An expert guide to liver transplantation

Written by: Dr Deepak Joshi
Edited by: Karolyn Judge

The prospect of a liver transplant may be overwhelming, so being well informed about what’s involved in the process can provide a sense of security for prospective patients.


Here with essential information specifically for this situation is leading consultant hepatologist Dr Deepak Joshi.


Older man who may need a liver transplant


When is liver transplantation required?

A liver transplant can be required in two main scenarios.


One is the setting of acute liver failure. Most of these patients are very unwell. Patients are admitted to hospital acutely. I'd say that's quite rare overall, now in the UK.


The opposite setting is that when one develops chronic liver disease and develops liver failure; that can be the development of jaundice, so yellowing of the eyes, development of fluid in the tummy area which is called ascites, and then these patients require consideration of liver transplantation.


Everybody needs to have an assessment and if you think about it as an MOT, we don't only look at the liver but we look at the heart, the lungs, the kidneys, but also the psychosocial aspects as well. These are the two main clinical scenarios.   



How is it performed exactly?

After a patient is assessed for liver transplantation, and their indications are accepted, you go on to a national waiting list.


Patients can also be considered for living-related liver transplantation and that involves a separate assessment of the potential donor.


Then essentially, it's surgery; patients can be called in at any time and then surgery can last anything between six to eight hours. In the UK, all surgery is performed in very experienced centres with very good outcomes.



How safe is it? Is there any patient who might not be suitable for it?

Liver transplantation is very safe. When we talk about outcomes, we're looking at five-year outcomes. We don't talk about 30-day, 90-day or one-year survival rates anymore because we want patients to benefit long term.


As part of the assessment, like I said, we would assess patients for other diseases which may not be clinically obvious. That's why we look at the heart, the kidneys and the lungs. Once you're assessed for liver transplantation, then the majority of patients will go on to be transplanted.



How long does it generally take?

Once patients are accepted on a transplant waiting list, you are listed according to your blood group and there's a national score called a transplant benefit score, which is calculated and modified and adjusted as one remains on the list.


The whole point of that score is to identify those that would benefit the most from a liver transplantation. However, one can wait up to a year for transplantation. One has to be quite patient, as well. The whole point of the score is that if you deteriorate and then your score may increase, and your likelihood of transplantation may also improve.



Will I require any follow-ups after my operation? What is recovery like?

Recovery, I would say, is directly related to how well one is going into liver transplantation. I would say, most patients would remain in hospital for a minimum of two weeks. A lot of that is about pain killers but also looking for any complications after the transplant. Also, part of that, time is also spent educating patients on their medication; when to take it, how to take it, what sort of red flags there are if there should be any concerns.


Once patients are discharged, they'd be seen weekly for the first month and then fortnightly and every three weeks. It depends.


Also, patients will need lifelong clinical review, but once you're stable on your medication and well, it could be an outpatient review every six months. The longer you go out from transplant, the longer the time period between clinical reviews.



If you require a liver transplant and want highly-experienced treatment, arrange a consultation with Dr Joshi via his Top Doctors profile.

By Dr Deepak Joshi
Hepatology (liver specialist)

Dr Deepak Joshi is a leading consultant hepatologist practising at private clinics in London. Dr Joshi specialises in liver disease, liver transplant, pancreatic diseases, bile duct diseases, and cirrhosis amongst others. At present, Dr Joshi is practising at the Guthrie Clinic, a part of King's College Hospital, the Institute of Liver Studies, and the London Liver Centre.

After qualifying in medicine from King's College in 2001, he went on to train in hepatology at the Institute of Liver Studies for five years, where he carried out a PhD researching into predictors of fibrosis in patients following a liver transplant. He further honed his skills in adult and paediatric endoscopy and ERCP whilst training at the reputable University College London Hospitals.

An active researcher in the hepatology field, he has published extensively in peer-reviewed papers, contributed to book chapters, and co-authored "Hepatology at a Glance". His main clinical interests include biliary disease, as well as treatment and management of all kinds of conditions to do with the liver or pancreas.

Dr Joshi educates future hepatologists as a clinical lecturer at King's College London outside of his practising and research hours. In addition, he sits on the expert panel of the PSC Support, a leading charity for primary sclerosing cholangitis. Additionally, he is a Liver Committee member for the British Society of Gastroenterology, which he has been a participant of since 2016.

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