Liver Transplant in india

Liver Transplant and Surgery: Understanding the Basics of the Procedure

Liver transplantation is now the treatment of choice for selected groups of patients with end-stage liver disease or liver failure. Liver failure can be either acute (fulminant or sub-fulminant failure) or chronic (decompensated cirrhosis). In the pre-transplantation era, liver failure was nearly universally fatal, with mortality from fulminant hepatic failure of 80–90% and 1-year mortality in decompensated cirrhosis of more than 50%. Thus, liver transplantation has become the standard of care for either acute or chronic liver failure.

What is a Liver Transplant?

Liver transplantation, an established form of treatment for end-stage liver disease, has gained acceptance in India over the last 10 years. India's unique features have contributed to the growth of both deceased donor and living donor transplantations, of which the living donor currently dominates the picture. Living donors contribute 80% of liver transplants in India, and deceased donors contribute 20%.

Eligibility Criteria for Liver Transplant in India :

The donors need to meet specific criteria to ensure the safety and success of a liver transplant. In India, the requirements for becoming a liver donor include:

• 1. Being between the ages of 18 and 55.
• 2. Having a compatible blood type with the recipient.
• 3. Being in good overall health.

To ensure they are physically and mentally prepared for the treatment, liver transplant donors must undergo a complete medical evaluation that includes blood testing, imaging exams, and psychiatric assessment. It is essential to prioritize the donor's health and ensure they are fully aware of liver donation's risks and potential consequences. The process of figuring these things out is somewhat complicated. After fulfilling the liver transplant criteria, your name will be added to the nationwide waiting list.

Finding a Liver Donor in India:

Are you or someone you need for a liver transplant in India? Finding a liver transplant donor can be a challenging and emotional process, but we're here to help! In this blog, we'll guide you through how to get a liver donor in India and explore the possibility of a living liver transplant donor in India.

Challenges of Finding a Liver Donor:

• 1. India has a vast population but low organ donation rates, making it extremely difficult to identify liver donors.
• 2. Long waiting lists and high death rates are the results of the demand for liver transplants being significantly greater than the supply.
• 3. Cultural and religious convictions, ignorance, and misperceptions about organ donation also contribute to the shortage of donors.
• 4. Additionally, the prevalence of fatty liver disease and viral hepatitis in India raises the demand for liver transplants, adding to the challenges that are already present.

Liver Transplant Procedure:

You will go through a series of evaluations at the transplant center, where you will meet members of your transplant team. You may need to visit the transplant center several times over a few weeks or even months. Your team will ask you about your medical history and perform medical tests. These tests may include:-

• a physical exam
• blood and urine tests
• tests that provide pictures of organs inside your body
• tests to see how well your heart, lungs, and kidneys are working

The team will use the results of these tests to tell:-

• how likely you are to survive transplant surgery
• what other diseases and conditions do you have
• the cause and severity of your liver disease

Your team will find out if you are healthy enough for surgery. Some medical conditions or illnesses can make a liver transplant less likely to succeed. You may not be able to have a transplant if you are having:-

• a severe infection
• alcohol or drug abuse problems
• cancer outside the liver
• serious heart or lung disease

Also, the transplant team will find out whether you or your caregivers can understand and follow your doctor's instructions for care after your transplant. They need to be sure you are mentally prepared for caring for a new liver.

How long does a liver transplant surgery take?

A liver transplant surgery usually takes between 6 to 12 hours, depending on how complex it is and whether the donor is living or deceased. You'll have a general anesthetic, so you'll be asleep and won't feel any pain. Your anesthetist will help to prepare you for the operation. Once you're sleeping, your surgeon will make a large cut in your tummy (abdomen) and up towards your chest. The cut will be like a hockey stick or an upside-down Y.

During the procedure, doctors remove the damaged liver and carefully connect the new liver's blood vessels and bile ducts. The surgery may take longer if the patient has a complicated anatomy, previous abdominal surgeries, or unexpected complications. Surgeons must work with great care to ensure the new liver functions properly and that blood flows correctly.

It may be a whole liver, a reduced liver, or a split liver. A reduced liver is when only a part of the liver is used. A split liver is when either a right or left lobe is used. Both will grow over time to a full-sized liver. It'll attach your blood vessels and bile ducts to the donor's liver. Your surgeon may put two drainage tubes in before closing your wound. These will drain blood and fluid from around your liver. Once your surgeon finishes, they'll close the cut with stitches or clips.

Risks and Complications of Liver Transplant:

As with any major surgery, liver transplants come with risks. Complications occur both immediately after transplantation and in the long term. This blog describes the most frequent complications after liver transplantation, divided into two groups: Immediate Complications and Long-Term Complications.

