Sunday, April 02, 2006

No Joke - Be Kind To Your Liver

On a flight into Washington DC recently, two women sat behind my row discussing their lives. Eventually their conversation turned to an acquaintance of theirs who was in need of a liver transplant. One woman asked the other, “Do you need your liver?” To which the other lady replied, “Oh no, the liver isn’t really necessary.” The man sitting next to me and I exchanged surprised glances and shared a quiet laugh over this. My goodness.

The liver is the largest solid organ of the body and works to filter the blood, detoxify the blood, absorb and store vitamins and fats, produce bile, produce blood clotting factors, and supply the body with glucose and proteins. In the United States, the average cost of a liver transplant and associated services for the first year is about $320,000 dollars. Annual costs after the initial year of the treatment and transplant average close to $22,000 per year. This includes medicines to suppress rejection of the liver.

The coolest thing about the liver is its ability to reconstitute its mass after single or multiple resections (removing part of it). You can remove up to 80% of the liver and it will still function adequately. Although the human liver is a bit less adept than a dog’s liver, the liver will also regenerate itself in both donor and recipients. Within the first week, where most recovery occurs, the liver can usually double its post surgical mass. This fact is what allows parents to donate part of their own liver to their own child. It also provides “split liver” donation whereby a liver from cadaver (organ donor) is divided in two for two separate recipient patients.

To me, this regrowth is interesting because its cells are not particularly active in mitosis (cell division) yet under these conditions must enter a state of high cell proliferation to re-establish mass. It is also interesting because the structural organization of its vascular components must also be re-established to accommodate hepatocyte function.

Sadly, in the US, some 17,000 patients are awaiting a liver transplant and only about 5,500 transplants will be performed each year. 10% of these patients will die every year and the number of those on the waiting lists is increasing. That’s only one country. While there are several conditions that lead to the demise of the liver, about 64% of hepatic carcinomas in the Western nations have alcoholic cirrhosis as an underlying risk factor.

Your liver is extremely necessary and you will in fact die without it. Please be kind to it.