First words to liver transplant recipients when put on the waiting list.
Please read this before anything else……
You have advanced liver disease. Your doctor has predicted correctly that you need a liver transplant and our opinion is the same. We feel that the disease is sufficiently advanced for you to be listed. We list and treat patients with tense ascites, HRS as early as possible, as we have seen from our own data and experience that our patients have only a short window after which they become too sick to undergo liver transplant. However, listing for cadaveric liver transplant will mean a waiting period of 6 - 12 weeks. If you do not get a liver within that time, there is a higher chance of dying from the complications of liver disease. You can have a living donor liver transplant if you have a suitable donor.
No matter what caused your liver disease, the end stage of all damaged livers is called cirrhosis. Cirrhotic livers will not clear toxins, will not make adequate proteins, will not make adequate clotting proteins. For reasons unknown, it causes failure of vascular tone and the body is fooled into thinking that you have less fluid in your body and the kidney starts preserving fluid. This leads to ascites and leg swelling.
Low proteins and large amount of fluid will lead to more infections, compromised quality of life. Cirrhosis increases the risk of getting liver cancer. All these contribute to early death in these patients. Sometimes the liver disease can be treated to slow the process of deterioration and this is why you must consult a liver specialist (Hepatologist).
People have studied the variation in liver disease and the risk of dying from liver disease. We all know that not all alcoholics develop liver disease and we know that all cirrhotics will not die from liver disease. So we started stratifying the risk. The best assessed risk model is called the MELD score developed in Mayo Clinic in USA. This number is derived from a formula using bilirubin (your jaundice number), creatinine (your kidney number) and INR (Blood clotting number). This number varies between 6 and 40 and this number predicted the 3 month survival of patients with liver disease. This has been predicted to be accurate and is used all over the world to assess the risk of dying and allocate livers for transplantation.
When you have a compromised health due to liver disease, it is very important to make sure that the other organs in your body remains healthy. If we are able to keep other organs healthy, we can ensure a longer length of life for the patient. To this end, we advise all patients to walk 2K every day, as much as possible, do respiratory exercises, do hand grip exercises on a regular basis.
For all liver disease patients, we evaluate for underlying cardiac illness and respiratory illness and we prefer to do a complete health check-up. The results of the study will be available in 5 days and any option to improve your health can be done. We also make sure that all the options of improving your liver health is done and such optimisation will improve your liver condition and will help you get on with life better.
All these treatments require monthly monitoring to make sure that every system in your body is functioning optimally. Tests that are done to detect optimal functions are CBC, Bilirubin, Creatinine, Electrolytes, Albumin, INR. These are tests that are grouped together as CLD follow up labs. These labs can be sent to the liver physician and you need to see the doctor only when needed. Your liver co-ordinator will call you and discuss your results. By ensuring that your health is not on the down swing, we stabilise your health by making minor adjustments and prevent recurrent hospitalisations that can shorten your life.
Liver diseases tend to worsen at different rates. If your MELD change is rapid, due to any other illness, you may not get back to the best health. This will lead to sudden changes in your health and will increase the risk of dying from the disease. Transplant alone will not change this. Prompt medical attention and structured care will allow you to recover quickly.
We recommend that you prepare financially for liver transplant once the diagnosis of cirrhosis is made. The rough cost of liver transplantation in our unit is 20 L*. Incidental admission costs vary between 1 l to 4 L depending on the severity of the complication. It is for this reason and the inability to restore normal health that we advise our patients to list for transplant at a MELD of 15. This is the recommendation of most of the liver associations around the world.
We will check the MELD number at specified intervals and if we feel that your MELD number is high enough to warrant transplantation, we can proceed to do the appropriate testing for living donor liver transplantation, if you and your family feels it is appropriate for you.
You have advanced liver disease. Your doctor has predicted correctly that you need a liver transplant and our opinion is the same. We feel that the disease is sufficiently advanced for you to be listed. We list and treat patients with tense ascites, HRS as early as possible, as we have seen from our own data and experience that our patients have only a short window after which they become too sick to undergo liver transplant. However, listing for cadaveric liver transplant will mean a waiting period of 6 - 12 weeks. If you do not get a liver within that time, there is a higher chance of dying from the complications of liver disease. You can have a living donor liver transplant if you have a suitable donor.
No matter what caused your liver disease, the end stage of all damaged livers is called cirrhosis. Cirrhotic livers will not clear toxins, will not make adequate proteins, will not make adequate clotting proteins. For reasons unknown, it causes failure of vascular tone and the body is fooled into thinking that you have less fluid in your body and the kidney starts preserving fluid. This leads to ascites and leg swelling.
Low proteins and large amount of fluid will lead to more infections, compromised quality of life. Cirrhosis increases the risk of getting liver cancer. All these contribute to early death in these patients. Sometimes the liver disease can be treated to slow the process of deterioration and this is why you must consult a liver specialist (Hepatologist).
People have studied the variation in liver disease and the risk of dying from liver disease. We all know that not all alcoholics develop liver disease and we know that all cirrhotics will not die from liver disease. So we started stratifying the risk. The best assessed risk model is called the MELD score developed in Mayo Clinic in USA. This number is derived from a formula using bilirubin (your jaundice number), creatinine (your kidney number) and INR (Blood clotting number). This number varies between 6 and 40 and this number predicted the 3 month survival of patients with liver disease. This has been predicted to be accurate and is used all over the world to assess the risk of dying and allocate livers for transplantation.
When you have a compromised health due to liver disease, it is very important to make sure that the other organs in your body remains healthy. If we are able to keep other organs healthy, we can ensure a longer length of life for the patient. To this end, we advise all patients to walk 2K every day, as much as possible, do respiratory exercises, do hand grip exercises on a regular basis.
For all liver disease patients, we evaluate for underlying cardiac illness and respiratory illness and we prefer to do a complete health check-up. The results of the study will be available in 5 days and any option to improve your health can be done. We also make sure that all the options of improving your liver health is done and such optimisation will improve your liver condition and will help you get on with life better.
All these treatments require monthly monitoring to make sure that every system in your body is functioning optimally. Tests that are done to detect optimal functions are CBC, Bilirubin, Creatinine, Electrolytes, Albumin, INR. These are tests that are grouped together as CLD follow up labs. These labs can be sent to the liver physician and you need to see the doctor only when needed. Your liver co-ordinator will call you and discuss your results. By ensuring that your health is not on the down swing, we stabilise your health by making minor adjustments and prevent recurrent hospitalisations that can shorten your life.
Liver diseases tend to worsen at different rates. If your MELD change is rapid, due to any other illness, you may not get back to the best health. This will lead to sudden changes in your health and will increase the risk of dying from the disease. Transplant alone will not change this. Prompt medical attention and structured care will allow you to recover quickly.
We recommend that you prepare financially for liver transplant once the diagnosis of cirrhosis is made. The rough cost of liver transplantation in our unit is 20 L*. Incidental admission costs vary between 1 l to 4 L depending on the severity of the complication. It is for this reason and the inability to restore normal health that we advise our patients to list for transplant at a MELD of 15. This is the recommendation of most of the liver associations around the world.
We will check the MELD number at specified intervals and if we feel that your MELD number is high enough to warrant transplantation, we can proceed to do the appropriate testing for living donor liver transplantation, if you and your family feels it is appropriate for you.
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