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LIVER Transplant

Organ Donation – an overview

Liver Transplant in India

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Today, organ donation provides hope to a plethora of people around the globe. Though it’s a difficult decision, it’s a major leap of hope for patients with end-stage organ failure. But unfortunately, the number of people awaiting organ donation is always higher than the people willing to donate.

While our body overall depreciates during the lifetime, sometimes diseases or genetics may attack and destroy one specific organ while the remaining body remains comparatively healthier. It depends on which organ is wearing down. There are various life-sustaining treatment options before transplantation, which can be helpful to improve your health. For example, when it comes to kidneys, dialysis helps a person who has damaged kidneys.

Types of organ donation

There are principally two types of organ donation – living donation and deceased donation.

  • Living organ donation
  • Living donation is when someone donates a portion of their liver or one of their kidneys to a patient while the donor is still alive. Living donors can donate one kidney, a lung, or a portion of the liver, pancreas, or intestine. This offers an alternative for people waiting for a deceased donor, and it increases the number of organs available, saving more lives. Living donors can be friends, spouses, family members, or altruistic donors, who wish to help someone in need.

  • Deceased organ donation
  • It is important to remember, that deceased donation is only possible after all attempts to save the patient’s life have been tried, and brain death has been declared. Even though the person, who is brain dead, is technically dead, but the organs would be still functioning and hence appropriate for organ donation. Such a donor can donate kidneys, liver, lungs, heart, pancreas, and intestines. In 2014, hands and faces were added to the organ transplant list.

Liver Transplant – An Overview

The liver is the body's largest internal organ, located below the diaphragm on the right side of the abdomen. Liver has a unique ability to regenerate. In fact, up to 70 percent of the liver can be safely removed without causing any inconvenience for a healthy individual. The remnant liver grows rapidly to re-establish the full functional capacity required for an individual, within a week’s time, though sometimes it may take about 3–4 weeks for the liver to attain its former size.

The liver performs many complex functions in the body, including:

  • Makes most proteins needed by the body
  • Metabolizes, or breaks down the nutrients from food to make energy, when needed
  • Prevents shortage of nutrients by storing certain vitamins, minerals, and sugar
  • Makes bile, a compound needed to digest fat and to absorb vitamins A, D, E, and K
  • Makes most of the substances that control blood clotting
  • Removes potentially toxic by-products of certain medications

When is Liver transplant needed?

Liver transplantation surgically replaces a failing or diseased liver with one that is in good physical shape. At this time, Liver Transplant in India is the only cure for liver insufficiency or liver failure. Liver failure can happen suddenly (acute liver failure) as a result of viral hepatitis, drug-induced injury or infection. Also, liver failure can also result of a long-term problem. The following conditions may result in chronic liver failure:

  • Chronic hepatitis with cirrhosis
  • Primary biliary cholangitis (previously called primary biliary cirrhosis, it isa rare condition where the immune system inappropriately attacks and destroys the bile ducts)
  • Sclerosing cholangitis (scarring and narrowing of the bile ducts inside and outside of the liver, causing the backup of bile in the liver)
  • Biliary atresia (a rare disease of the liver that affects newborns)
  • Alcoholism
  • Wilson's disease (a rare inherited disease with abnormal levels of copper throughout the body, including the liver)
  • Hemochromatosis (a common inherited disease where the body has too much iron)
  • Alpha-1 antitrypsin deficiency (an abnormal rise in alpha-1 antitrypsin protein in the liver, resulting in cirrhosis)

Send us your query to know the Liver Transplant Cost in India. Get Free Consultation from the Top 10 Liver Transplant Doctors in India by filling up the form given on the website.

Evaluation for Liver Transplant

Once you decide where you would like to have your liver transplant, you'll need to have an evaluation to see if you're eligible at the Best Hospitals for Liver Transplant in India. The evaluation will check to see if you:

  • Have a liver condition that would benefit from transplantation
  • Might benefit from other less aggressive treatment options
  • Are healthy enough to undergo surgery and post-transplant treatments
  • Are willing and able to follow the medical program outlined by the transplant team
  • Can emotionally handle the wait for a donor liver
  • Have a supportive network of family and friends to help you during this stressful time

Request your appointment with the Top Liver Surgeons in India at the Best Liver Transplant Hospitals in India.

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  • A Liver specialist (Hepatologist)
  • Transplant surgeons
  • A transplant coordinator, usually a registered nurse, who is proficient in catering to liver-transplant patients
  • Social workers to discuss about the patient’s family and friends, employment history, and financial strength
  • A psychiatrist to make it easy for the patient to deal with issues like anxiety or depression, which may accompany a complex procedure like liver transplant
  • An anesthesiologist to make the patient aware about the potential anesthesia risks
  • A chemical dependency specialist to help such patients, who have history of alcohol or drug abuse
  • A financial counsellor, who acts as a bridge between the patient and his or her insurance companies

Request an appointment with the Best Liver Transplant Surgeons in India by filling up the free consulation form given on the website.

