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Transplant Surgeries


Liver Transplant

Liver Transplant Treatment in India 

Overview of Liver Transplant 

A liver transplant involves surgically removing a diseased liver and replacing it with a healthy liver (or its segment) from a donor. 

Most of the donated livers come from people who have died. These people may be registered donor or their kin consent them to become a donor. Less commonly, 

Types of Liver Transplants

 Living donor transplants 

When a healthy living individual, often a family member, friend or stranger whose tissue matches, donate a segment of their liver, it is called a living donor. During this procedure, surgeons remove a part of the living donor’s healthy liver.

 Deceased donor transplants 

Most of the livers for transplants come from people who have just died; these are called deceased donors. Adults typically receive the entire liver, but sometimes a donated liver may be used for two recipients. The larger part of the deceased liver may go to an adult, and the smaller part may go to a child.

 Signs and Symptoms of liver disease 

  • Itching of skin
  • Yellowing of the eyes or skin known as Jaundice
  • Dark colored urine or clay-colored bowel movements
  • Ascites: its accumulation of fluid in the abdomen
  • Bleeding tendency
  • Mental confusion, forgetfulness

 What is the need for Liver Transplant? 

 

The main reason for liver transplant is liver failure. It could be of two types, acute onset liver failure and chronic liver failure. 

Acute liver failure is the sudden onset of liver failure; this could be due to: 

  • Drug-induced due to some reaction to pain killers or prescribed medications
  • Viral hepatitis
  • Infection
  • Clots/injury in a vessel supplying blood to the liver

 Chronic Liver failure can be the result of long-term problems, such as: 

  • Alcoholic liver disease
  • Cancer
  • Biliary atresia common reason in children
  • Cirrhosis, fatty liver disease
  • Autoimmune, genetic disorders

 Tests & Diagnosis 

  • CT scan of the abdomen: CT scan is done to determine the liver size and to identify any abnormalities such as liver tumors. 
  • Ultrasound of the liver: a study of the liver and the surrounding organs. Doppler test determines how well the blood vessels responsible for carrying blood to and from the liver are working. 
  • Blood tests: These include liver clotting tests, function tests, routine blood tests, and culture. 

Liver Transplant Procedure

 Before Procedure

 Presurgical studies, including urine tests, blood tests, CT abdomen, chest X-rays ultrasound, ECG, etc.are performed to evaluate the seriousness of the liver disease. Once all the tests are done, and doctors found the need for a liver transplant, the patient is registered as a candidate for a liver transplant and put on a Waitlist.

 Pre-transplant tests are performed with the donor's liver to make sure that the donor's liver has a good chance of working in the body. When the liver is: 

  • Healthy
  • Right size
  • Matches your blood type 

For the best results, the Donor's liver should be transplanted within 8 hours; however, it can be used for up to a duration of 24 hours. Before surgery, the patient receives a dose of antibiotics and steroids to prevent infection rejection of the new liver, respectively.

 Procedure 

  • Liver Transplant is performed under general anesthesia, and the procedure takes approximately 6 to 8 hours.
  • An incision is made in the upper part of the abdomen.
  • Important structures such as the inferior vena cava above, behind, and below the liver, the common bile duct, the portal vein, the hepatic artery are segregated together.
  • The diseased liver is removed.
  • A new & healthy liver is placed and reconnected to the blood vessels and bile ducts. Blood will now flow into this new liver.
  • Adequate control of bleeding is done.
  • The incision is closed.
  • The liver begins to regenerate itself almost immediately.

 After the procedure: 

  • After the transplant is done, the patient is moved to the ICU. 
  • A machine (Ventilator) assists the patient's breathing, and a tube is inserted through the nose into the stomach to provide the patient with nutrients and fluids.
  • Antibiotics are prescribed to protect against infections.
  • The liver recipient should take medications for the rest of his life to avoid any Rejection syndrome (this is a rejection of the new liver by the recipient's body).
  • For successful transplantation, regular follow-ups are important, initially weekly, and then you can gradually reduce the frequency of follow-ups and testing. It will help the doctor to understand how well the Liver is functioning and early detection of a rejection episode. 

Recovery

 Eating a well-balanced diet and regular exercise is important after liver transplant. It will help you recover and keep you healthy. 

To prevent damaging your new liver, you should avoid alcohol. Your diet after liver transplant should be low in cholesterol, salt, sugar and fat. 

You may follow these steps or consult your dietician: 

  • Eat at least five servings of vegetables and fruits each day.
  • Avoid pomegranates, grapefruit and its juice, and Seville oranges due to their effect on immunosuppressant medications
  • Choose whole grain foods over processed ones
  • Drink fat-free or low-fat dairy products, which is important to maintain optimal phosphorus and calcium levels.
  • Eat lean meats, fish and poultry.
  • Follow the food safety guidelines.
  • Stay hydrated by drinking adequate fluids.

  No. of days required 

  • Total number of days: 62
  • Days in Hospital: 22
  • Days Outside Hospital: 40

 The donor needs to stay in the hospital for 3-5 days.

Specialists


Dr. Arvinder Singh Soin
Dr. Kancherla Ravindranath
Dr. Neelam Mohan
Dr. R. V. Raghavendra Rao
Dr. Sanjay Singh Negi
Dr Shamsudin Mohamed Rela
Dr. Subash Gupta
Dr. Vinay Kumaran
Dr. Vivek Vij
Dr. Geeta Billa
Dr. Rajasekhar Perumalla


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