Successful Living Donor Liver Transplantation for Decompensated Chronic Liver Failure

Chief Complaints

A 47-year-old male patient with a Body Mass Index (BMI) of 21 presented to the Liver Transplant Department at PACE Hospitals, Hitech City, Hyderabad, with abdominal distension due to ascites. He also had complications related to advanced liver disease, including hepatic encephalopathy and impaired kidney function associated with hepatorenal syndrome.

The patient was a known case of chronic liver disease with recurrent ascites. His condition was complicated by hepatorenal syndrome and hepatic encephalopathy, indicating progression to decompensated liver failure. He was admitted for further evaluation and management due to worsening liver function and associated complications.

On examination, the patient was conscious, coherent, and oriented. Abdominal distension was present due to fluid accumulation. He appeared clinically unwell, and a detailed systemic examination was carried out as part of the liver transplant evaluation.

Following the clinical evaluation, the liver transplant team conducted a comprehensive assessment based on the patient’s history of chronic liver disease, abdominal distension due to ascites, hepatic encephalopathy, and impaired kidney function associated with hepatorenal syndrome.

A detailed medical history, physical examination, and required laboratory and imaging investigations were carried out to assess liver function, kidney function, fluid accumulation, coagulation status, and the overall severity of the disease. Based on the evaluation, the patient was diagnosed with decompensated chronic liver failure with ascites, hepatic encephalopathy, and hepatorenal syndrome.

The patient’s MELD-Na score was 24, indicating advanced liver disease and an increased risk of further complications.

Based on the confirmed diagnosis, he was advised to undergo Decompensated Chronic Liver Failure Treatment in Hyderabad, India, under the care of the liver transplant team.

After detailed consultation with Dr. CH Madhusudhan (Senior Consultant Surgical Gastroenterologist and Liver Transplant Surgeon), Dr. Govind Verma (senior consultant interventional gastroenterologist and hepatologist), Dr. Suresh Kumar (Consultant Surgical Gastroenterologist), and the internal medicine team, the patient’s clinical condition and investigation findings were reviewed to determine the most appropriate treatment plan.

Considering the advanced stage of liver disease, recurrent ascites, hepatic encephalopathy, hepatorenal syndrome, and a MELD-Na score of 24, it was determined that Living Donor Liver Transplantation was identified as the most suitable definitive intervention.

The patient’s wife voluntarily came forward as the living liver donor. Blood group testing showed that both donor and recipient were B positive. After completing donor evaluation, recipient assessment, medical fitness checks, and necessary clearances, transplantation using a modified right lobe liver graft was planned.

The patient, donor, and family members were counselled regarding the severity of the disease, the transplant procedure, possible risks and complications, postoperative care, long-term medicines to prevent graft rejection, and the importance of regular follow-up.

Following the decision, the patient was scheduled to undergo Living Donor Liver Transplantation (LDLT) in Hyderabad at PACE Hospitals under the expert supervision of the liver transplant team.

The following steps were carried out during the procedure:

• Preoperative Preparation and Anaesthesia: After completing the required donor and recipient investigations, medical clearances, and informed consent, the patient was taken up for surgery under general anaesthesia with continuous monitoring.

• Abdominal Exploration and Liver Mobilization: The abdominal cavity was accessed, and the diseased liver was carefully assessed. The liver was mobilized from the surrounding structures while controlling bleeding and protecting nearby organs.

• Native Liver Removal: The major blood vessels and bile duct connected to the diseased liver were carefully identified and controlled. The native liver was then removed to prepare the recipient site for transplantation.

• Modified Right Lobe Graft Implantation: A modified right lobe liver graft donated by the patient’s wife was placed in the recipient’s abdomen. The graft was positioned appropriately to restore liver function.

• Vascular and Biliary Reconstruction: The graft blood vessels were connected to the recipient’s blood vessels to restore blood flow. The bile duct was also reconstructed to allow proper drainage of bile from the transplanted liver.

• Graft Assessment and Closure: After confirming satisfactory blood flow to the graft and controlling bleeding, the surgical area was carefully checked. The abdomen was closed in layers, and the patient was shifted for close postoperative monitoring.

The postoperative period was uneventful, except for a temporary requirement for oxygen support, which was gradually weaned off. Increased abdominal drain output was managed conservatively with albumin support. Intravenous fluids, urine output, kidney function, graft function, and overall recovery were closely monitored. Medicines to prevent graft rejection and infection, provide gastric protection, control pain, nausea, and fever, and support nutrition were given as required. The doses of anti-rejection medicines were adjusted according to liver function test results.

Upon discharge, the patient was advised to take medicines to protect the transplanted liver and prevent rejection, prevent bacterial and fungal infections, provide gastric protection, manage pain, nausea, and fever, and support nutrition and recovery. He was instructed to take all medicines exactly as prescribed and not to alter transplant-related medicines without medical advice.

The patient was advised to maintain proper wound and drain care, follow the recommended diet, take medicines regularly, and protect himself from infections. He was also instructed to attend all scheduled follow-up visits so that liver function, kidney function, and medicine doses could be monitored.

The patient was advised to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, abdominal pain, repeated vomiting, breathing difficulty, reduced urine output, worsening jaundice, confusion, bleeding, wound discharge, or any sudden deterioration in his condition.

The patient was advised to return for a follow-up visit with the Surgical Gastroenterologist in Hyderabad at PACE Hospitals, to monitor transplanted liver and kidney function, assess recovery, adjust anti-rejection medicines, and identify any early signs of infection, rejection, or other complications.

This case highlights the successful management of decompensated chronic liver failure with ascites, hepatic encephalopathy, and hepatorenal syndrome through Living Donor Liver Transplantation. The patient recovered well after surgery and was discharged in stable condition with medications, counselling, and follow-up advice.