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Liver Transplant and Surgery

Overview

Introduction

The Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation at Dr L H Hiranandani Hospital, Powai, Mumbai comprises of Surgeons, Gastroenterologists, Medical & Radiation Oncologist, Intensivists, Anesthetists, Technicians, Counselors and Specialized Nurses who have exhaustive experience in the management of Gastrointestinal, Hepatobiliary and Pancreatic diseases. The mission of the team is to provide state of the art services using evidence based guidelines at an affordable cost. It also endeavors to pioneer training and research in the field of Digestive and Hepatobiliary sciences.

The Transplant team has the distinction of being one the most experienced in the region. The team members have been trained at the best centers in the world and have vast experience in managing Liver Transplant patients. A competent nursing and technical support team ensures optimum and uncompromising patient care. The department has advanced critical care unit with dedicated ICU beds. The team is also backed up by an enthusiastic and hard working team of physiotherapists and Dieticians.

We have established a successful transplant program and cater to adult and pediatric patients with End Stage Liver Disease. We have also been successful in establishing a Deceased Donor Transplant Program.

The team has a distinction of being versatile in their approach and is capable of performing Living Donor and deceased donor Liver Transplants, complex epato-Pancreato-Biliary, G.I. Onco surgery procedures. We have an avid interest in surgical education and research and our team members have to their credit several articles published in internationally acclaimed and peer reviewed journals.

About your Liver Transplant What you need to know ?

About the Liver

Liver is the largest abdominal organ. Liver weighs about 1200 – 1500 grams in an average roughly 2% of body weight. Liver, though a single organ, broadly it can be divided into two parts – right and left liver and 8 independent segments (each having its own blood supply and biliary drainage) functioning as a single organ. Liver as a whole has a hepatic artery supplying oxygenated blood, a portal vein carrying blood from intestines to liver and bile ducts draining bile formed in the liver to intestines. Blood from liver is delivered to heart via three hepatic veins.

Liver produces bile which is drained by biliary tree. Gall bladder is a reservoir for the bile lies on the liver bed, and is attached to bile duct. It regulates delivery of bile into intestines. Liver is endowed with remarkable capacity to regenerate after division into parts. This is the basis of Live Related Liver Transplants, and the reason why live related liver transplant is possible.

Functions of Liver

The liver is in the right upper abdomen. The liver serves many functions, including the detoxification of substances delivered to it from the intestines, and the synthesis of many proteins.

  • Liver is the powerhouse of body. It is the main organ of metabolism i.e. it involves, series of breaking down and making up of chemical reactive and generation of energy
  • Liver converts food into chemicals necessary for life and growth
  • Liver processes and removes drugs, alcohol and other substances generated in body that may be harmful
  • Liver produces elements necessary for the absorption of fats and vitamins
  • Liver manufactures important proteins that are necessary for normal blood clotting and building muscle
  • Liver maintains the hormonal balances
  • Liver stores important vitamins

Who requires a Liver Transplant?

Liver transplant may be necessary for patients who suffer from:

  • liver damage due to alcoholism (Alcoholic cirrhosis)
  • primary biliary cirrhosis
  • long-term (chronic) active infection (hepatitis B or C)
  • liver (hepatic) vein clot (thrombosis)
  • birth defects of the liver or bile ducts (biliary atresia)
  • metabolic disorders associated with liver failure (e.g., Wilson's disease)

Liver failure causes many problems, including malnutrition, problems with blood clotting, bleeding from the gastrointestinal tract, and jaundice. Frequently, patients who undergo liver transplantation are quite ill, and require hospitalization in the Intensive Care Unit prior to surgery. A large, upper abdominal specialized incision is used for liver transplant.

Liver transplants are performed in many centers across the country. The healthy liver is obtained either from a living donor or from a donor who has recently died but has not suffered liver injury. The diseased liver is removed through an incision made in the upper abdomen. The new liver is put in place and attached to the patient's blood vessels and bile ducts. The operation can take up to 12 hours to complete and may require large volumes of blood transfusions.

Patients require hospital care for one to four weeks after liver transplant, depending on the degree of illness. After liver transplantation, patients must take immunosuppressive medications for the rest of their lives to prevent immune rejection of the transplanted organ.

What is liver transplant?

Liver transplant means removing a whole or part of liver from a deceased or living person, placing and attaching in a patient of end stage liver disease, after removing whole liver.

What are types of liver transplant?

Liver is obtained from a Deceased donor or Live Related donor.

Deceased Donor (Cadaver) – Liver is obtained from patients who are brain dead. (They are actually dead for from legal, ethical, spiritual and clinical point of view). Once a brain dead patient is identified, and is deemed as a potential donor, the blood supply to his body is maintained artificially. This is the principle of deceased organ donation. Young patients who die of accidents, brain hemorrhage or other causes of sudden death are the donors suitable for organ donation.

Living Donor – Part of liver from living related donor is a certain and timely available option and only hope for cure. Liver surgery can be carried out safely in almost all patients. All patients are listed for deceased donor liver but timely organ availability is uncertain. Liver has the capacity to regenerate if a part of normal healthy liver is removed. Hence we can divide part of liver from a live donor and implant it into another patient. In a live donor liver transplant, a portion of the liver is surgically removed from a live donor and transplanted into a recipient immediately after the recipient's liver has been entirely removed.

Donor safety is the first objective of whole process. Utmost care is taken while selecting and operating liver donors. The risk of serious morbidities following a living donor liver resection is 10%.The risk of death in the donor is 0.02to 0.05%. Live donor liver transplantation is possible because the liver (unlike any other organ in the body) has the ability to grow back to its original size. The regeneration of liver following surgery is complete by 4 to 8 weeks.

