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A liver transplant is considered when the liver is severely damaged and cannot function properly, a condition known as end-stage liver disease or acute liver failure. The decision to proceed with a liver transplant depends on the underlying cause, the severity of the condition, and the patient’s overall health. Below are the key situations when a liver transplant may be necessary:

1. Chronic Liver Disease (End-Stage Liver Disease)

This occurs when the liver is progressively damaged over time and can no longer perform its essential functions. Common causes include:

• Cirrhosis: Scarring of the liver due to long-term damage.
  • Causes: Chronic hepatitis B or C, alcohol-related liver disease, non-alcoholic fatty liver disease (NAFLD), or autoimmune hepatitis.
• Portal hypertension: High blood pressure in the liver’s blood vessels, leading to complications like bleeding or fluid buildup.

2. Acute Liver Failure

This is a sudden loss of liver function, often occurring in a matter of days or weeks. It can be caused by:

• Toxic overdose: Paracetamol (acetaminophen) overdose.
• Viral hepatitis: Acute hepatitis A, B, or E.
• Drug-induced liver injury: Reactions to certain medications or supplements.
• Wilson’s disease: A genetic disorder causing copper buildup in the liver.

3. Liver Cancer

A transplant may be an option for certain types of liver cancer, such as:

• Hepatocellular carcinoma (HCC): If the tumor is within specific size and number criteria and has not spread outside the liver.
• Other liver cancers may also be considered depending on the stage and response to treatment.

4. Metabolic Disorders

Some genetic or metabolic conditions can cause liver damage or failure, including:

• Wilson’s disease (copper accumulation).
• Hemochromatosis (iron overload).
• Alpha-1 antitrypsin deficiency.
• Primary hyperoxaluria.

5. Biliary Atresia (in Children)

This is a congenital condition where the bile ducts are absent or damaged, leading to liver failure in infants. It is the most common reason for liver transplants in children.

6. Other Conditions

• Primary sclerosing cholangitis (PSC): Inflammation and scarring of the bile ducts.
• Primary biliary cholangitis (PBC): An autoimmune disease destroying the bile ducts.
• Budd-Chiari syndrome: Blockage of the liver’s blood vessels.
• When is a Liver Transplant Not Recommended?

A liver transplant may not be suitable if:

• The patient has advanced cancer that has spread beyond the liver.
• There are severe heart, lung, or other organ diseases.
• The patient has active alcohol or substance abuse issues (unless they have completed a rehabilitation program and are committed to sobriety).
• There are uncontrolled infections or other life-threatening conditions.

Evaluation for a Liver Transplant

Before a transplant, patients undergo a thorough evaluation to determine if they are suitable candidates. This includes:

• Blood tests and imaging studies.
• Assessment of liver function and severity (e.g., MELD score for adults or PELD score for children).
• Psychological and social evaluations to ensure readiness for post-transplant care.

Timing of a Liver Transplant

• The timing depends on the severity of liver disease, as determined by:

MELD score (Model for End-Stage Liver Disease): A scoring system used to prioritize patients on the transplant waiting list. Symptoms such as ascites, hepatic encephalopathy, or recurrent infections.

If you or someone you know is experiencing liver-related issues, consult a hepatologist or transplant specialist to discuss whether a liver transplant is appropriate. Early evaluation and intervention can improve outcomes.