1. Immediate complications:

The major immediate or short-term complications include:

• 1. Technical complications: Arterial complications, particularly hepatic artery thrombosis (blood clotting) (the blood vessel that supplies blood to the liver), are the most frequent.

• 2. Medical complications: When the transplant is successful, the patient is awake and stable, with spontaneous respiration, preserved kidney function, and gradual improvement of liver activity. The most frequent medical complications during the early post-transplant period are hemodynamic alterations and neurological, respiratory, and kidney complications.

• 3. Liver graft dysfunction: The early dysfunction of the graft can be due to problems of the graft itself (rejection of the new liver, dysfunction/malfunction, nonspecific cholestatic syndrome), Complications of the surgical technique, or other causes, such as drug-related liver toxicity or infections.

• 4. Infections: Infections are the major short-term complications. Anti-rejection drugs (immunosuppression) increase the risk of infections by suppressing the immune system that rejects the transplanted liver. This problem reduces with time.

• 5. Rejection: In the absence of anti-rejection drugs, a transplanted organ invariably experiences rejection from the immune system as the immune system cannot distinguish between the transplanted liver and unwanted bacteria and viruses.

2. Long-term complications:

In earlier times, liver transplantation was considered an experimental procedure and the last therapeutic option for critical patients. In these circumstances, the long-term complications were never considered a great concern. Today, with improved survival in most transplant centers, increasing attention is being given to long-term complications. The most frequent complications are:-

• 1. Chronic rejection: Chronic rejection is usually not evident until at least 6 months after transplant. The pathogenesis is still unclear.

• 2. Renal failure: Post-transplantation chronic renal failure is closely related to the use of calcineurin inhibitors.

• 3. Arterial hypertension: This is a frequent complication in liver transplant recipients. Its prevalence varies between 50-70% in the first post-transplantation months but decreases thereafter, probably due to the reduction of the immunosuppressive doses.

• 4. Diabetes mellitus: A few may develop diabetes mellitus following transplantation. The occurrence depends on the time elapsed since transplantation and particularly on the immunosuppressive drugs.

• 5. Bone complications: Osteopenia (when bones become weaker than normal) is a frequent finding in patients with advanced, chronic liver disease. Globally, 20-40% of liver transplant recipients suffer from atraumatic bone fractures in vertebrae and the ribs.

• 6. Obesity: Obesity is a quite frequent complication in transplantation patients with a prevalence that ranges between 15 and 40% one year post-transplantation.

Life After Liver Transplant:

• 1. A liver transplant is a major operation, and it can take time to recover (up to a year). It's important to understand the commitment that you need to make to your health after the operation.

• 2. After you've had a liver transplant and been sent home from the hospital, you'll need to return for regular appointments at the liver transplant center. For the first 2 to 3 months, these will probably be about once a week. You'll then go less often as you recover – usually every few months and once a year.

• 3. Your transplant doctors will check your general health and how your liver is working at your check-up appointments, as well as if you have any complications from your surgery.

• 4. Contact your transplant team if you have any questions during your recovery, such as what you can and can't do. They are there to help you and can offer advice and support to help you get on with life after a liver transplant.

What happens if your body rejects your New Liver ?

If your body rejects your liver, your immune system starts to attack it because it realizes your new liver came from a different person. So, it sees it as something that isn’t supposed to be there. Rejection isn’t all or nothing. If your body starts to reject your new liver, this can often be stopped. So, telling your transplant team if you think this is happening is important.

Your transplant doctors will prescribe immunosuppressant medicines for you that aim to stop your body from rejecting your new liver, but sometimes, it can still happen. The risk is greatest just after your transplant operation, but less often, it can happen months or years later. The most important things you can do to help prevent this are taking the right dose of your medicines at the right time every day and ensuring you attend your clinic appointments, even if you’re feeling well.

You may get some symptoms if your body acutely rejects your liver, such as a fever or extreme tiredness, and your eyes and skin may look yellow (jaundice). Your tummy may feel tender, too. Ask your transplant team what else to look out for.

Causes of liver damage in adults and children :-

• Cirrhosis is the most common condition that causes irreparable damage to the liver, leading to a requirement for liver transplants in India. It can cause severe deterioration of the liver by blocking the blood flow through the organ and causing it to malfunction. Multiple factors, such as Hepatitis B and C, fatty liver, overconsumption of alcohol, and autoimmune disease of the organ, can cause cirrhosis of the liver.
• Liver cancer or any other cancer that leads to metastasis in the liver
• Primary biliary sclerosis
• Genetic Liver disease

Children:- Biliary atresia is the most common condition due to which kids might need a liver transplant in India. Kids suffering from such a medical condition are born with a blocked bile duct or even without it. It leads to cirrhosis of the liver in infants, causing the failure of this organ. Only a liver transplantation procedure can help save the lives of kids with biliary atresia.

