Successful Living Donor Liver Transplantation for Decompensated Liver Cirrhosis
PACE Hospitals
PACE Hospitals’ expert Liver Transplant team successfully performed a Living Donor Liver Transplantation (LDLT) on a 40-year-old male patient diagnosed with decompensated cirrhosis secondary to chronic alcohol-related liver disease. The aim of the procedure was to replace the diseased liver with a healthy donor liver graft, restore liver function, and prevent life-threatening complications associated with end-stage liver disease.
Chief Complaints
A 40-year-old male patient with a Body Mass Index (BMI) of 18 presented to the Liver Transplant Department at PACE Hospitals, Hitech City, Hyderabad, with abdominal distension associated with breathlessness for the past five days. He also complained of tremors involving both lower limbs and loss of appetite.
Past Medical History
The patient had a history of chronic alcohol-related liver disease diagnosed 4 months before. He was also diagnosed with hepatic encephalopathy 2 months earlier and had been experiencing recurrent episodes of abdominal distension, suggesting progressive decompensation of liver function.
On Examination
On examination, the patient was conscious, alert and oriented. Abdominal distension was noted and was associated with breathlessness. Tremors involving both lower limbs were observed. The patient appeared weak and reported loss of appetite. Abdominal examination findings were consistent with abdominal distension in the background of chronic liver disease. No focal neurological deficits were reported in the available case details.
Diagnosis
Following the clinical evaluation, the liver transplant team conducted a comprehensive evaluation based on the patient’s complaints of abdominal distension with breathlessness, tremors involving both lower limbs, and loss of appetite in a known case of chronic alcohol-related liver disease.
A detailed medical history, physical examination, and necessary preoperative assessment were performed to evaluate the severity of underlying liver disease, associated complications, and overall suitability for liver transplantation.
Comprehensive laboratory and imaging investigations were carried out to assess liver function, kidney function, coagulation status, portal hypertension, ascites, and overall transplant fitness. Based on the evaluation, the patient was diagnosed with decompensated liver cirrhosis.
The decompensation was associated with portal hypertension, ascites, coagulopathy, hepatic encephalopathy, and hepatorenal involvement. The patient’s Model for End-Stage Liver Disease (MELD)-Na score was 23, indicating significant severity of liver disease, and the Child-Turcotte-Pugh (CTP) score was Class C, suggesting advanced liver dysfunction.
Based on the confirmed diagnosis and severity of the condition, the patient was advised to undergo Decompensated Liver Cirrhosis Treatment in Hyderabad, India, under the care of the liver transplant team, to manage advanced liver failure and prevent further life-threatening complications.
Medical Decision-Making (MDM)
After a detailed consultation with Dr. CH Madhusudhan (liver transplant surgeon), along with the cross-consultation with Dr. Govind Verma (Senior Consultant in Gastroenterology and Hepatology), a comprehensive clinical evaluation was carried out to determine the most appropriate management plan for the patient. The patient was a known case of chronic alcohol-related liver disease and presented with abdominal distension associated with breathlessness, tremors involving both lower limbs, loss of appetite, recurrent ascites, and a previous history of hepatic encephalopathy.
Based on the clinical findings and investigations, the patient was diagnosed with decompensated liver cirrhosis with portal hypertension, ascites, coagulopathy, hepatic encephalopathy, and hepatorenal involvement. His MELD-Na score was 23, and the Child-Turcotte-Pugh (CTP) score was Class C, indicating advanced liver dysfunction and a high risk of further deterioration.
After understanding the patient’s condition, the patient’s brother came forward as a living liver donor. Following the required donor evaluation, recipient assessment, medical fitness review, and necessary clearances, it was determined that Living Donor Liver Transplantation (LDLT) with an extended right lobe graft was the most suitable definitive intervention.
