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Liver Transplantation

The liver is the largest solid organ in the body and fulfills many important functions, which are necessary for life. Some of its functions include:
  • Detoxification of toxins produced in the body as well as those consumed
  • Builds special proteins to prevent bleeding
  • Makes bile to break down fats from food
  • Stores and metabolizes sugar for energy
  • Metabolizes drugs consumed
  • Stores vitamins and minerals
  • Breaks down proteins in absorbed food
Liver transplantation is the replacement of a diseased liver with a healthy liver from another person (allograft). The most commonly used technique is orthotropic transplantation, in which the native liver is removed and replaced with the donor organ in the same anatomical location as the original liver. Today, Liver transplantation in India has become a viable treatment option for end-stage liver disease and acute liver failure. The surgical procedure is very demanding and ranges from 4 to 18 hours, depending on the outcome.
People who need liver transplant may suffer the following:
  • Acute liver failure
  • Chronic liver failure
Symptoms that a patient suffering from Cirrhosis may present include:
  • Ascites (fluid in the abdomen)
  • Fatigue
  • Confusion
  • Change in sleep patterns
  • Itching
  • Easy bruising
  • Nausea and vomiting
  • Muscle cramping
  • Swollen ankles
  • Dark urine
  • Fever and infections
  • Pain over the liver
  • Internal bleeding
  • Jaundice (yellow color of the skin or the white part of the eyes)
  • Spider veins (broken blood vessels on the face, arms & chest)
  • Change in appearance of bowel movements (pale stools, black stools or fatty stools)
However, not all patients are symptomatic and some of them may have no or minimal symptoms. Liver transplantation is a life-saving procedure for people with liver disorders. Liver cirrhosis, which was at one time considered a terminal disease, is now completely curable if treated at the right time.
When disease damages the liver, it does not function normally. Some of the causes of Liver damage include:
  • Hepatitis B
  • Hepatitis C
  • Chronic alcohol consumption
  • Non-alcoholic steatohepatitis ( Fatty Liver )
  • Autoimmune disorders
  • Cryptogenic Cirrhosis
  • Hemochromatosis
  • Drug induced
In addition to liver failure, liver cancer may develop as a result of many of these diseases. There are also cases of sudden liver failure, with unknown causes, called acute or sub-acute fulminant liver failure.
At HCG each patient is assessed in detail so that the specialists can chart out a personalized treatment plan which would be best suitable for the patient based on their health for a transplant. The transplant assessment process helps to determine if the patient requires a transplant, the assessment includes extensive medical tests and treatment planning sessions between the caregivers and the transplant team. A thorough check is completed to determine that the patient does not have any other conditions or health problems which would involve risk for a liver transplant.
Types of Liver Transplants
Deceased donor Liver transplantation:
If there are no Living donors or if the patient opts for a Deceased donor, the patient will be listed as per the Blood group by the Zonal Co-ordination Committee, which overlooks the fair distribution of all available cadaver livers among the hospitals offering Liver Transplantation. Once registered, the patient will be on the List as per his or her blood group. The allocation of the liver is on a rotation basis among the hospitals offering transplant. When an organ is available, the patient is called to the hospital. We expect the patient to respond immediately and reach the hospital at the earliest.
There is usually a waiting period of a few months for this type of a Transplant. This is not particularly suitable for patients with HCC (Hepatocellular Carcinoma) where the long waiting times may be detrimental to the patient. However, if no suitable donors are available, The specialists may consider performing either TACE/TARE/RFA on these patients to slow the progression of HCC.
This type of Liver transplant involves harvesting the liver from a brain dead donor whose family is willing for organ donation. The Liver is harvested and transplanted to a suitable candidate. Usually the whole of the Liver is transplanted to a single recipient, however, in some cases, the liver may be split to give benefit to two recipients.
Living Donor Liver transplantation (LDLT):
Living Donor Liver Transplant involves removal of a part of the liver from the living related donor and transplanting the same to the patient in need of Liver transplant.
Living donor liver transplants are as successful as deceased donor liver transplants and significantly reduce the risk of health deterioration and death for patients who would otherwise wait on the list for the next available deceased donor organ.
Benefits of Living Donor Liver Transplant:
  • The recipient receives a high quality organ with excellent graft function
  • Decreased recipient waiting time for liver transplant
  • The capacity for the team to plan the transplant before the recipient’s health deteriorates further
  • Reduced risk of death while waiting for transplant
  • High success rates for donor and recipient
Disadvantages of Living Donor Liver Transplant:
  • Placing an otherwise healthy individual (the donor) at risk
  • Risk of complications
Assessment of Living donor:
Potential donors have a thorough evaluation by the health care team. They undergo a series of blood tests, x-rays, ultrasounds and consultations with specialists to provide information about the procedure.
  • Donors must be in excellent physical and emotional health
  • Donors should not have any history of cancer, or any active infection at the time of donation
  • Donors must have normal liver function
  • The blood vessels to the liver and bile ducts in the liver must be suitable for transplantation. (Which is determined by a Contrast Enhanced CT scan of the abdomen and MRCP)
  • Donors should have family and friends who can provide support before, during and after surgery
Principles Guiding Living Donor Selection:
  • Living donor must be between the ages of 18 and 50 years
  • Should be a blood relative or spouse of the recipient(HLA typing is routinely performed for assessing the relation). First degree relatives can get clearance for donation from a committee within the Hospital. However, any second degree relative will have to obtain clearance from the state government. The Transplant coordinator will assist the family by providing guidance, but it should be noted that the onus of obtaining the clearance rests solely with the family and the team will not be involved in obtaining the same.
  • Living donation must be completely voluntary
  • Donor safety is the priority during assessment & donation
  • It is the donor’s responsibility to communicate if there are any concerns or issues that need to be addressed regarding the assessment or he/she has a change of heart and does not want to donate
  • At any point, if the Surgeon feels that the donor may not be a suitable candidate, he will not go ahead with the procedure as donor safety is paramount
Once the tests and consultations are completed, the transplant team will meet to review the results. If there are no contraindications and the recipient is prepared to go forward, he/she will be placed on the waiting list for liver transplant.