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Liver Transplant: Everything You Need To Know!

Liver Transplantation in India

What Is Liver Transplant?

The surgical procedure in which a diseased liver of an individual is replaced with a healthy one from a donor is known as a liver transplant. This may involve either a complete or a partial liver transplantation. There can be various types of donors and also a variety of conditions in which a liver transplant may be needed. Liver is the largest organ in the human body in terms of weight. It weighs around 1.5 kg in both males and females. It performs a variety of functions in order for well functioning of the human body.

Functions of liver:

  • Metabolism of drugs and toxins
  • Removal of degradation products from the body which are the byproducts of normal metabolism such as ammonia, bilirubin
  • Synthesis of proteins and enzymes
  • Production and synthesis of bile

Medical Conditions Requiring Liver Transplant:

  • A recent exposure to substances or conditions which result in signs and symptoms of liver failure over a very short period of time will result in an acute case of liver failure. These include acetaminophen overdose, stabbing injury over the liver, viral infections such as viral hepatitis B and C, ingestion of mushrooms or some idiosyncratic drug reaction. Such patients are listed top in the recipient list owing to the fact that an acute condition can often go misdiagnosed and lead to death of the patient.
  • Chronic liver failure: This is the abuse caused to the liver over a chronic period of time, like abuse of excessive alcohol or certain drugs since ages. Though the liver has the excellent capacity to regain the lost cells and build up its structure, a chronic condition, often called as liver cirrhosis is the ultimate gross condition of the liver requiring a transplant to increase the life span of the individual.
  • Fatty liver is the excessive accumulation of fats in the liver cells accounting for failure of the liver to function normally over a chronic period of time. This condition too calls for a transplant from a donor as soon as possible.
  • Autoimmune hepatitis: Destruction of the liver by the patients own immune system
  • Primary Biliary Cirrhosis: Destruction of small bile ducts within the liver
  • Primary Sclerosing Cholangitis: Destruction of bile ducts inside and outside the liver.
  • Neonatal sclerosing cholangitis: Infection and scarring of the bile ducts in the liver of an infant
  • Biliary atresia: Absence of bile ducts outside the liver
  • Carolis disease: Abnormality of the bile ducts within the liver
  • TPN-induced cholestasis: Patients who receive intravenous nutrition, termed total parenteral nutrition (TPN) sometimes develop bile stasis which is slowing or stopping of normal bile flow, that can over time lead to liver injury and failure.
  • Hemachromatosis: Excess iron deposition in the liver
  • Wilsons disease: Abnormal copper metabolism 
  • Alpha-1 anti-trypsin deficiency: This condition is characterized by a lack of gene product that limits the activity of trypsin, an enzyme that digests protein. Over time this leads to progressive destruction of the liver and lung.
  • Glycogen storage disease (type I, III, IV): This is an inherited metabolic disorder
  • Tyrosinemia: This is a disorder of tyrosine metabolism
  • Hepato cellular carcinoma: Cancer of the non cirrhotic liver

Signs and Symptoms That Call For a Liver Transplant:

  • Yellowing of skin and mucus membranes i.e jaundice: This occurs due to excessive bilirubin and bilivirdin in the blood stream
  • Encephalopathy: This is a state of mental confusion and occurs as a result of accumulation of metabolites in the brain since the liver is unavailable for the metabolic procedure.
  • Ammonia accumulation in the brain, altered sleep cycles, dementia, confused gait
  • Bleeding in the gastro intestinal tract
  • Fluid retention in the body, stomach(ascites), chest (hydrothorax), legs(pedal edema)

Diagnostic Tests Done Prior To Liver Transplant:

  • Testing for the blood type: Out of the four blood groups A, B, AB and O, blood group AB is universal recipient and blood group O is universal donor. The Rh type either – or + however does not bother the process of organ transplant.
  • Human Leukocyte Antigen HLA test: HLA is a protein found on the membranes of white blood cells in the human blood stream. It is used to maintain the immunity and helps distinguish the body between its own and foreign cells. In cases with a positive HLA test outcome indicates that the body has a tendency to produce antibodies against its own tissues. Thus the chances of a transplant failure are quite high.
  • Cross match test: In cases of organ transplant, the body will always treat the organ as a foreign object and begin to destroy it. The body perceives it as an antigen and begins producing antibodies to kill it. However if the recipients blood is mixed with the cells or tissues of the donor in an in vitro method, then an estimation of the response can be made. A cross match is considered positive if antibodies begin to form in the reaction, negative if no antibodies form. A negative cross match test is always a thumps up for an organ transplant procedure.
  • Other serological tests to test for the positivity of sexually transmitted diseases, hepatitis, HIV, cytomegalovirus are also carried out.

Types of Liver Transplant:

This depends upon the type of donor from whom the liver is being taken and placed in the body of the recipient. Donors can be of the following types:

  • Brain dead organ donors: These are individuals in whom the brain has stopped working totally but the other organs, particularly the liver continue to function well. Such cases are seen in road traffic accidents where there is a direct injury to the head, or in cases of gunshot wounds. This can be done after taking consent from the individual’s family since such patients are ideal candidates for liver transplant.
  • Cardiac death organ donors: Sometimes a patient suffers a devastating brain injury and carries a vague neurological prognosis but fails to meet the strict criteria defining brain death in that there is still detectible brain function. In these circumstances, the patients family may decide to withdraw life-sustaining medical support with the intention of allowing the patient to die. In this scenario, death is not defined by brain death but rather cardiac death. Organ donation can occur after cardiac death but, again, only if the family gives consent.
  • Living organ donors: This is a major challenging procedure for both the donor as well as the recipient. It is impossible for any healthy individual to donate his or her entire liver since he himself will not be able to survive without a liver. Thus only a part of the liver from the donor is taken and placed in the missing part of the recipient’s liver and both the livers are allowed to heal and grow at their own pace.