You cannot have a transplant if you have:

  • Cancer in any other part of your body
  • Serious heart, lung, or nerve disease
  • Active alcohol or illegal drug
  • An active and severe infection

About the Procedure

The transplant involves a major operation to remove the diseased liver and replace it with a normal donor liver. This may sound relatively easy, but the surgery is very demanding and can take between 6-18 hours to complete. The diseased liver must be disconnected from four major blood vessels and the tube that carries bile from the liver to the intestines, known as the bile duct, has to be disconnected from the bowel. The new liver is then placed in the proper position, and the major blood vessels and bile duct are reattached to complete this complex procedure. Get in touch with us for Affordable Cost of Liver Transplant in India.

  • Deceased-donor liver transplant

It isn't necessary to match the donor and recipient for age, sex or race. All donors are screened for hepatitis viruses and the HIV virus. What's more, all deceased donor organs are tested extensively to help ensure that they don't pose a health threat to the recipient. As soon as a deceased donor is declared brain-dead, the liver is removed and placed in sterile fluid similar to fluid in body cells. It is then stored in the refrigerator. The harvested liver needs to be transplanted within 24 hours of recovery – which is why recipients are often called to the hospital in the middle of the night or at short notice.

  • Living-donor liver transplant

Regeneration happens over a short period, possibly days to weeks and certainly within eight weeks. When surgeons remove a piece of the donor's liver, the part that remains grows back quickly to its original size. Get in touch with us to know the Liver Transplant in India Success Rate.

What follow-Up is necessary after a Liver Transplant?

Your first return appointment after a liver transplant will generally be scheduled about 1 to 2 weeks after discharge. Patients usually return to their transplant hospital approximately 5 months after the transplant. If a T-tube was inserted during the operation, it will be removed by the transplant surgeon at this time. Typically patients are scheduled to return to the hospital at their 1-year transplant anniversary date and annually thereafter.

Expect six months or more recovery time before you'll feel fully healed after your liver transplant surgery. You may be able to resume normal activities or go back to work a few months after surgery.

Your first return appointment after a liver transplant will generally be scheduled about 1 to 2 weeks after discharge. Patients usually return to their transplant hospital approximately 5 months after the transplant. If a T-tube was inserted during the operation, it will be removed by the transplant surgeon at this time. Typically patients are scheduled to return to the hospital at their 1-year transplant anniversary date and annually thereafter.

Expect six months or more recovery time before you'll feel fully healed after your liver transplant surgery. You may be able to resume normal activities or go back to work a few months after surgery.

Chances of rejection

Practicing good hygiene, obtaining routine vaccines, and making healthy lifestyle choices are very crucial after a complex procedure like liver transplant, to bring down your risk of infection. Your body will regard your new liver as a foreign object. You will need regular medication to prevent your immune system from attacking the liver.


  • Complications associated with Liver Transplant
  • Two of the most common complications following liver transplant are rejection and infection.

Rejection

Your body's natural defences, the immune system works to destroy foreign substances that invade your body. The immune system, however, cannot distinguish between your transplanted liver and unwanted invaders. When the liver is transplanted from one person (the donor) into another (the recipient), the immune system of the recipient triggers the same response against the new organ that it would have against any foreign material, setting off a chain of events that can damage the transplanted organ. This process is called rejection. It can occur rapidly (acute rejection), or over a long period of time (chronic rejection). Rejection can occur despite close matching of the donated organ and the transplant patient.

Infection:

Because anti-rejection drugs that suppress your immune system are needed to prevent the liver from being rejected, you are at higher risk for infections. This problem lessens as time passes. Not all patients have problems with infections, and most infections can be treated successfully as they happen.

Other problems that can affect liver transplant:

Onset of the issue due to which transplant was required is the most common trouble for patients with liver transplants. Also, Hepatitis C virus may damage a transplant if the patient was infected before the procedure took place. Other problems can be blockage of the blood vessels going into or out of the liver and damage to the tubes that carry bile into the intestine. Contact us to request quick appointment at the Top 10 Liver Transplant Hospitals in India.

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FAQ's Liver Transplant in India

Anyone with a chronic or acute, severe liver disease leading to liver failure can be considered for a liver transplant.

The common diseases that need a liver transplant include: advanced liver disease due to Hepatitis C, Hepatitis B, or alcohol induced damage. Other diseases needing a liver transplant include biliary problems such as primary sclerosing cholangitis, biliary atresia (children), metabolic diseases, primary biliary cirrhosis, and primary liver cancer.

There are a wide range of liver transplants based on the existing condition & the availability of donors:

  • Living Donor Liver Transplantation (LDLT)

    Liver is transplanted with a part of a living donor's healthy liver and removal of the diseased liver from the patient. The liver in both the donor & receiver then grows back to its normal size.

