Liver Transplant @ Zydus
Liver transplantation is a surgical procedure performed to remove a diseased or injured liver and replace it with a whole or a portion of a healthy liver from another person, called the donor. Since the liver is the only organ in the body able to regenerate, a transplanted segment of a liver can grow to normal size within a matter of few weeks.
When is a liver transplant recommended?
A liver transplant is recommended when a person’s liver no longer functions adequately enough to keep them alive. The indications for liver transplant were previously broadly divided into two categories – Chronic Liver Disease and Fulminant Liver Failure. Third and fourth indications have come up in recent years between the two extremes – Acute-on-chronic Liver Failure and Severe Alcoholic Hepatitis.
A successful liver transplant is a life-saving procedure for people with acute/fulminant liver failure. Liver failure can happen suddenly –as a result of infection or complications from certain medications, for example. Liver failure resulting from a long-term problem – called chronic liver failure – progresses over months, years or decades.
How are candidates selected for Liver Transplant
- Alcohol related liver disease is the most common etiology for patients requiring liver transplant in India and worldwide
- Chronic hepatitis, including hepatitis B and Hepatitis C These hepatitis predominate as the cause of liver transplant in developed countries
- Autoimmune hepatitis caused by abnormality of your immune system
- NASH, or nonalcoholic steatohepatitis, a disease caused by a buildup of fat in the liver resulting in inflammation and damage to liver cells. It is the most rising cause of liver transplant and is expected to become the number 1 cause of liver disease requiring liver transplant within next decade
- Some genetic conditions, including Wilson disease where dangerous levels of copper build up in the liver, and hemochromatosis where iron builds up in the liver
- Disease of vessels – Budd Chiari Syndrome
- Diseases of the bile ducts - Primary biliary cholangitis, Primary sclerosing cholangitis, and biliary atresia. Biliary atresia, a disease of absent or malformed bile ducts usually identified shortly after birth, is the most common cause of liver failure and transplant in infants
- Primary liver cancer, meaning cancers that originate in the liver, such as hepatocellular carcinoma are also amenable to liver transplant if they present within established criteria. Unfortunately most individuals in India are diagnosed late and hence cannot be transplanted
Referral by your Liver physician / GI physician / Medical Gastroenterologist for transplant is the first step. You are evaluated to determine if you are a suitable candidate.
Evaluation will include assessment of your:
What tests are required for evaluation?
- Liver disease and other conditions you may have;Mental and emotional health
- Other vital metabolic support systems
- Ability to adhere to the complex medical regimen required after transplant and
- Likelihood of surviving the transplant surgery
Extensive testing is required before someone can be placed on the transplant list. This usually includes:
What happens during Liver Transplant surgery?
- Detailed medical history
- Psychological and social evaluation
- Diagnostic tests to evaluate the status of your heart, lung and other organs
- Imaging studies, such as CT scans and ultrasound, to assess your liver and blood flow through various vessels
- Multiple blood tests to determine your blood type, kidney function and liver function, and check for other infectious, immune, and inherited diseases
- HIV, hepatitis, drug and alcohol screening
Liver transplant surgery is complex and generally takes between 6 and 10 hours. During the operation, surgeons will remove the entire injured or diseased liver and replace it with the donor liver. Several tubes will be placed in your body to help it carry out certain functions during the operation and for a few days afterward.
These include a breathing tube, intravenous lines to provide fluids and medications, a catheter to drain urine from your bladder, and other tubes to drain fluid and blood from your abdomen. You’ll be kept under close observation in a specially designed intensive care unit for a few days and then moved to a regular room. The length of your hospitalization depends on your specific circumstances and if complications arise, the stay could be extended.
What are the risks associated with Liver Transplant?
The two main risks following liver transplant are infection and rejection of the new liver by your body’s immune system. Your immune system attacks unwanted foreign substances – like bacteria and viruses – that invade your body. But the immune system can’t distinguish between the transplanted liver and unwanted invaders, so it may try to attack – or reject – your new liver.
To prevent rejection, all transplant patients must take anti-rejection medications, called immunosuppressant. These drugs are given to suppress your immune system in an effort to ward off rejection of the new liver. However, by suppressing your immune system you become more susceptible to infections. Fortunately, this problem usually lessens as time passes and most infections can be treated successfully with other drugs.
The other thing to be aware of is that liver disease can recur in the transplanted liver. One of the primary problems with hepatitis C patients was universal recurrence of the virus after transplantation. However, with the advent of newer, more effective treatments, hepatitis C can be cured before or after liver transplantation.
Patients with advanced liver disease from hepatitis B require lifelong medication to suppress the virus both before and after transplantation. Autoimmune diseases such as primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) may also recur.
Rejection does not always cause noticeable symptoms. In fact, sometimes the only way rejection is detected is from routine blood tests. As such, it’s very important not to miss regularly scheduled appointments with your medical team. If there are symptoms, each individual may experience them differently. Some of the more common signs and symptoms of rejection include:
Myths about Liver Transplant
- loss of appetite
- itchy skin (pruritus)
- dark-colored urine
- jaundice (a yellowing of the skin and whites of the eyes)
- abdominal tenderness or swelling
Myth 1 – Liver Transplant is only for elite class
Liver transplant is 100 times cheaper in India than any other developed country of the world. The overall cost varies from 12 -25 lakhs for the operation. But the most important fact that people do not know is that there are a lot of social organizations and NGOs that help people financially for liver transplant. What people fail to understand that you end up spending more than the cost of transplant after cirrhosis just for repeated admissions with complications. It is advisable to get transplanted rather than getting admitted multiple times in Intensive care unit. A lot of individuals who present to hospitals have spent more than 30-35 lakhs for treatment before even thinking of liver transplant.
Myth 2 – Liver Transplant is not successful
The survival rate in India in whichever center of India you take is equal to the rest of the worlds. In fact when we compare the data from majority of our centers, as we do LDLT, the survival is superior. We expect 90% patients to walk home after a transplant and the survival rate of 5 years is 70 percent which is 5 times that of the patient who is in need for liver transplant.
Myth 3 – You have to travel out of Gujarat to get a liver
We, at Zydus Hospitals have a complete in-house team for Liver Transplant unlike other centres with a combined experience of more than 1000 transplants. You no longer need to travel out of the state to get a liver.
Who can be a living donor?
Any person from the family (1st degree relatives- spouse, siblings, parents, children/ 2nd degree relatives- all others) who is blood group compatible can donate his/ her liver.
The living donors are assessed in 4 stages for ruling out any liver disease and any other systemic diseases. This helps the liver team in deciding the suitability of the living donor.
With the present availability and expertise in surgery and anesthesia, the surgery for living donor is very safe. The risk of surgery for the donor is 0.2 to 0.5 %.
Why choose Zydus ?
Zydus Hospitals, Ahmedabad offers end to end Liver Care solutions. We offer our services right from Clinical Assessment → Disease Detection → Disease Management.
A dedicated team of Gastroenterologists, Liver & Hepatobiliary Transplant Surgeon, Transplant Anaesthetist, Transplant Dietary Specialists & experienced team of co-ordinators. Together our Liver Care Team will provide you information, guidance & support. More than a team of medical specialists we wish to be a part of your extended family.
The best is to protect your liver from developing cirrhosis. Even if you develop cirrhosis, it is not the death sentence nowadays and you can still expect to survive a functional life with good quality after a liver transplant.