treated?

Liver failure grows suddenly in a patient and can lead to some serious complications. The doctor may try to control the symptoms and the complications through medication or by conducting a liver transplant.

Medications

The doctors prescribe certain medicines that help in reducing the effects of Acetaminophen overdose or mushroom poisoning.

              Liver transplant

The doctor opts for liver transplant in cases where liver failure is irreversible. In the procedure, the doctor replaces the patient’s deceased liver with a healthy liver donated by another person.

              Screening tests

The screening tests help in detecting infections in the blood by collecting and analysing the samples of the patient’s blood.

        Reducing the risk bleeding

Bleeding can be reduced with the help of medications because blood loss may further worsen the complications.

 When do I contact the doctor?

Liver failure is dangerous for the patient’s life. The patient should be closely monitored for symptoms of acute liver failure. One should consult the doctor as soon as they start noticing any signs or symptoms of the disease in a person. The appropriate treatment and the associated side effects should be thoroughly evaluated and discussed with the doctor.

What is Hepatocellular Carcinoma?

Hepatocellular carcinoma is a condition that commonly arises in patients who are diagnosed with chronic liver diseases such as acute liver failure. Hepatocellular carcinoma is the most common kind of primary liver cancer. Primary cancers like Hepatocellular carcinoma originate from the patient’s liver itself.

Symptoms

 The symptoms of Hepatocellular carcinoma include:

  •   Sudden loss of weight
  •   Poor appetite
  •   Pain in the upper parts of the abdomen.
  •  Feeling of nausea and vomiting
  •   Weakness and fatigue
  •    Swelling in the abdomen
  •    Jaundice
  •     Pale coloured stools
Causes

The causes of Hepatocellular carcinoma are often unclear in some cases. However, in certain cases, it may develop due to chronic infection which is caused by the hepatitis virus. The disease may even develop due to certain abnormalities in the liver cells when they go through mutations. These clusters of cells may turn into a cancerous tumour.

Risks

The factors which increase the risk of Hepatocellular carcinoma in people include:

  •  Infections caused by the Hepatitis virus.
  •  Liver diseases like Cirrhosis, hemochromatosis and Wilson’s disease.
  •  Diabetes
  •  Accumulation of fat in the liver.
  •  Drinking and smoking.
        Prevention

There is no known prevention for this disease.

How is it diagnosed?

The disease can be diagnosed using the following tests:

  • Blood tests
  • Imaging tests
  •  Liver biopsy
How is it treated?

The doctor may try to control the symptoms and the complications of Hepatocellular carcinoma through medication or through surgical procedures.

             Surgery

The doctor conducts a surgery to remove the cancer from the patient’s liver.

              Liver transplant surgery

The doctor may opt for a liver transplant surgery in which he will remove the diseased liver and replace it with a healthy liver donated by another person.

       Destroying the cancerous cells

Cancer cells in the liver can be destroyed completely by subjecting them to extremely hot or cold conditions.

       Chemotherapy

In the procedure, the chemotherapy drugs are delivered to the liver with the help of a catheter.

        Radiation therapy

The doctor conducts a radiation therapy when a surgery can’t be conducted to treat the disease.

When do I contact the doctor?

The patient should be closely monitored for symptoms of Hepatocellular carcinoma. One should consult the doctor as soon as they start noticing any signs or symptoms of the disease in a person. The appropriate treatment and the associated side effects should be thoroughly evaluated and discussed with the doctor.

What is Liver Metastases?

Liver metastasis is a type of secondary liver cancer that starts growing in some other part of the body and then slowly spreads into the liver. The cancerous cells which originally develop in the patient’s heart, lung, breast or any other body part are carried to the liver where they settle and form another tumour. Liver metastasis disturbs the liver function and may result in swelling of the liver.

Symptoms

The symptoms of liver metastases include:

  • Poor appetite
  • Loss of weight
  • Colour of the urine becomes dark
  • Swelling in the abdomen
  • Jaundice
  • Pain in the right portion of the abdomen
  • Feeling of nausea and vomiting
  • Confusion
  • Fever
  • Liver becomes enlarged
Causes

The cause of liver metastases depends on the original location of cancer. The primary cancers which often spread to the liver and cause liver metastases include:

  • Breast cancer
  • Colon cancer
  • Rectal cancer
  •  Kidney cancer
  •  Esophageal cancer
  •   Lung cancer
  •   Skin cancer
  •  Ovarian cancer
  •  Pancreatic cancer
  •  Stomach cancer
Risks

Patients who are suffering from the specified primary cancers are at a risk of developing liver metastasis. Apart from that, obesity, an inactive lifestyle, unhealthy eating habits, excessive smoking and drinking can lead to liver metastasis.

