Liver transplant in India

Liver and its Functions:
Liver is located on the right side behind the rib cage. It has many functions including processing proteins, fats and carbohydrates, and breaking down toxic substances such as drugs and alcohol. The liver makes the chemical components that help your blood clot. If the liver fails, you lose the ability to clot blood and process nutrients needed for life. The liver also excretes a yellow digestive juice called bile, which may accumulate if your liver is not functioning properly.

Liver transplant:
A liver or hepatic transplant is a major surgical procedure in which diseased or damaged liver is replaced with a healthy liver. This procedure is very time consuming and demanding. It is performed in case of acute liver failure or an end stage liver disease.

Common Reasons for Liver transplant:
Some of the most common reasons for liver transplant are as follows;

• End-stage Cirrhosis which can be a result of alcoholic cirrhosis, chronic hepatitis, hemochromatosis, primary bilary sclerosis, etc.
  
  
• Liver cancers like Cholangiocarcinoma, primary hepatocellular carcinoma, primary hepatocellular malignancies and hepatic adenomas.
  
  
• Fulminant viral hepatitis (A, B, C, D), hepatic thrombosis may cause Fulminant hepatic failure.
• Genetic liver diseases

Candidates for Liver transplant:
Persons who suffer from irreversible acute or chronic liver disease are possible candidates for liver transplant. The decision to start the process of determining if you are a candidate should be taken seriously. Besides determining your candidacy, it is important to consider the emotional, physical and financial aspects of a transplant.

Two main considerations for whether someone is a candidate for liver transplant are:

• Your condition will benefit from a liver transplant
• The surgery would do more good than harm

Not a Candidate for Liver transplant:
Certain conditions disqualify a person from undergoing a liver transplant because a successful outcome is unlikely. These conditions are known as absolute contraindications. They include the following:

• AIDS (acquired immunodeficiency disease)
• Cancer presently existing in an organ other than the liver
• Metastatic cancer of the liver (advanced liver cancer that has spread to another organ)
• Alcoholic liver disease coupled with failure to abstain from alcohol for the last six months
• Severe active infection
• Active substance abuse (for example, alcohol or heroin)
• Irreversible brain dysfunction
• Advanced heart or lung disease

Donors for Liver transplant:
Liver transplant can be performed with the help of two types of donors:

• Deceased donor: Liver transplant can be done with a deceased donor from someone who has died. The large majority of liver transplants use the entire liver from a non-living donor for the transplant, particularly for adult recipients
  
  
• Living donor: A living donor is usually someone in the family or a close friend.

Preparation for Liver transplant:
The preliminary evaluation, called a Phase I Evaluation, is the first step in helping you and the transplant team determines if transplant is an appropriate treatment option Every patient is evaluated by a liver specialist, called a hepatologist, and a surgeon. The appointment will take a full day, and can be very tiring. The following tips will help you prepare for this first appointment:

• You must have a family member or another support person or people accompany you to help understand the significant amount of information you will receive about the transplant process.
  
  
• Because you will undergo many tests, do not eat or drink anything after midnight of the day before your appointment.
  
  
• Plan to bring a snack. Please bring any medications you are taking.

Evaluation and Tests for Liver transplant:
You will need to bring all of your previous medical records, X-rays, liver biopsy slides, operative reports and a record of medications to your pre-evaluation. To complement and to update previous tests, some or all of the following diagnostic studies are generally performed during your evaluation. If specific problems are identified, additional tests may be ordered.

• Computed tomography, which uses X-rays and a computer to generate pictures of the liver, showing its size and shape
  
  
• Doppler ultrasound to determine if the blood vessels to and from your liver are open
  
  
• Echocardiogram and stress testing to help evaluate your heart
  
  
• Pulmonary function studies to determine your lungs' ability to exchange oxygen and carbon dioxide
  
  
• Blood tests to determine blood type, clotting ability, and biochemical status of blood, and to gauge liver function. Serology screening is also included.

Liver transplant Procedure:

• The surgery usually takes between five and six hours, but may be longer or shorter due to the difficulty of the operation and the experience of the surgeon.
  
  
• Liver transplant is performed under a general anesthesia.
  
  
• Before the surgery, a tube is placed through the mouth of patient into windpipe to help breathe during the operation.
  
  
• A Y-shaped incision in the abdomen is made and the diseased liver is removed. Donated liver is then inserted and attached to the major blood vessels and to the bile ducts. The incision is then closed at the end of surgery.
  
  
• Entire procedure of liver transplant surgery usually takes about 6-12 hour to perform successfully.

