Live Donor Liver Transplant in india

Why such a large number of patients are coming to India for Liver Transplant Surgery?

India has few of the world’s largest dedicated centres offering Living Donor, Adult and Paediatric Liver Transplantation.
Multidisciplinary Liver Transplant Set-up.
Vast experienced and highly skilled Liver Transplant Team.
Highly Advanced and dedicated Operating rooms for Liver Transplantation.
Dedicated Liver Transplantation Intensive Care Units (ICU).
Dedicated Centre for Paediatric Liver Diseases and Transplantation.
Latest Technology.

Get a Free No Obligation Opinion from India’s Top Liver Transplant Surgeons

Surgeons who have an experience of performing more than 1200 Liver Transplant Surgeries.
Surgeons who have a success rates which are at par with the best centres in the world and an excellent safety record for the donors.
Guinness record holding Surgeons having to their credit of performing liver transplantation on a five-day-old infant.
Surgeons have a vast experience of performing surgeries in leading hospitals across the world.

Write to us: [email protected] Call us anytime at our International Helpline Number : +91-7387617343

Most Advanced Technology for Better Surgery Outcomes

Blood Bank with 24 hour aphaeresis facility,
Advanced laboratory and microbiology (infection control) support,
Advanced cardiology,
DSA and Interventional Radiology,
Portable and Colour Ultrasonology,
Liver Fibro-scan
64 slice CT scanner
3 T MRI
PET-CT
Nephrology (including 24 hour dialysis and CVVHD) facilities.
Liver

LIVER TRANSPLANTATION

Liver is the largest and the most overworked organ of the human body. It works nonstop so that we can work efficiently. It’s the Liver that keeps working round the clock, makes blood proteins, produces Vitamin K and other clotting factors that help in clotting of blood, secretes bile to digest all the cholesterol and fats in our meals, absorbs Vitamin D so that are bones are strong, stores important minerals like copper and iron and Vitamin A, K and glucose for future use, fights infection by producing anti bodies, purifies our blood by removing the toxic substances, metabolizes our medicines, maintain balance between sex hormones estrogen and testosterone and much more. To top it all it has the unique capacity to regenerate or regrow itself when diseased.

WHAT MAKES THE LIVER GO BAD?

Anything that is taken for granted and not tended to properly, goes bad. Same is the case with our liver. Viral Infections that are transmitted through impure food and water like Hepatitis A and C can cause serious damage to the liver. Though there is vaccination available for hepatitis A, the search is still on for a vaccine against Hepatitis C. Hepatitis B is another life threatening infection transmitted by contaminated blood that affects the normal functioning of the liver. Luckily it is a vaccine preventable disease.

People who drink alcohol on a daily basis are surely causing damage to their liver. Over the years, the healthy liver cells are replaced with scar tissue or large amount fat cells resulting in Liver Cirrhosis or fatty liver or alcoholic liver disease in alcoholics. The liver function in both these conditions deteriorates to irreversible levels. In some cases the normal cells of the liver become abnormal and start multiplying at a high rate resulting in primary tumors (benign or malignant) of the liver. These abnormal cells do not perform the functions of normal liver cells. Slowly the tumor takes over the entire liver rendering it useless to the body. In some cases the tumor may be localized to a particular lobe or segment of the liver.

At times cancer from other parts of the digestive system like colorectal cancer can spread to the liver (secondary tumors or metastasis) through the blood vessels. The tumor cells get lodged in the liver and multiply there. Few diseases can be due to abnormality in the genetic make up of the person for e.g. Wilson’s disease, alpha 1 anti trypsin deficiency, glycogen storage disease etc. Some times the immune system cells attack the liver of the host assuming it to be a foreign body, and destroy it. These are known as auto immune diseases.

SYPTOMS OF LIVER DISEASE – HOW DOES THE LIVER CRY FOR HELP?

Just like a person in trouble cries for help, our liver too sends continuous signal to alert us that something is wrong with it and we should seek help for it. The most perceptible signs include constant weakness and fatigue in an individual along with loss of appetite. This is associated with weight loss. There may be episodes of vomiting with or without blood. The person will feel nauseated with certain food stuffs. There will visible yellowing of the skin and conjunctiva called as jaundice. The person may bruise easily and the bleeding may not stop like in nose bleeding. The abdomen will appear to be bloated (ascitis). Sometimes there is deposition of bilirubin (a by product of red blood cell break down that is normally removed by a healthy liver) in the brain tissue resulting in deteriorating mental functions like consciousness and orientation. This is known as hepatic encephalopathy.

TRANSPLANT- IS IT A WAY OUT FOR ALL PERSONS WITH LIVER DISEASE?