Prevention

The disease can be prevented through the following means:

  •    Staying away from cancer causing chemicals and toxins
  •   Treating the primary cancers which may spread and result in liver metastases
  •    Maintaining a controlled body weight
  •    Following a balanced diet
  •    Maintaining a healthy and active lifestyle
  •  Quitting smoking and drinking
  •  Treating hepatitis infections
How is it diagnosed?

The doctor examines the size of the patient’s liver to detect the presence of cancer cells. He also examines the surface of the liver and checks the presence of any symptoms of liver cancer in the patient. In order to further confirm the presence of the disease, he opts for the following tests.

  •  Liver function tests
  • Laparoscopy
  •  CT scan
  •  MRI scan
  •   Blood tests
How is it treated?

While treating the disease, the doctor aims for controlling the symptoms and increase the patient’s life span. The treatments in most cases don’t cure the disease completely. The doctor decides the treatment based on the person’s age and health, the size, location and the type of primary cancer and the kind of cancer treatments the patient has had in the past.

    Chemotherapy

Chemotherapy involves the use of drugs to kill the cancerous cells and stop cancer from damaging the patient’s liver further.

   Biological response modifier (BRM) therapy

Biological response therapy is a treatment that involves the usage of antibodies and vaccines that increase the immune system’s ability to fight cancer.

   Targeted therapy

Targeted therapy is also used to destroy cancer causing cells without harming the healthy cells in the patient’s body. The therapy may result in side effects like fatigue and diarrhoea.

    Hormonal therapy

Hormonal therapy is used to treat liver metastases that are caused by cancers like breast or prostate cancer which are dependent on hormones for their growth.

   Radiation therapy

The radiation therapy uses high-energy radiation from radiation machines or radioactive substances to destroy the cancerous cells.

    Radiofrequency ablation (RFA)

RFA involves the use of high-frequency electrical currents to kill cancer causing cells.

 When do I contact the doctor?

One should consult the doctor as soon as they start noticing any signs or symptoms of liver metastases in the person. The appropriate treatment and the associated side effects should be thoroughly evaluated and discussed with the doctor. People who have suffered from cancer in the past should get regular checkups done.

 What is Hepatitis C?

Hepatitis is caused by a virus named Hepatitis C virus (HCV). The virus infects the liver, which results in inflammation of the liver. The virus is highly dangerous for the human body, and once it has entered, it becomes difficult for the immune system to discard it from the body, and as a result, the infection becomes chronic. The infection caused by HCV is the main root of terminal liver disease, and this liver disease requires a liver transplant. The terminal liver disease is also a major risk factor for liver cancer.

Symptoms

3/4 of the population suffering from hepatitis does not experience any signs and symptoms in the beginning. Over the time as the inflammation progresses, the persistent swelling may increase and some of the following symptoms may occur:

  •  Loss of appetite and weight.
  • Aches in muscles.
  •    Fever.
  •  Yellowish tint in the eyes.
  •  Severe weakness and fatigue.
  • Enlargement of breasts in men.
  •   Rashes on the palms.
  •  Difficulty in clotting of blood.
  •    Blood vessels become spider-like.
Causes

Blood is the main transportation mode for HCV and it can be transmitted in one of the following ways:

  •     Using an already used needle while injecting drugs.
  •      Using needles that are not sterilised.
  •       Getting the organ from a person who is already infected with HCV.
  •       Blood transfusion.
  •       Sharing personal care items (razor, nail clippers, toothbrush, etc.) with a person infected with the virus.
  •       Sexual intercourse with an infected person.
Risks

The following conditions may increase the risk of disease:

  •    Drug addiction.
  •    Tattoos and piercings.
  •     A blood transfusion or an organ transplant.
  •    Treatment with hemodialysis.
  •     Being born to a woman with HCV.
Prevention

To prevent the occurrence of Hepatitis C, these are certain things one should take care of:

  •   Avoid sharing personal items such as razors and toothbrush.
  •   Practice safe sex.
  •  Adopt healthy lifestyle.
  •  Avoid alcohol and consumption of drugs.
  •  Avoid sharing needles while using intravenous drugs.
How is it diagnosed?

