When a liver is unable to perform its function properly it is replaced with another healthy liver which is donated by an individual liver is the vital organ of human body as it performs functions like removal toxins from body, regulation of immune system, processing of nutrients and hormones, production of bile and helps to produce protein clotting factor.

Liver transplant is done in individuals who lack proper functioning of liver because of chronic stage of liver disease. Liver can fail in certain individuals who will require immediate transplant of the organ. The number of recipient is greater than the donors.7, 200 transplants of liver were performed in US in 2014 among American adults and children. [1]

 Liver failure can be short term or long term. If the liver infection occurs quickly it is known as acute liver infection and if it takes as long as months or years it is known as chronic infection of liver. Major cause of chronic liver failure is cirrhosis which is a condition in which liver is scarred. It is one of the most common reasons of cirrhosis. Reasons which lead towards liver failure and transplant include;

Hepatitis B and C, alcoholic liver, fats, genetic disorders etc.

Potential risks for patients of Liver transplant

The ratio of performing liver transplant from a living donor is low, but if it is performed very small portion is taken. Living donor transplant is done for children because deceased donor of liver size this small is available. Now the approach is also used for adults. The surgery carries risks for the recipient. All surgeries include risks and several surgeons have come across complications in regard to liver transplantation. The knowledge of risks provides us knowledge to avoid the future risks of infection and reduced complications during the surgery and treatments. Occurrence of any potential after liver transplantation is very rare event. But if it occurs it further requires medical attention and treatment.

Following risks for patients of liver transplant can take place:

1.      Leakage of bile of Liver transplant

Bile is the yellowish fluid which is produced in the liver of human for lipid digestion. If proper cautions are not taken such problems occur. Bile leakage is the complication which often resolves itself. Medically, such problem can be treated by the help of doctor by putting a tube in live.

2.      Small for-size syndrome of Liver transplant

Any recipient who receives the part of liver above the borderline volume is at high risk of disease known as for-size syndrome. It is associated with hyperbilirubinemia, end of synthetic function of hepatic cells and ascites.

3.      Organ damage of Liver transplant

Deceased as well as living donors can cause organs to damage. If the complications are not corrected it further lead towards severe problems and even death. [2]

4.      Infection of Liver transplant

People with liver transplant are at great risk of getting an infection. Infections can occur at the sight of surgery. These infections can be bacterial or viral. When liver is transplanted anti-rejection drugs are given to recipient to suppress the immune system. This risk can be reduced over time. Not all the patients get problem from these infections and there are several infections which can be treated naturally.

5.      Rejection of Liver transplant

Our immune system is responsible for fighting against any foreign body which enters in our body. The immune system is not so efficient to tell the difference between an invader particle and transplanted organ and can therefore cause reactions or attack to destroy which is the reason behind rejection of the transplanted organ. 30% patients of liver transplant experience organ rejection in the first year of transplantation. In this case patients are advised to take anti-rejection medicines to avoid the attack of immune system.

Risk management program for patients

Post-surgery the patient is at risk of several things as discussed above, the patient becomes sensitive. Therefore a management program is necessary for it. Other than post-transplantation infections other diseases such as renal dysfunction, heart diseases, metabolic issues, and malignancies can take place which can further lead towards severity of disease and finally death. Surgeons and physicians therefore have an important role to play in this domain in order to bring healthy outcomes. [3]

Patients of liver transplant have multiple disorders after transplant and therefore long term management is required. Management to improve metabolic procedure in patient is same as it is in general population but combination therapy is given which means several drugs are given for treatment. Severe kidney diseases can be developed in patients after transplantation of liver. It can also lead towards health issues such as diabetes, hypertension etc. If immunosuppressants are taken for long period of time then it can result in increased risk of malignancy. Therefore collaboration with program of transplant is important.

If any kind of risk occurs after transplantation the next vital approach is management of these risks which involves following actions.

·         Disclosure of information without any delay.

·         Give physiological and physical care to the patient.

·         Proper physiological care is given to medical staff that holds the responsibility of transplant.

·         Responses such as diagnosis and treatment staff and hospital staff are standardized.

·         The transplantation damage is reduced.

In order to address disclosure and minimizing damage mediums such as mass media, government and related societies and networks are established to take advantage of.

Potential infection control risks of Liver transplant

When liver is transplanted in a patient, standard techniques are required. Patients are usually immune compressed which is majorly due to aerobic bacteria. Selective bowel contamination is used which eradicate the anaerobic bacteria. It is found that risk of infection is reduced in patients after the use of SBD. There is a concern about arousal of resistant bacteria. It is suggested to use SBD for the patients who recently had liver transplant surgery. Institutes of Europe use tobramycin and amphotericin. While other institutes use nystatin, polyyxin B. immunosuppressant play contributing role in spread of infection, usage of drugs result in high rate of morbidity. Low dose acyclovir reduces the risk of herpetic infections. Prophylaxis is used for long fraction of time in order to avoid infection caused by opportunistic pathogens.  [4]

How hospital can mitigate the risks?

The risks can be reduced in hospitals by following certain protocols as stated below

·         Frequent hands wash, before and after touching the patient.

·         Alcohol based hand rub should be used such as ethanol.

·         Finger nails should be short and trimmed.

·         Long sleeves should be avoided.

·         Use of gloves and mask.

·         Wearing scrubs is encouraged while wearing house clothes should be avoided.

·         Instruments contaminated with blood, serum, excretions should be discarded or handled with care.

·         Sterilized instruments should be used.

·         Ventilators should be on to avoid infection from air borne pathogen.

·         Respiratory protection should be given to reduce the risk of infection.

·         Usage of respiratory mask.

·         Isolation is also required.

·         Preference of subglottic suction pump to avoid accumulation of fluids.

·         Head position of the patient should be in angle of 35 or 40 and body should be semi recumbent.

·         Oral care should be provided on daily basis.

·         Safe antiseptic should be used to clean the areas.

·         Needles less connectors should be used.

International safety patient goal for group of patients

First of all patient should be identified properly. Accurate detail should be provided to the surgeons and hospital in order to deal with any unfortunate incident if it occurs.

Effective communication should be done with patient in order to know where is hurting or what problem is he facing.

Medications should be properly done under proper conditions. And if any infection occurs it should be immediately treated. [5]

Safe surgery should be ensured. Every step should be properly taken and kept on record.

Health related risks should be reduced and if it occurs proper precautions should be taken and close examination should be done in sterile environment.

Great care should be taken of patient and he should not fall or bend.

References of Liver transplant