Liver Transplantation for Cirrhosis Patients in the UAE

Liver transplantation is a beacon of hope for people in the UAE battling end-stage liver diseases like cirrhosis. Cirrhosis occurs when healthy liver tissue is replaced by scar tissue due to long-term damage, which can lead to liver failure if left untreated. In such critical cases, liver transplantation emerges as the most effective treatment, offering patients a chance at a longer life with improved quality.

Cirrhosis and Its Impact

Cirrhosis often stems from chronic conditions like hepatitis infections (B and C), excessive alcohol consumption, fatty liver disease, autoimmune hepatitis, and certain genetic disorders. These conditions gradually damage the liver over time, leading to cirrhosis. Symptoms can include fatigue, jaundice (yellowing of the skin), swelling in the legs and abdomen, easy bruising, and confusion. In advanced stages, cirrhosis can cause serious complications like hepatic encephalopathy (confusion), ascites (abdominal fluid buildup), and liver cancer.

Criteria for Liver Transplantation

When cirrhosis progresses to a severe stage where other treatments are no longer effective, liver transplantation becomes a viable option. Patients are carefully evaluated based on the severity of their liver disease, overall health, and their ability to undergo major surgery and lifelong immunosuppressive therapy post-transplantation. In the UAE, specialized transplant centres meticulously assess each patient to ensure the best possible outcomes.

The Transplant Procedure for Liver Transplantation in the UAE

Liver transplantation is a complex and life-saving surgical procedure that involves replacing a diseased or failing liver with a healthy liver from either a deceased or living donor. In the United Arab Emirates (UAE), liver transplantation is conducted at specialized transplant centres that adhere to rigorous protocols to ensure the best outcomes for patients with end-stage liver disease, including cirrhosis.

A. Pre-transplant Evaluation:

Before undergoing liver transplantation, patients undergo a thorough evaluation process to determine their suitability for the procedure and to prepare them physically and mentally for surgery:

1. Medical Assessment:

a. Medical History: A detailed review of the patient's medical history is conducted, focusing on the underlying cause of liver disease (such as chronic hepatitis B or C, alcoholic liver disease, autoimmune hepatitis), progression of symptoms, previous treatments, and overall health status.

b. Physical Examination: A comprehensive physical examination helps assess the extent of liver damage and the patient's overall physical condition, including signs of portal hypertension (such as ascites or splenomegaly).

c. Diagnostic Tests: Blood tests, including liver function tests (LFTs) to assess liver enzymes (ALT, AST, bilirubin), clotting factors (PT, INR), and albumin levels. Viral hepatitis markers (HBV, HCV), and imaging studies such as ultrasound, CT scan, or MRI are performed to evaluate the liver size, structure, presence of tumors, and portal vein anatomy. In some cases, a liver biopsy may be conducted to assess the severity of cirrhosis and the presence of liver cancer (hepatocellular carcinoma).

2. Psychosocial Evaluation:

a. Mental Health Assessment: Evaluation of the patient's mental health status, including any history of depression, anxiety, or substance abuse, as these factors can impact the patient's ability to cope with the transplantation process.
b. Social Support:  Assessment of the patient's support system at home and the availability of caregivers who can assist during the recovery period.
c. Patient Education: Counseling sessions to educate the patient and their family about the transplantation procedure, potential risks and complications, and the need for lifelong immunosuppressive therapy post-transplant.

3. Financial Evaluation:

b. Financial Planning: Guidance on financial resources available to cover out-of-pocket expenses and potential financial assistance programs.

B. Transplant Surgery:

Once a patient is deemed suitable for transplantation based on the evaluation, the surgical procedure is carefully planned and executed:

1. Donor Selection:

b. Living Donor: Alternatively, living donor liver transplantation involves the surgical removal of a portion of the healthy donor's liver (usually a family member) and its transplantation into the recipient. Living donor transplantation is feasible because the liver has the remarkable ability to regenerate to near-normal size within weeks after surgery.

2. Surgical Procedure:

a. Recipient Surgery: The recipient is prepared for surgery under general anaesthesia. The surgical team makes an incision in the upper abdomen (right upper quadrant) to access the liver.
b. Exploration and Hepatectomy: The diseased liver is carefully inspected and dissected from surrounding structures while minimizing blood loss. Techniques to manage portal hypertension, a common complication of cirrhosis, are employed to control bleeding and maintain hemodynamic stability.
c. Implantation of Donor Liver: Once the diseased liver is removed (hepatectomy), the healthy donor liver is transplanted into the recipient. The surgical team meticulously connects the donor liver's blood vessels (hepatic artery, portal vein, hepatic vein) and bile ducts to the recipient's corresponding structures. Proper alignment and anastomosis (suturing or stapling) are critical to ensure adequate blood flow and bile drainage.
d. Closure: After confirming the functionality of the transplanted liver and hemostasis (control of bleeding), the surgical incisions are closed in layers with sutures or staples

C. Post-transplant Care and Recovery:

After the transplant surgery, the focus shifts to intensive care and long-term management to support the patient's recovery and prevent complications:

1. Immediate Post-operative Phase:

b. Immunosuppressive Therapy: To prevent rejection of the transplanted liver, patients are prescribed a combination of immunosuppressive medications (such as tacrolimus, cyclosporine, or sirolimus) immediately after surgery. These medications suppress the immune system's response, allowing the new liver to function without being attacked by the recipient's immune system.

2. Long-term Management:

c. Lifestyle Modifications: Patients are advised to maintain a healthy lifestyle, including a balanced diet low in sodium and cholesterol, regular physical activity, abstinence from alcohol, and avoidance of certain medications that can interfere with liver function or interact with immunosuppressive drugs.

Benefits of Choosing the UAE for Liver Cirrhosis Treatment

Choosing the UAE for liver cirrhosis treatment, including liver transplantation, offers several distinct benefits:

a. Advanced Medical Expertise: The UAE hosts specialized transplant centres with advanced medical technology and highly skilled healthcare professionals trained in global standards of care.

b. Comprehensive Care Facilities: Hospitals like NMC Royal Hospital Abu Dhabi and King's College Hospital Dubai offer comprehensive liver disease management, from diagnosis through to advanced treatments like transplantation.

c. Rigorous Patient Evaluation: UAE transplant centres rigorously evaluate patients to ensure optimal outcomes, considering factors like disease severity, overall health, and suitability for surgery.

d. State-of-the-Art Technology: Leading hospitals in the UAE are equipped with state-of-the-art surgical facilities, including hybrid operating theatres, advanced imaging, and critical care units.

e. Multidisciplinary Approach: Patients benefit from a multidisciplinary team approach involving hepatologists, surgeons, nurses, and support staff, ensuring personalized care and treatment plans.

f. International Standards: Many healthcare providers in the UAE adhere to international healthcare standards and protocols, offering reassurance in terms of quality and safety.

g. Access to Living Donor Transplantation: UAE centres facilitate living donor liver transplantation, enhancing treatment options and potentially reducing waiting times compared to some regions.

Leading Liver Transplant Centers in the UAE:

1. NMC Royal Hospital, Abu Dhabi