The following technologies are used to find the existence of Hepatitis C:

  • Blood tests
  • Biopsy
  • Fibroscan
How is it treated?

The following methods are used to treat the disease:

              Medication

Antiviral medicines are generally used to clear out the virus from the body. The doctor can advise a combination of medicines that have to be taken over some days or weeks. While you are taking the medicines, the doctor will monitor the response.

            Liver Transplant

If the liver is severely damaged because of the virus, liver transplantation is an available option. During the procedure, the surgeon replaces the injured liver with a healthy liver. Most of the healthy livers for transplantation come from deceased patients, although, some of them come from patients who are living, but they donate a portion of their liver to the receiver. For a person infected with the virus, transplantation is not the ultimate cure. The patient will have to continue taking antiviral medicines as the infection may recur in the healthy liver too.

When do I contact the doctor?

You should immediately consult a doctor, if you suddenly start to notice the symptoms such as fatigue, fever, jaundice, loss of appetite, sore muscles, nausea, dark urine, bleeding, vomiting, or yellow-gray stools. If you feel extremely confused or start to hallucinate, this could also be a probable sign of Hepatitis C.

 What is Bile Duct Cancer?

Bile duct cancer, also known as cholangiocarcinoma, develops in the tubes called bile ducts that connect the liver and the gall bladder. The bile ducts are responsible for carrying the digestive liquid bile which is a waste product of the liver. The cancer usually causes narrowing of the bile ducts and disturbs their function.

Bile duct cancer can be of the following types:

  •       Intrahepatic cholangiocarcinoma: It develops in the parts of the bile ducts inside the liver.
  •       Hilar cholangiocarcinoma: It develops in the bile ducts that are situated right outside of the liver.
  •      Distal cholangiocarcinoma: It develops in the part of the bile duct that is close to the small intestine.
Symptoms

The symptoms of bile duct cancer include:

  •   Jaundice
  •     Irritation on the skin
  •     Pale stools
  •     Fatigue and weakness
  •     Pain in the abdomen area
  •    Unusual weight loss
Causes

Bile duct cancer develops when the bile duct cells go through certain genetic changes called mutations. These mutated cells combine and form a cancerous tumour. The cause of these genetic mutations in still unclear.

Risks

The following factors increase the risk of bile duct cancer in people:

  •     Primary sclerosing cholangitis: The disease makes the bile ducts hard and causes severe damage which might lead to bile duct cancer.
  •   Chronic liver disease: Patients who have suffered from chronic liver diseases are at a higher risk of developing bile duct cancer.
  •      Problems in bile duct since birth: People who are born with choledochal cysts are at a higher risk of developing bile duct cancer.
  •     Age: The risk of developing bile duct cancer increases with age.
  •   Smoking: People who smoke are more vulnerable to liver problems and hence have a higher probability of having bile duct cancer.
Prevention

Bile duct cancer can be prevented by getting a vaccination for hepatitis B virus, taking precautions to avoid blood-borne or sexually transmitted infections, treating hepatitis infections (such as B and C) to help prevent cirrhosis and quitting smoking and drinking.

How is it diagnosed?

The doctor diagnosis bile duct cancer by conducting several tests on the patient which help in indicating the presence of cancerous cells in the bile duct.

  •  Tumor marker test
  • Liver function test
  • Examining the bile duct with a small camera
  • Biopsy
  • Imaging tests
How is it treated?

Bile ducts are responsible for draining of the digestive fluid bile. Bile duct cancer disturbs the function of the bile tubes. The doctor focuses on restoring the function of bile ducts using treatment. The doctor may opt for the following therapies while treating bile duct cancer.

Surgery

During surgery, the doctors try to remove the tumour from the patient’s body. The deceased part of the bile duct is removed and the ends are joined back together.

 Liver transplantation

In this procedure, the doctor removes the diseased liver from the patient’s body and replaces it with a healthy liver donated by another person.