Who can donate?
Selecting the correct donor for a live donor liver transplant requires experience, skill and technical expertise on the part of the many doctors, transplant coordinator and other health care professionals who make up the Live Donor Team.

Potential live liver donors are carefully evaluated. The health and safety of the donor is the most important concern during the evaluation. Only donors in good health are considered.

A potential donor should:

  • Be either a relative or spouse,
  • Have a compatible blood type
  • Be in good overall health and physical condition
  • Be older than 18 years of age and younger than 55 years of age
  • Have a near normal body mass index (not obese)

A donor must be free from:

  • History of Hepatitis B or C
  • HIV infection
  • Active alcoholism or frequent heavy alcohol use
  • Any drug addiction.
  • Psychiatric illness currently under treatment
  • A recent history of cancer

What are the positive aspects of liver donation?

  • The gift of an organ can save the life of a transplant candidate.
  • Donors have reported positive emotional experiences, including feeling good about giving life to dying person.
  • Transplants can greatly improve recipients' health and quality of life, allowing them to return to normal activities.
  • Transplant candidates generally have better results when they receive organs from living donors as compared to organs from deceased donors.
  • Better genetic matches between living donor and candidates may decrease risk of organ rejection.
  • A living donor makes it possible to schedule the transplant at a time that is convenient both for the donor and the transplant candidate.

How long would I take to recover after liver donation?
Please talk to transplant team members to understand what to expect, although the surgery and recovery process can differ among living donors. Consider talking with other donors and contacting the organizations. As a liver donor, you may stay in the hospital up to 10 days or longer in some cases. The liver typically regenerates in two months. Most liver donor returns to works and normal activities in three months, although some may need more time. Attend follow-up visits to clinic regularly as advised and do blood or other investigations to make sure that you are recovering approximately. Think about how the donation process may affect your daily activities. How much time off will you need for work? How will this affect your care giving responsibilities such as childcare or caring for an elderly relative? How it is going to affect your personal life and body image?

What are the risks of liver transplant?
The biggest risks associated with liver transplants are rejection and infection..Rejection occurs when the body's immune system attacks the new liver as an unwanted foreign substance; just as it would attack a virus. To prevent rejection, transplant patients must take drugs to suppress the immune system. However, because the immune system is weakened, it is harder for liver transplant patients to fight other kinds of infections. Fortunately, most infections can be treated with other medicines.

What medicines do I have to take?

  • Anti rejection drugs
  • For the first three months after transplantation you need to take the following medicines.
  • Antibiotics – to reduce the risk of infections
  • Antifungal liquid – to reduce the risk of fungal infection
  • Antacid – to reduce the risk of stomach ulcers and heartburn
  • Any other medicines that you have to take will be prescribed for you depending on your Symptoms.

 

Why are Anti Rejection Drugs (Immunosuppressant Drugs) needed?
One's body doesn't accept other's organ. It is body's defense system to try to attack and destroy other's organ. Anti rejection drugs makes defense mechanism weak against donor's organ and allow liver graft to sustain and work normally.

What precautions should I take after my liver transplant?
Communication, cooperation and coordination between the transplant team, local physician, pharmacist, Liver Transplant Coordinator or Liver Transplant Consultant and the patient is essential for well-being of the Liver Transplanted recipient. It is important to follow the instructions that will help prevent or lessen complications.

One of a patient's most important jobs is to ensure that family physician, local pharmacist, and his family members are aware of the transplant, the medications he takes each day, and the precautions he must follow to stay healthy. Each of his family members should have the telephone number of his Liver Transplant Coordinator or Liver Transplant Consultant.

The patient and his family members must be fully aware about the precautions to be taken after a successful Liver Transplant. Nothing can be taken for granted after this operation. A rigorous session with Liver Transplant Coordinator or Liver Transplant Consultant is recommended for the patient and his family members to understand the Life after Liver Transplant and precautions to be taken.

Some facts about liver transplant

  • A liver transplant is needed when the liver fails, usually because of long term disease.
  • About 1,00,000 people in India die of liver failure every year.
  • First successful liver transplant was done in 1967
  • The number of liver transplants has been steadily increasing for more than 15 years.
  • Cirrhosis is the most common reason for liver transplant
  • Donated livers can come from either diseased donors or living donors.
  • The five year survival rate of liver transplant patients is over 70%.

Our Team

Full Time Consultant
Name Designation Qualification Availability
Dr. Rahul Kakodkar Full Time Consultant - Liver Transplant, Gastrointestinal & Hepatobiliary - Pancreatic Surgeon MBBS, MS, DNB (Gastroenterology Surgery), MNAMS

Monday to Saturday : 8 am - 8 pm


Visiting Consultant
Name Designation Qualification Availability
Honorary Consultant Hepatobiliary and Liver Transplant

ONLY IPD

Dr. Hitesh Mehta Honorary Consultant General, Gastrointestinal & Laparoscopic Surgeon MS (General Surgery)

ONLY IPD

Dr. Jahoorahmad Z Patankar Honorary Consultant in General Paediatric & Liver Surgeon MBBS, MS (General Surgery), MRCS (Edinburgh), DNBE, MCH (Paediatric Surgery)

ONLY IPD

Dr. Subhash Gupta Honorary Consultant Liver Transplant & Hepatobiliary Surgeon MS (Surgery), MBBS

ONLY IPD