The patient and family members were counselled in detail regarding the severity of the liver disease, the need for liver transplantation, the surgical procedure, possible risks and complications, postoperative ICU care, long-term immunosuppressive therapy, medication adherence, infection prevention, and the importance of regular follow-up after transplantation.
Surgical Procedure
Following the decision, the patient was scheduled to undergo Living Donor Liver Transplantation (LDLT) in Hyderabad at PACE Hospitals under the expert care of the liver transplant team.
The procedure involved the following steps:
- Preoperative Preparation and Anaesthesia: The patient was shifted to the operating room after completion of the required preoperative evaluation, donor assessment, and necessary clearances. General anaesthesia was administered, and the patient was prepared for liver transplant surgery with continuous monitoring.
- Recipient Exploration and Diseased Liver Assessment: The abdominal cavity was accessed, and the diseased liver was carefully assessed. Features of advanced chronic liver disease and portal hypertension were considered during the surgical dissection.
- Native Liver Mobilization and Removal: The diseased liver was carefully mobilized from the surrounding structures. Major blood vessels and bile duct structures were identified and controlled. The native diseased liver was then removed to prepare the recipient for graft implantation.
- Donor Liver Graft Implantation: A right lobe modified liver graft donated by the patient’s brother was implanted. The graft was positioned appropriately in the recipient’s abdomen to restore liver function.
- Vascular Reconstruction: The donor liver graft's blood vessels were connected to the recipient’s major blood vessels to restore blood inflow and outflow. After vascular reconstruction, blood flow to the transplanted liver graft was checked.
- Biliary Reconstruction: The bile duct connection was reconstructed to allow bile drainage from the transplanted liver, which is important for normal digestive and liver function after transplantation.
- Hemostasis and Closure: After confirming satisfactory graft perfusion and control of bleeding, the surgical area was checked carefully. The abdomen was closed in layers, and the patient was shifted to the intensive care unit for close postoperative monitoring.
Postoperative Care
The postoperative period was uneventful, except for a brief requirement of oxygen support, which was gradually weaned off. The patient was closely monitored for graft function, hemodynamic stability, and overall recovery. He received medicines to protect the transplanted liver and prevent rejection, prevent infection, gastric protection, nutritional support, nausea control, pain relief, fever control, and other supportive care as required.
Discharge Medications
Upon discharge, the patient was advised of medications for graft protection and prevention of rejection, along with antibiotics for infection prevention. He was also prescribed medicines for gastric protection, nutritional supplementation, nausea control, pain relief, fever management, and other supportive care.
Advice on Discharge
The patient was advised to follow the recommended diet, maintain proper hygiene, and take all prescribed medications regularly. He was counselled regarding the importance of immunosuppressive therapy, infection prevention, and regular follow-up after liver transplantation.
He was also advised to avoid exposure to infections, follow transplant team instructions carefully, and report any new or worsening symptoms immediately.
Emergency Care
The patient was informed to contact the emergency ward at PACE Hospitals in case of the development of symptoms like fever, abdominal pain, vomiting, breathing difficulty, worsening weakness, yellowish discoloration of the eyes, confusion, bleeding, wound-related concerns, or any sudden clinical deterioration.
Review and Follow-Up Notes
The patient was advised to attend regular follow-up visits with the Surgical Gastroenterologist in Hyderabad at PACE Hospitals after discharge. Follow-up was recommended to monitor transplanted liver function, adjust medicines when required, assess recovery, and detect any early signs of infection, rejection, or other postoperative concerns.
Conclusion
This case highlights the successful management of decompensated liver cirrhosis through Living Donor Liver Transplantation. The patient had advanced liver disease with portal hypertension, ascites, hepatic encephalopathy, coagulopathy, and hepatorenal involvement. Timely transplant evaluation, living donor support from the patient’s brother, expert surgical care, and careful postoperative monitoring helped achieve a successful outcome. The patient recovered well and was discharged in a stable condition with medications, counselling, and follow-up advice.
