Success Story of Living Donor Liver Transplantation for Decompensated Liver Cirrhosis

A 55-year-old male patient with a history of hepatic encephalopathy (brain dysfunction due to liver insufficiency) and a known case of chronic liver disease was presented to the hepatologist with a distended abdomen and altered behaviour. He was admitted to the hospital for further management.

Medical History

Delving deeper, it was evident that the patient was a known case of diabetes, chronic liver disease and underwent multiple EVI banding in the past.

Diagnosis 

Upon being admitted to PACE Hospitals and undergoing necessary investigations, the patient was diagnosed with the following: 

• Decompensated Chronic Liver Failure with Portal Hypertension, Ascites, Hepatic Encephalopathy, Hepto Renal Syndrome.
  

The condition of the decompensated liver in chronic liver failure disease is due to portal hypertension, which explains the reason for ascites, hepatic encephalopathy, damaged hepatorenal system, and his altered sensorium. The Model for End-Stage Liver Disease (MELD) Na score is 32, and the Child-Turcotte-Pugh (CTP) score falls in the range of C.

Treatment

The diagnosing transplant hepatologist, Dr. Govind Verma, asserted a liver transplant was the only way to salvage / save the patient for liver cirrhosis treatment.

The patient was put on multiple life-saving supports; efforts were made to obtain a liver from donors after the party was counseled about the urgency of a liver transplant. Finally, the wife of the patient came forward willfully to donate a portion of her liver.

Both the patient, the donor, and their attendees were counseled about the liver transplant procedure. Passing the pre-anaesthesia checkup (PAC) test and obtaining all the clearances, the patient signed the informed consent.

The patient underwent living donor liver transplantation (LDLT), receiving the right lobe modified liver graft. The procedure was supervised by the liver transplant surgeon, Dr. CH Madhusudhan, and it was accomplished devoid of any complications.

The aftermath

The post-operative period was uneventful except for the requirement of insulin infusion to counter the level of uncontrolled sugars in the blood. The recuperation was devoid of any defects in the liver draft, as evidenced by Doppler examination.

On the 9th day of post-operation, the medical team observed a sudden onset bloody drain output, which was managed conservatively. Coagulopathy is one of the most common anticipated complications in patients suffering from end-stage liver disease (ESLD). In fact, coagulopathy and thromboembolic disorders have been considered one of the dominant clinical complications in ESLD. This is a similar hemorrhagic post-operative hemorrhagic incident that was dealt with in the conventional way.

The necessary medicines, immunosuppressive, antibiotics, antifungals, proton pump inhibitors, multivitamins, antiemetic, analgesics, antipyretics & other supportive care were given along with the counseling. Once the patient achieved hemodynamic stabilization, he was discharged with the necessary medications and advice for follow-up.

Praising the selfless sacrifice of the wife of the patient, the liver transplant surgeon - Dr. CH Madhusudhan remarked on the role of the healthcare team in the procedure, “Thanks to the tireless efforts of devoted family members and the exceptional skills of the PACE team of coordinators and medical specialists, a life-saving liver transplant was successfully performed. Both the donor and the recipient are on the road to recovery, showcasing the triumph of human compassion and medical excellence," said Dr. CH Madhusudhan, Liver Transplant Surgeon at PACE Hospitals, Hyderabad.

Altered sensorium (altered mental status) refers to the broad spectrum of disorders of mentation, including impaired cognition, diminished attention, reduced awareness, and/or altered level of consciousness, which may be gradual or sudden in onset in cirrhosis patients. 

Although believed to be originated from hepatic encephalopathy, the etiology of altered sensorium this is a challenge to the medical fraternity as they need to rule out various extensive diagnoses (neurologic examination, infections, metabolic abnormalities, drug intoxication, and intracranial haemorrhage etc.) before arriving to the cirrhotic state. 

It has been shown that liver transplantation can improve both neurological manifestations apart from maintaining a stable liver function.

Department of Liver Transplantation