Treatment Procedures For Liver Transplant:

A typical standard surgical approach for liver transplantation is as follows:

  • Incision: The surgical cutting blades are made to make incisions in the upper right gastric region so as to expose the skin, fascias and muscles in order to see the liver region
  • Evaluation: The abdomen is evaluated for any pre existing malignancy or signs of any systemic conditions present which would prevent liver exposure
  • Working on the recipient liver: The liver present in the recipient is mobilized and detached from the abdominal cavity. The blood vessels going in and out of liver are cut and ligated in order to prevent internal bleeding and to maintain a bloodless field of surgery.
  • Isolation: The vital structures are well preserved such as the inferior vena cava, portal vein, hepatic artery and the bile duct.
  • Sewing in the new liver: First, venous blood flow is re-established by connecting the donors and the recipients inferior vena cava and portal veins. Next, arterial flow is re-established by sewing the donors and recipients hepatic arteries. Finally, biliary drainage is achieved by sewing the donors and recipients common bile ducts.
  • Observe for proper bleeding control
  • Closure of the incision

Immunosuppression Following A Liver Transplant:

The human body has developed a very sophisticated series of defenses against bacteria, viruses, and tumors. The machinery of the immune system has evolved over millions of years to identify and attack anything that is foreign or not "self." Unfortunately, transplanted organs fall into the category of foreign, not self. A number of drugs are given to transplant recipients to dampen the responses of their immune system in an attempt to keep the organ safe and free of immunologic attack. If the immune system is not sufficiently weakened, then rejection - the process by which the immune system identifies, attacks, and injures the transplanted organ - ensues.

Commonly used drugs to prevent rejection by suppressing the immune system are listed below. They work through different mechanisms to weaken the immune systems responses to stimuli and are associated with different side effects. As a result, these medications are frequently used in various combinations which increase the overall immunosuppressive effect while minimizing side effects. These medications are as follows:

  • Corticosteroids
  • Calcineurin inhibitors
  • Mycophenolate mofetil
  • Mammalian target for rapamycin (mToR ) inhibitors
  • Antibodies that target the IL-2 receptor
  • Antibodies that remove T cell from the circulation
  • Investigational drugs

Complications And Risk Factors Associated With Liver Transplant:

  • Hepatic artery thrombosis or blocking of the hepatic artery
  • Portal vein thrombosis
  • Biliary leakage and strictures may occur due to injury to the bile ducts
  • Bleeding is a risk of any surgical procedure but a particular risk after liver transplantation because of the extensive nature of the surgery and because clotting requires factors made by the liver. Most transplant patients bleed a minor amount and may get additional transfusions after the operation. If bleeding is substantial or brisk, return to the operating room for control of bleeding is often necessary. In general, approximately 10% of transplant recipients will require a second operation for bleeding.
  • Infection - Infections can occur during the healing of the wound created by any operation. Liver transplant recipients are also at risk for infections deep within the abdomen, particularly if there is a collection of blood or bile (from a bile leak). The immunosuppressive medications along with the history of liver failure increase the liver transplant recipients risk for developing an infection after transplantation.
  • Obesity, smoking and alcohol pose a heavy risk at the time of surgery and also post the transplant when all the procedure has been done

Am I Good Candidate For Liver Transplant:

If you’ve been diagnosed well for the liver disorders and the survival chances are totally nil, you are an ideal candidate for a liver transplant. Any of the following conditions can give you as well as the doctor a green signal for the need to replace the liver as soon as possible:

  • Cirrhosis of liver
  • Fatty liver
  • Primary biliary cirrhosis
  • Chronic liver failure conditions
  • Primary scelorosing cholangitis

Recovery Time:

It is advisable to keep the patient under observation in the intensive care unit for about 3 to 4 days where the vital signs are monitored. If all goes well, you will be shifted to the regular ward area for a period of 10 days where you will still ne under constant vigilance. Excluding this time, a period of about 3 months is needed for you to get back to your regular schedule.

Success Rate:

The success rate for any type of organ transplantation is decided upon the survival rate one year and five years after the transplant has been done. However this also takes into account who the donor was and under what indications was a transplant recommended.

  • Liver transplant from living donors shows a survival rate of 88 percent after 1 year and 75 percent after 5 years
  • Liver transplant from cardiac or brain dead donors shows a survival rate of 67 and 77 percent after 1 and 5 years respectively

Benefits of Liver Transplant:

A liver transplant will help you in the following manner:

  • Restore the functions in the your body which were carried out by your liver earlier
  • Bring about a change in your overall health
  • Reduces the chances of liver disease getting worse and further complicating the condition

Cost comparisons:

A liver transplant would cost you around 20 to 30 lakh in India including all the diagnostic as well treatment procedures, hospital stay and medications. This is far less than what you would be required to pay in the United States or UK/Australia

Why choose India?

We at MedcureIndia take utmost care of our clients; considering how valuable their lives are for us too. We aim at directing our clients/patinets to the excellent institutes offering top class liver transplant services at affordable rates, assuring the best treatment outcomes.

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