Transplant is definitely a boon for all those suffering from irreversible liver damage. It can be considered as an option for primary benign and malignant tumors of the liver, liver damage due to viral infections, acute liver failure not treated with medicines, recurring ascitis with infection, deteriorating mental functions, Wilson’s disease, hereditary liver disease, liver cirrhosis, biliary atresia in children etc. Liver transplant is an option to improve quality of life in both children and adults.

WHEN CAN A TRANSPLANT NOT BEEN DONE?

A person is not suitable for a transplant if he is mentally incapable of following the doctor’s instructions, if he has a serious heart, lung or nerve disease, or he is a chronic alcoholic or a drug abuse patient with no intention of stopping the consumption, or if he is having cancer elsewhere in the body, or an active infection in the body.

HOW DOES A PERSON GET ENLISTED FOR A TRANSPLANT?

A person, who has been thoroughly checked and investigated by a doctor (Hepatologist) and has been advised for a transplant, is immediately registered by the hospital as a candidate for transplant. The hospital team, transplant coordinator along with the NGO’s that deal with organ procurement and transplant keep a constant tab on the incoming options of donor livers available, match the body mass index and blood group of the donor and recipient and the stage of liver disease of the recipients. Those with end stage liver disease with deteriorating condition are considered first. The entire transplant team is in constant communication with the recipient before, during and after the transplant to ensure that the whole procedure is successful.

HOW IS THE CANDIDATE LIST PREPARED?

Each patient above 18 years of age is scored on the basis of values from three blood tests which include serum creatinine, serum bilirubin and international normalized ratio (it is a measure of clotting time). Those with highest values from these tests are placed on the top of the transplant list, and the rest follow. This is known as model end stage liver disease (MELD) scoring. A similar scoring is done for patients below 18 years of age and is known as pediatric end stage liver disease (PELD) scoring. A patient’s score can range from 6 to 40. In the event of a liver becoming available to 2 patients with the same MELD score and blood type, time on the waiting list becomes the deciding factor. Before the MELD / PELD list starts, there is another set of patients falling in the status 1 category that are the high priority patients. These patients suffer from acute liver disease, whose disease has developed within 7 days and are placed in intensive care unit and have very less chance of survival (less than 7 days) without a transplant. Both MELD and PELD scoring is based on probability of death within 3 months, if the patient does not receive the transplant. Based on this system, livers are first offered locally to status 1 patients, then according to patients with the highest MELD or PELD scores. Next, if there are no local recipients, the liver is offered regionally, in the same order, and finally, on a national level.

WHAT ARE THE VARIOUS TYPES OF TRANSPLANT?

The type of Liver transplant depends on the source of the liver. If it is obtained from a recently brain dead declared donor, then it is called a cadaveric transplant. This liver can be given to two patients, one adult and one child. The smaller left lobe can be transplanted in a child and the larger right lobe can be transplanted to an adult. This procedure is then termed as split liver transplant where the one liver is split in to two and both are benefitted. Cadaveric Transplants are however very few due to rare availability and difficulty in harvesting cadaver organ.

LIVE RELATED DONOR LIVER TRANSPLANT

If an immediate relative of the patient for example mother, sibling, spouse volunteer to donate a part of their liver to the patient, it is termed as live donor liver transplant. In this a small segment from the donor’s liver is placed into the recipient abdomen. Both the livers grow back to the full size within 6-8 weeks with no complications to the donor. If a mother donates a small part of her liver to a small child, it is also known as reduced size liver transplant. The type of Liver transplant can also be decided by the placement of the new liver. If it is placed in place of the original liver, then it is known as Orthotopic transplant. In case the original liver is left in place and the new liver is attached very near to it, then this is called as Heterotopic transplant. This is generally used if there is a chance that the original liver may recover. If the original liver recovers its function, the new liver shrivels away. In case the original liver does not recover, the new liver takes over the entire function and the original liver shrinks and shrivels away. This procedure is rarely used now days.

WHAT IS THE CRITERION FOR DONOR – RECIPIENT MATCH?

For a donor recipient liver match, the donor should have approximately the same body mass index (weight to height ratio) as the patient. The donor should be free from any disease or illness physically and mentally. He should have a same or compatible blood type as the recipient. A living donor should be between 18 to 60 years of age and should be willing to donate voluntarily and not for any financial gains.

WHAT ARE THE PREOPERATIVE PREPARATIONS?

The preoperative preparation is very crucial for the recipient and for a donor if it is going to be a live donor transplant. Once the hospital gets notification on the availability of a liver from a cadaver, it has to be removed from the body of a brain dead person within 8 hours of death.

The liver is thoroughly checked to see if it’s in condition (blood type, and size are also seen) to be inserted into the diseased person. The recipient is contacted according to his MELP/PELD score and is asked to report immediately to the hospital where he is registered.