Can a person resume normal life after a Liver Transplant?

Yes, one can surely resume their normal life about 3 to 4 months after going for a liver transplant in India. However, it would help if you didn't take your health casually after going through such a major surgery. You must follow the medications, diet, and exercises prescribed by experts after a liver transplant to ensure your long-term good health and well-being. It is additionally recommended that women try to avoid pregnancy in the first year after going through a liver transplant in India.

Most people may return to school, work, and other normal activities within two months of the surgery. If you have the option of returning to your job part-time, you could gradually increase your working hours as your energy levels rise would be better. Even though most patients can resume driving within 4 to 6 weeks after a liver transplant in India, this factor would largely depend on the overall health of an individual patient.

Traveling should ideally be undertaken 6 to 12 months after the surgery, especially if you are going to a remote region. Medications and vaccinations must be considered, especially before going on a vacation.

conclusion:

In conclusion, getting a liver donor transplant in India might be tough, but don't give up! Liver transplantation has a high success rate. Approximately 90% of patients survive the first year after surgery. The five-year survival rate is around 75–85%, this depends on the patient's overall health. For patients with liver cancer or other complex conditions, survival rates may differ. It's important to tell more people about organ donation and teach them why it's so important. Also, we need to correct any wrong ideas people have about donating. Building a strong support system and using online platforms can help find potential living donors.

Studies have suggested that the chances of successful transplantation are enhanced by reducing the time delay between harvest and transplant of the organ. Therefore, transportation of the organ is a critical factor. For this purpose, "green corridors" have been created in many parts of India. A "green corridor" refers to a route cleared out for an ambulance carrying the harvested organs to ensure delivery at the destination in the shortest time possible. The hospitals involved in transplantation, city traffic authorities, and, in certain cases, airport authorities collaborate to transport an organ from one hospital to the next. The formal name of "green corridor" was given in July 2014 when the hospital authority and police in Chennai coordinated to transport a heart from one hospital to another in half the regular time. The system has been used effectively in cities such as Mumbai, Gurgaon, Hyderabad, Bangalore, Kolkata, and Indore.

FAQ’s

1. What is a liver transplant, and why is it necessary?

A liver transplant is a surgical operation where a diseased or damaged liver is replaced with a healthy liver from a donor. The operation is required when an individual's liver is no longer able to function normally because of conditions like cirrhosis, liver cancer, hepatitis, or acute liver failure. When the liver fails, it can cause life-threatening complications, and a transplant might be the only solution to save the patient's life.

2. How many hours is a liver transplant, and what is the recovery like?

The liver transplant operation usually lasts between 6 to 12 hours, depending on the intricacy of the procedure. Recovery from surgery generally takes weeks to months, and hospitalization takes 7 to 14 days on average. Patients during recovery have to take immunosuppressant drugs to avoid organ rejection and adhere to strict medical protocols to keep the new liver functioning well. Regular follow-up is required to check for any complications.

3. How do physicians decide who should have a liver transplant?

Physicians determine the severity of liver disease through a scoring system known as the MELD (Model for End-Stage Liver Disease) score. The MELD score takes into account parameters such as bilirubin, creatinine, and INR (international normalized ratio). The score serves to prioritize the patients according to the severity of their condition. Other aspects, including the health of the patient and age, are also taken into account in deciding on the transplant eligibility.

4. What are the dangers of a liver transplant?

Although liver transplants are life-saving, there are potential risks, including rejection of the organ, infection, bleeding, and problems with anesthesia. The patients have to remain on immunosuppressant medication for the rest of their lives, which can pose a risk for diseases and some cancers. Other long-term problems can be damage or malfunctioning of the liver and need for additional medical procedures. Under suitable care and follow-up, most of the patients also live long healthy lives following transplantation.

5. How is a living donor liver transplant different from a deceased donor liver transplant?

A living donor liver transplant is where a donor (often a close friend or family member) donates part of their healthy liver to the recipient. Because the liver can regenerate, both the donor and recipient's livers will return to normal size after the transplant. A liver transplant from a deceased donor uses a liver from an individual who has died, usually after brain death. Both procedures are successful, although living donor transplants tend to have shorter waiting periods for recipients.