Role of Liver Transplant Specialist in Comprehensive Care for Decompensated Cirrhosis
A Liver Transplant doctor /specialist plays a vital role in managing patients with advanced decompensated cirrhosis, where timely evaluation and treatment decisions are critical. In this case, the patient had portal hypertension, recurrent ascites, hepatic encephalopathy, coagulopathy, and hepatorenal involvement, making liver transplantation the definitive treatment option. The liver transplant team helped in assessing disease severity, stabilizing the patient before surgery, coordinating living donor evaluation, planning the transplant procedure, and monitoring recovery after surgery. Postoperative care included close observation of graft function, infection prevention, medication management, and counselling for long-term follow-up.
Frequently Asked Questions (FAQs)
Why does decompensated cirrhosis cause abdominal distension?
Decompensated cirrhosis can cause abdominal distension because fluid collects inside the abdomen, a condition called ascites. This usually happens due to increased pressure in the liver blood vessels, known as portal hypertension, and reduced liver function. As fluid increases, the abdomen may feel tight, heavy, or swollen.
Why did this patient have breathlessness with abdominal distension?
Breathlessness can occur when excess abdominal fluid puts pressure on the diaphragm and lungs. This makes it harder for the lungs to expand fully, especially while lying down or walking. In advanced liver disease, weakness, anemia, or fluid imbalance may also add to breathing discomfort.
Why do tremors occur in advanced liver disease?
Tremors in advanced liver disease may occur due to hepatic encephalopathy, a condition where the liver cannot clear toxins properly from the blood. These toxins can affect brain and nerve function, leading to hand flapping, tremors, confusion, sleep changes, or reduced alertness.
What does a MELD-Na score of 23 indicate?
A MELD-Na score of 23 indicates significant liver disease severity. This score helps doctors understand how seriously the liver is affected and how urgently advanced treatment, including liver transplantation, may be needed. A higher score usually means a higher risk of complications and worsening liver failure.
What does Child-Turcotte-Pugh Class C mean?
Child-Turcotte-Pugh Class C means advanced liver dysfunction. This classification is used to assess the severity of cirrhosis based on factors such as bilirubin, albumin, blood clotting ability, ascites, and hepatic encephalopathy. Class C usually indicates severe liver disease that needs specialist care.
Why was liver transplantation advised for this patient?
Liver transplantation was advised because the patient had decompensated cirrhosis with serious complications such as ascites, portal hypertension, coagulopathy, hepatic encephalopathy, and hepatorenal involvement. In such advanced liver disease, medicines may help control symptoms, but a liver transplant may be the definitive treatment to restore liver function.
Is it safe to donate part of the liver?
Living liver donation is generally considered safe when the donor is carefully selected and medically fit. Before donation, the donor undergoes detailed tests to check liver health, blood group compatibility, overall fitness, and surgical risk. The liver has the ability to regenerate, but donation is still a major surgery and must be done only after complete evaluation and counselling.
Why are immunosuppressive medicines needed after liver transplant?
Immunosuppressive medicines are needed to prevent the body from rejecting the transplanted liver. After a transplant, the immune system may identify the new liver as foreign and attack it. These medicines help protect the graft, but they must be taken exactly as advised because missing doses can increase the risk of rejection.
What precautions are needed after liver transplant surgery?
After liver transplant surgery, the patient should take medicines regularly, maintain hygiene, avoid exposure to infections, follow the recommended diet, and attend follow-up visits on time. Fever, abdominal pain, vomiting, jaundice, confusion, wound discharge, or sudden weakness should be reported immediately. Long-term care is important to protect the transplanted liver.
Why is regular follow-up important after liver transplantation?
Regular follow-up is important to monitor transplanted liver function, adjust medicines, check for infection, and detect early signs of rejection or other complications. Blood tests and clinical reviews help doctors ensure that the graft is working well. Follow-up also helps guide diet, lifestyle, and long-term recovery after transplant.
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