  • Cadaver Liver Transplantation

    Liver transplant is done with the healthy liver of a deceased person and removal of the diseased liver from the patient!

  • Domino Liver Transplantation

    Liver taken from a liver transplant recipient is placed into a second person with a liver disease and awaiting transplant. It is typically for elderly patients.

  • Split Liver Transplantation

    Liver transplant is performed by taking the healthy liver of a deceased person and splitting into two for transplanting into two patients and removal of the diseased liver from both the patients.

  • Auxiliary Liver Transplantation

    Liver transplant is done in which only a part of the diseased liver is removed and the rest of the organ is left to regenerate over a period of time.

  • Paediatric Liver Transplantation

    Liver transplant surgery done in infants or children where there is little hope for survival without the removal of the diseased liver and replacing it with a healthy organ.

The person must be a close relative aged between 18-55 years, have a matching blood group, and weigh between 50-90 kgs (but not fat) in case of a living donation.

Liver donation is quite safe because the liver can regenerate to its original size within 2-3 months after removal of a part of it. The donor suffers from no long-term effects, no need to take any medication beyond 2-3 weeks, and is back to normalcy in a month. He/she can resume with strenuous physical activity such as weight lifting, etc. in three months.

A typical liver transplant can last from 8-12 hours. The surgery for the donor lasts approximately 5-6 hours.

Most donors are hospitalized for 7-10 days after surgery. Usually the incision staples are removed about 7-10 days post-operatively.

The success of a liver transplant depends on the expertise available at a given centre. The liver transplant is successful in more than 90% patients who get it done at well established centres across the world. And it provides an excellent quality of life with a normal life expectancy for age.

Depending on how much of the liver needs to be removed the risk to the donor from the operation is 0.1 to 0.5%. Typically, the hospitalization is one week. It may take around a month before the donor feels recovered enough to return to work. The donor has to avoid lifting heavy weights for three months. Long term problems are rare but hernias may occur and some donors have had intestinal obstruction due to the intestine getting stuck to the scar of surgery. Life is otherwise normal. There are no dietary restrictions and no need to take medicines in the long term. Also there are no restrictions on activity beyond three months.

Just as with any other major surgery, there are risks with transplant surgery. Some immediate complications include bleeding and blood clotting problems, malfunction of the donor liver and respiratory problems.

Long term complications include rejection of the transplanted liver and infection. Most of these complications can be treated.

Yes, however the number of medicines and doses reduces with the passage of time. Most patients are only on small doses of 1 or 2 medicines at about a year after the liver transplant. They are also down to a single medicine in 2-4 years that needs to be taken life-long.

This is not true. Though such persons do have a higher susceptibility to infection than usual, this will diminish rapidly by 3-6 months after the liver transplant when the doses of the immunosuppressive medicine are reduced. Hence initially they should be a little cautious, but later, even though the infection rate remains a little higher, it will not interfere with normal daily activities. In most cases, the infections that occur can be treated easily.

Most patients can return to a normal or near-normal lifestyle six months after a successful liver transplant. Recipients should avoid exposure to people with infections. It is significant to maintain a balanced diet and stay on prescribed medications to stay healthy.

Children can attend school and participate in sports and other age-appropriate activities and can have a normal married life with no fertility issues.

Studies have shown that women who undergo liver transplant can conceive and give birth normally. However, they have to be carefully monitored due to higher incidence of premature births. Mothers are advised against nursing babies due to the likelihood of the immunosuppressive drugs being transmitted to the infants through the breast milk.

The overall chances of surviving a liver transplant depend on many factors. However, overall 87% to 95% of adult patients survive for the first year.

This is unusual in practice. However, the decision would be made to transplant the liver for in patient who is more ill or with more urgent need by using the MELD score. MELD stands for Model for End Stage Liver Disease which is a scoring system that uses a Bilirubin, a renal function, and a coagulation test called the INR for determining how ill someone is and their chance of living or dying while still awaiting a liver transplant or in general with a liver failure.

After your child's surgery, he/she will be taken to transplant ICU where he/she will stay for a week. After your child is transferred out of ICU to the pediatric floor, the length of stay will depend on how quickly he/she recovers. Average length of hospital stay is about 3 weeks.

Your child will take two major types of medications in addition to multivitamins and health supplements to prevent rejection. Contact your medical team immediately in case your child misses a dose.

Initially your child has to come to the liver transplant clinic twice a week for laboratory work up and physical examination or as frequently advised by the medical team. With the progression of recovery these visits become frequently less.

Your child should avoid strenuous exercises for the first six weeks after surgery.

The survival rate in the total 241 liver transplants: 215 adult and 26 pediatrics transplants performed during the last 3 years is 90%.

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