Liver cirrhosis: When transplantation is required

Its cirrhosis is called the final stage of various liver diseases that cause chronic hepatic inflammation. The most common causes are chronic viral hepatitis (chronic hepatitis B and C), chronic alcohol consumption, cholestatic diseases, autoimmune liver diseases, as well as metabolic diseases such as non-alcoholic etiology fatty filtration of the liver due to obesity, malnutrition, diabetes mellitus, hyperlipidaemia etc. Causes of cirrhosis of the liver “The most common cause of cirrhosis of the liver in Eastern countries remains chronic hepatitis B, while in the Western world non-alcoholic etiology fatty liver disease (now called metabolicly associated fatty liver disease). The final result of chronic hepatic inflammation (depending on the cause) is the creation of fibrosis (ulves) and regenerative nodules within the liver, conditions that prevent proper hepatic function”, points out Dr.Dimitrios Karagiannakis MD, PHD Special Pathologist- Hepatologist Academic Scholar EKPA Deputy Director III Medical Hospital Metropolitan General. Symptoms, complications and treatment “First the patient with cirrhosis of liver remains completely asymptomatic, as the liver manages to counter damage (recompensated cirrhosis). However, with the progress of the disease, there is a rupture of the counter-infection with complications such as as askitis (wet in the abdomen), splenic enlargement, esophageal varices (dilated veins in the esophagus), varsorrhagia (severe varicose veins), liver encephalopathy, hepatocellular cancer, etc. Ascite is treated with salt restriction in the diet and administration of diuretics. In severe cases it may be necessary to remove the fluid with a needle (vaccine puncture). For varsus we administer beta-blockers medication to reduce the risk of varsorrhagia, which if it happens is treated with emergency gastroscopy and binding of ringed varicose veins. As regards hepatocellular cancer, it is treated with surgical resection, cauterisation, chemobolism, oral or intravenous immunotherapy. The choice of appropriate treatment depends on the extent of the tumor and the number of outbreaks,” explains the expert. When’s the liver transplant? “It should be stressed,” he continues, “that cirrhosis of the liver is not the end of the path of a patient suffering from some hepatological disease. On the contrary, it seems to be a dynamic situation that can not only deteriorate and progress from counterbalanced to uncompensated situation, but can also reverse. The basic condition for the latter to occur is the complete removal of the harmful-religion factor (e.g. successful treatment of chronic hepatitis) B or C, complete discontinuation of alcohol, treatment of fatty filtration, etc.), before the patient reaches very advanced stages of uncompensated cirrhosis. If this is not achieved and the patient has advanced uncompensated cirrhosis, then the only therapeutic option is liver transplantation. Tools that help assess the severity of cirrhosis and therefore the possibility of relapse are the measurement of MELD-Na score (score taking into account some haematological parameters), Child-Pugh score and liver elastography (special ultrasound technique that measures the degree of hepatic fibrosis). If the patient is a terminal and qualified for transplantation, he should meet certain conditions (appropriate age, not have severe cardiovascular and respiratory conditions, have no history of cancer or if he has to be treated for the last 5 years etc.). Hepatocellular cancer is not a contraindication for liver transplantation as long as it is within specific criteria (Criterions of Milan), which in practice does not mean that it has not expanded to such an extent as to pose a risk of recurrence to the graft,” concludes Dr Karagiannakis.