 Chemotherapy

Chemotherapy involves the usage of drugs to destroy the cancerous cells. It reduces the growth of the cancer and helps in controlling the symptoms.

 Radiation therapy

Radiation therapy involves the use of high-energy beams produced by a radiation machine or by the radioactive substances to kill the cancer cells.

Biliary drainage

Biliary drainage helps to restore the flow of bile. The doctor may carry a bypass surgery to make a new passage for bile drainage. This process also helps in controlling the signs and symptoms of bile duct cancer.

When do I contact the doctor?

One should consult the doctor as soon as they start noticing any signs or symptoms of bile duct cancer in the person. The appropriate treatment and the associated side effects should be thoroughly evaluated and discussed with the doctor.

 What is Biliary Atresia?

Biliary Atresia is a rare disease of the liver and bile ducts mostly occurring in infants. The early symptoms of the disease start developing anytime between 2-8 weeks after birth. Bile is a liquid produced by the cells in the liver which helps digest fat. It also carries the waste from the liver to the small intestine for excretion. When an infant is suffering from biliary atresia, the bile flow from liver to gallbladder is blocked causing the bile to be trapped inside the liver, and damaging the liver cells.

There are three main types of extrahepatic biliary atresia:

  •   Type I: Atresia is restricted to the common bile duct.
  •  Type II: Atresia of the common hepatic duct.
  •   Type III: Atresia involves the most proximal part of the bile ducts (>95% of all cases).
Symptoms

Initially, the symptoms of this disease are non-distinguishable to neonatal jaundice. Children and infants with biliary atresia begin to show particular symptoms of the disease from 2-8 weeks of their birth onwards. When the bile fails to drain from the liver due to blockage, it starts to build up inside and causes damage and scarring of liver cells.

The symptoms include:

  • Jaundice.
  • Itchiness.
  • Pale stool.
  • ·Dark or orange urine.
  • Swollen abdomen.
  •   Poor absorption of nutrients causing delay in growth and weight loss.
Causes

The causes and reasons of biliary atresia are not completely understood. But in some cases, the incomplete development of bile duct in the mother’s womb could be a reason, or the bile ducts could be affected due to a virus infection in perinatal period. Also, there are no links to medications taken during pregnancy. It is evident that 10-15% of infants with the disease are born with abnormalities in the:

  • Heart.
  •  Blood vessel (inferior vena canal anomalies).
  •  Intestinal (malrotation).
  •   Spleen (Polysplenia)
Risks

The main risk factors are:

  •       Infection.
  •    Smoking.
  •  Genetic factors.
  •    Environmental toxins.
Prevention

To prevent the occurrence of this disease, one should take care of:

  • Health.
  • Sleep hours.
  •    Physical fitness.
  •   Eating habits.
How is it diagnosed?

At TX Hospitals, diagnosis is made based on symptoms, physical examination, and medical history of the patient using blood tests, biopsy of liver, and imaging for a better and clearer picture.

Blood tests confirm liver function abnormalities and identify the cause of jaundice.

  •  X-ray
  • Ultrasound
  • Blood tests
  • Biopsy
  • Surgery
How is it treated?

Biliary Atresia cannot be treated with medication. Other treatment option include:

  Removal of damaged ducts

The surgeon removes the damaged ducts outside the liver and identifies smaller ducts still open and draining bile. A loop of intestine is then attached to these open ducts for proper drainage and flow of bile from healthy ducts.

Long-term antibiotic therapy

It is prescribed for avoiding any infection along with additional medications to maximize the success of the operation. In cases where Kasai procedure is not successful, liver transplant is the only solution. Success of the procedure is dependent on:

  • Age: Younger the infant, greater the success rates of operation.
  • Extent of Liver damage.
  • Number and size of functional and healthy ducts.
  • Experience of the surgical and medical team
When do I contact the doctor?

A person should immediately consult a doctor, if he/she experiences any vitamin deficiencies, weak bones, decreased mental function, enlarged veins or cirrhosis. Our expert doctor with the assistance of advanced equipments and technology, shall thoroughly take care of your health.

 Metabolic Liver Diseases

Metabolic liver diseases is an umbrella term that is used to describe rare conditions such as Wilson’s Disease, amino acid disorders and hyperoxaluria, in which the liver loses its ability to fun