Dr. Suresh Kumar Singhvi, Contact : +91-9560703966
Sir Ganga Ram Hospital, New Delhi 110060. OPD - F90 : .
Liver transplant is the treatment for end stage liver disease in both adults and children. In this operation, the diseased liver is removed and replaced by a healthy one. The success rate for the operation is high and terminally ill patient can return to normal lives. This kind of transplant has been done for more than 40 years.
The overall success rate of liver transplant is high and the majority of liver transplant recipients can return to normal activities. Since your body may reject the new liver, it is essential for you to take immunosuppressive medications and continue follow up at our liver transplant clinic. You will need to continue these medications for life, at a reducing dosage
Your new liver can come from either of the two sources: a living donor or a brain-dead deceased donor.
A) Living donor:
It is technically feasible to remove part of the liver from a living person and transplant it to a patient who needs a new liver. The operation has now been done since 1989. Depending on the size matching of the donor and recipient, either the left side (about 35%) or the right side (50-65%) of the liver will have to be removed. The liver remnant in the donor will grow to its original size in 6-8 weeks time.The donor complications-donor death 0.2 to 0.4%.
B) Brain-dead deceased donor:
You will be put on waiting list for a brain dead deceased donor liver and receive a liver graft according to the following criteria:
Unfortunately, the availability of deceased donor liver is not very often. Depending on your blood group, you may have to wait for 12-36 months before you get a new liver. During this waiting period, you may develop complications like spontaneous bacterial peritonitis which, if repetitive may produce severe adhesions in your abdomen rendering liver transplant difficult if not impossible. Overall the complications of liver disease would adversely affect the success rate of the liver transplant.
When potential deceased donor liver graft is allocated to you, you will be admitted to the hospital by our liver transplant coordinator. A series of tests and investigations (blood tests, cultures, chest x-ray, ECG) and assessments by the anesthetist will be performed on you promptly after admission. You will be explained on the nature, purpose, and risk of the operation by our transplant surgeons in the ward. You are also required to sign a consent form referring to the success rate or diseases from the cadaveric organ. For a minor patient(age under 18yrs) the patient s parents, guardian or next of kin should sign the form. It is important for you and your family to understand that assessments and investigations on the potential deceased donor are on going and unexpected changes may happen to the donors medical condition. There are uncertain circumstances that may render the donor unsuitable for donation even when you have been admitted to the hospital.
The most important criteria is that the donation of portion of the liver is done voluntarily. The potential donor should understand clearly.
The liver transplant team will consider the donor who understands the above criteria and who has demonstrated true voluntarism as potential living donor. The donor has to be a first degree relative and should be able to prove the relationship to the patient. The potential donor will then undergo evaluation including blood tests, CT Scan, MRI scan, psychiatrist evaluation and assessment by various specialists including cardiologist, pulmonologists and anesthetists. Depending on the clinical situation, the investigations can take a day to a week. The Transplant committee needs to approve all living donor liver transplant. The legal paper work has to be completed and the papers have to be submitted to the Approval Committee (Independent committee appointed by the Government) for clearance. Only after this formality the liver transplant takes place.
When a liver is available, you will be prepared for the liver transplant. If your new liver is from a living donor, both you and the donor operation will be done at the same time in two different operating theaters. If your new liver is from a person who has recently lost life, your liver transplant starts when the new liver arrives at the hospital.
Depending on the size and requirement of the recipient, the donor may donate the left lateral segment (about 20%) , left liver (35%) , or right lobe(about 50-65%) of the liver. The operation is done under general anesthesia. The incision is done and the abdomen is opened. After deciding the liver is normal and suitable for donation, the surgeon will remove the gallbladder and cannulate the cystic duct for operative cholangiography (to see the bile ducts). The absence of the gallbladder in the donor will not affect the quality of life afterwards. Next, the relevant inflow and outflow blood vessels and bile duct are freed. The liver is then transected at the plane depending on the type of liver donation. Finally the donated part of the liver is removed after the relevant inflow and outflow blood vessels are divided and ligated. The wound is then sutured. The duration of the operation is approximately 6 hours, but it may be a bit longer. There are possibilities that the donor operation is stopped because of the following reasons:
In this situation, the donor may have an abdominal wound, although he/she has not gone through the donor hepatectomy.
After the operation, the recipient and the donor (Living donor) will be treated in the Intensive care Unit. The duration of stay in the ICU depends on the rapidity of recovery of the donor and the recipient. Usually, the recipient stays for 5 days in ICU and the donor stays for 2-3 days in ICU.
You will stay in the hospital for an average of 1 to 3 weeks to be sure your new liver is working. You will take medications to prevent rejection of your new liver and to prevent infections. Your doctor will check for bleeding, infection and rejection. During this period you will start to learn how to take care of yourself and use your medicines to protect your new liver after you go home. In the hospital, you will slowly start eating again. You will start with clear liquids, then switch to solid food as your new liver starts to work
Rejection occurs when your body s natural defenses, called the immune system, damage the new liver. Your immune system keeps you healthy by fighting against things that don’t belong in your body, such as bacteria and viruses. It is common for your immune system to fight against the liver and try to destroy it.
To keep your body from rejecting the new liver, you will take medicines. These drugs, such as steroids, cyclosporines, tacrolimus, sirolimus, everolimus and Mycophenalat Mofetil (MMF) , are called immunosuppresants. Along with these medications you may need to take antibiotics, antivirals and antifungals too.
Liver transplant patients will see the doctor regularly to be sure that the new liver is working well. You will have regular blood tests to check that your new liver is not being damaged by rejection, infection or problems with blood vessels or bile ducts. You will need to avoid sick people and report any illnesses to your doctor. You will need to eat a healthy diet, exercise and not drink alcohol, especially if alcohol was the cause of damage to your own liver. You should use medicines prescribed to you by your doctor and not to take medicines over the counter. A information leaflet will be given to all patients to follow at home.
Yes. After a successful liver transplant, most people can go back to their normal daily activities. Getting your strength back will take some time, though depending on how sick you were before the transplant. You will need to check with your doctor on how long your recovery period should be. After recovery, most people are able to go back to work.
Diet, most people can go back to eating as they did before. Some medicines may cause you to gain weight and other may cause diabetes or a rise in your cholesterol. Meal planning and a balanced low fat diet can help you remain healthy.
The liver is the largest internal organ in one’s body. It is a complex organ that works non-stop, 24 hours a day, detoxifying just about everything that enters the body. It plays a vital role in regulating life processes – virtually all the blood returning from the intestinal tract to the heart passes through the liver. Anything that we consume is absorbed into the bloodstream, which passes through the liver. Therefore, the liver is essential to our life.
The liver’s sheer complexity makes it susceptible to many different diseases – including liver diseases like chronic hepatitis which leads to liver cirrhosis, unknown cause of liver failure or biliary diseases in adults, as well as biliary atresia in children and adolescents.
When the liver fails, a liver transplant provides hope for you and your family. Liver transplant offers as the last option for patients with end-stage liver disease