What are some Survivability issues for the Liver Transplant Candidate? Before I start, I want you to check out the click on ad boxes, as there is some useful information in some of them. I am constantly updating these items, where I can to be more relevant to the information you are looking for. There is a lot of information on diet and nutrition that I would recommend you check out. I remember when I was in the doctor’s office and was told of my diagnosis. The first thing out of my mouth, you guessed it, was how long have I got? The good doctor’s answer that I was expecting was the standard canned answer, which I received. But he also informed me that given my present numbers and being a good transplant candidate, and abstinence from alcohol, I could live a good quality life of up to 20 years or more. Frankly, in 20 years, I will be 86, and probably not too interested in the “or more.” While his answer was quite encouraging, I still felt the need to do some research on my own, to help give me a broader understanding of what I am dealing with, liver transplant or no liver transplant. While I am always searching for helpful information, here is what I have found to date through doctor contact and research:
Cirrhosis is the eleventh leading cause of death by disease in the US, killing more than 25,000 people each year. A damaged liver affects almost every bodily process, including the functions of the digestive, hormonal, and circulatory systems. The most serious complications are those associated with so-called decompensation, which occur when cirrhosis progresses. They include the following:
- Bleeding and fluid buildup (ascites).
- Infections.
- Damage to the brain (encephalopathy). Impaired brain function occurs when the liver cannot detoxify harmful substances.
Liver cancer is also a long-term risk with cirrhosis.
Cirrhosis is irreversible, but the rate of progression can be very slow, depending on its cause and other factors. Five-year survival rates are about 85% and can be lower or higher depending on severity.
- For example, for alcoholics with cirrhosis who abstain, a survival rate of five years or more can be as high as 85%. For those who continue drinking, the chance for living beyond five years is no higher than 60%.
- In patients with hepatitis B or C, the five-year survival rate after a diagnosis of cirrhosis ranges between 71% to 85%.
- About two-thirds of patients with primary biliary cirrhosis never develop symptoms and can have a normal life span. Once symptoms of liver damage, such as jaundice, occur, however, the average survival time declines. In one study of women diagnosed with primary biliary cirrhosis, about 36% developed symptoms over an 11-year period, and 11% either died or required liver transplantation.
Unfortunately, physicians are usually unable to determine when cirrhosis first occurred, which makes it difficult to determine prognosis.
Portal Hypertension
In cirrhosis, liver cell damage slows down blood flow. This causes a backup of blood through the portal vein, a condition called portal hypertension. The effects of portal hypertension can be widespread and serious, including fluid buildup and bleeding.
Ascites and Fluid Buildup. Ascites is fluid buildup in the abdomen. It is uncomfortable and can reduce breathing function and urination. Ascites is usually caused by portal hypertension, but it can result from other conditions. Swelling can also occur in the arms and legs and in the spleen. Although ascites itself is not fatal, it is a marker for severe progression. Once ascites occurs, only half of patients survive after two years. In fact, some experts refer to the phases of cirrhosis as preascitic and ascitic. Some physicians even believe that ascites signals the need for liver transplantation, particularly in alcoholic cirrhosis.
Variceal Bleeding. One of the most serious repercussions of portal hypertension is the development of varices, which are blood vessels that enlarge to provide an alternative pathway for blood diverted from the liver. In about two-thirds of patients they form in esophagus (the "food pipe"). They pose a high risk for rupture and bleeding because of the following characteristics:
- They are thin-walled.
- They are often twisted.
- They are subject to high pressure.
- Internal bleeding from these varices (variceal bleeding) occurs in 20% to 30% of cirrhosis patients. The risk of death from a single episode can reach 70%.
Bleeding commonly recurs within two weeks of the first episode, but after six weeks, the risk for recurrence is the same as for patients who have not had a bleeding event.
Factors that predict variceal bleeding in general include the following:
- Ascites.
- Encephalopathy.
- Large veins.
Factors that can increase the danger for a bleeding episode in high-risk individuals include the following:
- Moderate to intense exercise.
- Bacterial infection.
- Certain times of the day. Eating increases portal pressure, and there is a greater risk for bleeding in the evening. A lesser but still significant risk occurs in the early morning.
It is important for patients to be screened for esophageal varices and treated with preventive beta blockers if they show signs of risk. Between 30% and 40% of patients with cirrhosis experience bleeding, which carries a mortality rate of between 20% and 35%. Some experts recommend that all newly diagnosed patients be screened using endoscopy. Screening should also be considered for all previously diagnosed patients who have not been screened but would benefit from preventive treatments. Stay tuned for the next blog, where there is lots more information.
