Wiki Fatty Liver

The Journey of a Patient Undergoing Liver Transplant

Case Study: The Journey of a Patient Undergoing Liver Transplant

Patient Profile:

• Age: 55 years old
• Gender: Female
• Underlying Condition: Cirrhosis due to chronic hepatitis C
• Additional Factors: Type 2 diabetes, hypertension

Initial Diagnosis and Referral:

• Diagnosis: The patient had been living with chronic hepatitis C for several years. Despite antiviral treatment, she progressed to end-stage liver disease (cirrhosis), characterized by fatigue, jaundice, and ascites (fluid in the abdomen). Her liver function tests showed significantly elevated bilirubin, INR, and low albumin.
• Referral for Transplant: After failing to respond to other therapies, she was referred to a liver transplant center. Evaluation showed advanced cirrhosis, portal hypertension, and hepatocellular carcinoma (HCC), a small tumor within transplantable criteria.

Evaluation and Transplant List Placement:

• Comprehensive Evaluation: The patient underwent a thorough evaluation, including imaging (CT, MRI), cardiac and pulmonary testing, and psychological evaluation. Her case was reviewed by a transplant multidisciplinary team, assessing her MELD (Model for End-Stage Liver Disease) score, which quantifies liver disease severity.
• MELD Score: Her score was 22, indicating moderate severity, and she was placed on the transplant waiting list.

Waiting Period:

• Monitoring: During the waiting period (approximately 6 months), she was closely monitored for worsening liver function, infections, and changes in her cancer status. She received supportive treatments such as diuretics for ascites, regular paracentesis (fluid drainage), and nutritional support.
• Managing Complications: The patient developed hepatic encephalopathy (confusion due to liver failure) and required lactulose to manage her symptoms. Her MELD score fluctuated, but she remained eligible for transplantation.

The Liver Transplant Procedure:

• Donor Matching: After 6 months, a suitable deceased donor liver became available. The donor liver was a good match in size, blood type, and organ quality.
• Surgery: The patient underwent a 6-hour surgery where her diseased liver was removed, and the new liver was implanted. The surgery involved reattachment of blood vessels and bile ducts. She was transferred to the intensive care unit (ICU) post-operatively for close monitoring.

Post-Transplant Recovery:

• Immediate Post-Surgery:
  • The first 48 hours were critical. The patient was closely monitored for signs of rejection, bleeding, or infection. Immunosuppressive therapy (tacrolimus) was initiated to prevent organ rejection.
  • The liver function tests showed gradual improvement, and her bilirubin levels normalized within a week. She was weaned off the ventilator and moved out of the ICU after 4 days.
• Rehabilitation:
  • Over the next few weeks, the patient regained strength with physical therapy. She was educated on long-term medication management, infection prevention, and lifestyle modifications.
  • Immunosuppressive medications were adjusted, and regular blood work was done to monitor for rejection and liver function.

Long-Term Management:

• Medications:
  • The patient was maintained on a lifelong immunosuppressive regimen to prevent liver rejection. She was also prescribed medications to manage her diabetes and hypertension.
• Follow-Up:
  • Regular follow-up appointments were scheduled every 3 months to monitor for rejection, infection, or recurrence of liver disease. Ultrasound and blood tests were done periodically to ensure the liver was functioning well.
• Lifestyle:
  • The patient adhered to a low-sodium, healthy diet and engaged in regular exercise. She abstained from alcohol and maintained optimal control of her diabetes and hypertension.
• Quality of Life:
  • Over the next year, the patient’s quality of life significantly improved. She returned to normal activities and remained cancer-free. Her liver function stabilized, and she continued with routine medical surveillance.

Challenges and Considerations:

1. Risk of Rejection: The patient faced the ongoing risk of acute or chronic rejection, necessitating regular check-ups and adjustments in immunosuppressive therapy.
2. Infection Risk: Immunosuppressive drugs increase the risk of infections, so strict infection prevention measures were emphasized.
3. Psychosocial Aspects: Emotional support was important, as the patient experienced stress and anxiety before and after the transplant.

Conclusion:

The journey of a liver transplant patient is complex and requires multidisciplinary care, from pre-transplant evaluation through surgery and post-operative recovery. Long-term success depends on the patient’s adherence to medical recommendations, monitoring for complications, and maintaining a healthy lifestyle. With proper care, patients can regain a good quality of life post-transplant.

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