He then undergoes a series of preoperative evaluation that includes a CT scan and MRI to reassess the liver condition of the patient and of the other organs of the abdomen, ECG and cardiac function test to see whether the patient can withstand the load of the operation, pulmonary function tests and X-ray of the chest to assess the lung condition, renal function test to see whether the kidneys are functioning properly, endoscopy of the gastrointestinal tract is done to ensure it is clear.

Once the primary physician and the transplant physician are satisfied that the patient can tolerate the stress of surgery, he is taken to the operating room. The surgery is started immediately after the new liver reaches the hospital incase of a cadaveric transplant. Barring a few cases in which the patient is having some systemic illness, or is out of town, or the donated organ itself is not in good condition, in all other cases the patient is rushed to the operation theatre to go ahead with the transplant.

In case of a live donor liver transplant, both the patient and the donor undergo the same series of preoperative tests as mentioned before about one week prior to the scheduled date of surgery. Both the patient and donor report to the hospital in the morning on the day of surgery and their surgeries start together.

WHAT IS THE PROCEDURE?

A liver transplant can take about 10-14 hours. A live donor transplant is slightly longer as compared to the cadaveric transplant.

In a liver donor transplant both the donor and patient are shifted to connected operation theatres and two separate operating teams work on them. The surgical team working on the donor, cuts open the abdominal skin and fascia, retracts the muscles and major blood vessels to reach the liver. A portion of liver along with its blood supply and bile duct branch is cut along the anatomical segments given by Couinaud. Meanwhile the other operating team prepares the patient to receive the organ. The abdomen is cut in the similar manner and the diseased liver is approached. It is disconnected from its blood vessels and the bile channels and removed from the body of the patient. The area is prepared to receive the new transplanted liver. The new liver is placed in position and its blood supply and bile connections are re-established. A tube is left in place to remove the excess fluid that may accumulate in the abdomen. The abdomen is then stitched up. The patient and donor are both shifted to the intensive care unit.

WHAT HAPPENS AFTER THE SURGERY?

The patient remains in the ICU for about week and then shifted to the ward. He is discharged from the hospital after 3 weeks of surgery depending on the recovery. The donor remains in the ICU for 2-3 days after which he is shifted to the ward and discharged after 7-10 days of surgery.
In the ICU the patient as well as the donor is continuously monitored to note any discrepancy in the normal functioning of all the vital organ systems. The patient generally has an endotracheal tube inserted down his wind pipe and is attached to the artificial ventilator unit externally. During this phase he is not able to speak. And he is given only liquid fluids and medications through the intravenous route. A catheter is inserted in the bladder for voiding the urine. Once it is seen that the heart, lung, kidney, brain and the new kidney are functioning properly and no abnormality is detected, the patient is shifted to the ward. The donor also is shifted to the ward once all his organ systems are cleared of any abnormality. Both the livers grow to their full size in 6-8 weeks.

WHAT IS THE OUTCOME OF TRANSPLANT SURGERY?

The 1-year survival rate after liver transplantation is about 90% for patients living at home and about 60% for those who are critically ill at the time of the surgery. At 5 years, the survival rate is about 80%. Survival rates are improving with the use of better immunosuppressive medications and more advancement in the procedure. The patient’s willingness to stick to the recommended post transplantation instructions and guidelines is essential to a good outcome. Most patients return to their normal activities after 3 months of transplant depending on their pre-surgery health status. They are also able to resume their physical exercise routine and sex life within a year. Women can conceive after the first year of transplant after consultation with their physician. The patient has to stick to his daily medicine routine and a healthy diet and constant follow ups with his doctor to enjoy a long and a healthy life.

POST LIVER TRANSPLANT DIET AND MEDICATIONS

Fruits, Vegetables, Whole-grain cereals and breads, Low -fat milk and dairy products or other sources of calcium, Lean meats, fish, poultry, or other sources of protein. Salt intake should be minimized to avoid fluid retention in the body. It is important that during the first three months after a transplant patient should avoid eating foods that may contain bacterium that can cause problems whilst the patients are taking higher doses of anti rejection drugs. Immunosuppressants and antibiotics form the mainstay of post operative drug regime. Immunosuppressants are important to avoid rejection of the new liver and have to be taken life long. The dosage and frequency should be reduced as per the doctor’s order only.

WHAT ARE THE GENERAL PRECAUTIONS TO BE TAKEN?

Patients who have undergone any organ transplant need to protect their new organ from getting rejected. The patient has to maintain higher than normal standards of hygiene. He should avoid contacting any kind of infection. The incision sites should be cleaned daily and dried properly. The patient should wash his hands regularly with disinfectant and stay away from soil, animals and infected persons. Immunosuppressants reduce the ability of body to fight infection and so the patient is highly vulnerable to infections.

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