Types of Liver transplant Surgery:
There are three types of liver transplant surgery procedures - Orthotopic transplant, Heterotopic transplant surgery and Reduced-size liver transplant.

• Orthotopic transplant - The orthotopic approach requires replacing the recipient liver with the donor liver. After the donor liver is removed, preserved and packed for transport, it must be transplanted into the recipient within 12 to 18 hours. The surgery begins by removing the diseased liver from the four main blood vessels and other structures that hold it in place in the abdomen. After the recipient's liver is removed, the new healthy donor liver is then connected and blood flow is restored. The final connection is made to the bile duct, a small tube that carries bile made in the liver to the intestines.
  
  
• Heterotopic transplant – Heterotopic transplant surgery involves the addition of a healthy donor liver at another site, while the diseased liver is left intact. This liver transplant surgery procedure is performed when the doctor is of the opinion that the diseased liver might recover. The healthy liver is attached very near to the original liver. If the liver recovers, the other organ shrivels away. If not, then the original one shrivels and the donor liver performs the body functions.
  
  
• Reduced-size Liver transplant – Reduced-size Liver transplant is most often performed on children and involves the transplanting a part of the healthy donor liver into a patient. This procedure is performed when 15-20% of the original liver is intact. This way, one donor liver can be used for two successful transplants.

Follow Up Care Post Liver transplant:

• After liver transplant, the patient must frequently visit the transplant surgeon, about 1-2 times a week over about 3 months.
  
  
• The transplant surgeon and hepatologist monitor the patient's progress through blood tests. After a year of Liver transplant, follow-up care becomes individualized.
  
  
• Post transplant, patient will be on several different medications especially Immunosuppression medications which keep the body from fighting off the new organ.  You may be on other medications to control blood pressure, Insulin, antibiotics and antivirals, diuretics, and vitamins. 
  
  
• Typically, patients are seen every week for the first month post transplant, and then the frequency is reduced over time.
  
  
• Additional testing to monitor your health and liver function may vary from patient to patient.  Tests may include abdominal scans, ultrasounds, and liver biopsies.
  
  
• There are few dietary restrictions. The patient is often advised to restrict salt (sodium) intake. A well-balanced diet with adequate protein is necessary. For reasons that are not clear, obesity frequently becomes a problem with liver transplant patients. To avoid this problem, patients should take control of their calorie intake early on.

Liver transplant Rejection:
Unfortunately, when the immune system sees a newly transplanted organ as a foreign object that could be harmful to you, it attempts to rid your body of it. This is called as rejection. The anti rejection drugs taken after surgery help prevent rejection.  These drugs weaken the immune system to allow your body to accept the transplanted organ. Rejection is most common in the 6 months after transplant surgery, but it can happen at any time. It can also be treated. Treatment is most effective if rejection is caught early. Fever, Fatigue, Chills, Nausea Body ache and Jaundice are some warning signs of rejection of liver transplant. The patient needs to be aware of the signs of rejection so that it can be reported to the transplant coordinator immediately. Some tests are conducted to confirm rejection of the transplanted liver. These tests may include blood work and Liver biopsy. If the liver shows any signs of rejection, the dosage of immunosuppressant drugs is usually increased. If the biopsy shows a significant amount of rejection, the patient may be hospitalized for more intensive immunosuppressive therapy.

Advantages of Liver transplant:

• Liver transplants provide patients a chance for a longer, more active life in the final stages of liver disease or end-stage liver disease.
  
  
• There’s no question that transplant is a major operation. The recovery can sometimes be the most taxing but anti-rejection medications are making the process easier.
  
  
• If the transplant is performed before the recipient's health deteriorates, he or she is better able to tolerate the surgery and recovers more quickly.
  
  
• The donors and recipients recovered quickly, the donors were discharged in about a week and the recipients in 2 to 3 weeks.

Liver transplant in India:
Liver transplant in India is performed through cutting- edge clinical solutions, research, extraordinary patient care and infrastructure of world-class standards. This has addressed concerns of many patients and has helped them get rid of complex and most end stage liver diseases.Liver Transplant is a complex surgical exercise and need highly skilled consultants, ingenious technical staff and advanced technology working with perfect harmony, enormous dedication and team work. India offers a one stop solution for all those seeking critical procedures such as Liver transplant.

• recovery and in-hospital stay
• extensive lab tests
• anesthesia
• fees for transplant surgeons and operating room personnel
• organ recovery
• transportation to hospital
• lodging, transportation and food for family members while the patient is hospitalized
• physical therapy and rehabilitation
• patient lodging following discharge
• anti-rejection drugs and other medications