Liver Transplant

ILBS is the only centre under the aegis of the Delhi Government to have an active liver transplant program. This began in 2010. At ILBS, we have a very capable team that treats and supports adult and paediatric patients in end-stage liver disease. This includes pre and post transplant care. From our program’s inception in 2010 till now, we have offered living related transplantation services to liver patients and their living donors who have come to us from all parts of the country.

For more enquiries on Liver Transplantation or to make an appointment, please call

The Transplant Coordinator at ILBS on 46300000 extension 7053.

 

What is the process of Liver Transplantation?
Liver transplantation involves removal of the old diseased liver which is replaced with a new one. This involves the need for a donor. This procedure comes under the purview of the law governed by the Transplant of Human Organ Act, 1994. This is a law mainly for the protection of organ donors so that they are not made victims of coercion in various social circumstances.

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What should be known about a Liver Transplant?

In adults, a key reason for a liver transplant is cirrhosis. This can be caused by various diseases that destroy healthy liver cells. Certain causes of cirrhosis are

  • long-term infection from hepatitis B and C virus
  • Overuse of alcohol over time
  • autoimmune liver diseases
  • the buildup of fat in the liver
  • hereditary liver diseases

In children, a common cause for a liver transplant is biliary atresia. This is a condition where bile ducts are missing, damaged, or blocked. These are vital tubes that carry bile from the liver to the gallbladder and small intestine. When bile ducts are blocked, bile flows back to the liver and causes cirrhosis.

  • Other reasons for needing a liver transplant include
  • sudden liver failure, called acute liver failure, most often caused by taking too much paracetamol
    liver cancers that have not spread outside the liver
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How to confirm the need for a liver transplant?

The doctor will decide this and refer the patient for evaluation by a liver transplant team. The team includes liver specialists, called hepatologists; liver transplant surgeons; a transplant coordinator and nurses among other health care professionals all working using a multi-disciplinary team approach. The transplant team will begin by running a series of blood tests, an x ray, and other investigations to help decide the benefits from a transplant.

 

The transplant team will also check to see if

  • the patient’s heart, lungs, kidneys, and immune system are strong enough for surgery
  • the patient is mentally and emotionally ready for a transplant
  • the patient has a support system with family members or friends who can care before and after the transplant
  • the patient has the finances to cope with the long term care needed post transplantation
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Where will this new liver come from?

A healthy living near relation will donate part of his or her liver to a patient needing a liver transplant. This donor is usually an immediate family member- related emotionally to the patient.

All living donors are subjected to several tests before transplant surgery. These include

  • Blood tests
  • CT Scan
  • MRCP
  • Viral tests
  • Chest X-ray

 

These tests will ascertain the donor’s blood group compatibility with the recipient. These tests will also confirm that the part of the liver to be donated will be adequate for the recipient without risking a donor’s well being. In addition to this, clearances are also needed for the donor from the Cardiologist, Pulmonologist and Gynecologist (if the donor is female). Besides making sure that the donor’s liver will work as it should, it is also important to establish that the donor has no other pre-existing disease.

Transplantation involves a multi-disciplinary team approach wherein each case is put forward before a transplant board and discussed thread bare to ensure the best possible results.

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What happens in hospital?

Both the donor and recipient will be admitted to the hospital for a surgical procedure taking place at the same time. The surgery can take anything from 12 to 20 hours. The surgeon will remove the recipient’s old diseased liver and then replace it with the donated liver.

After Surgery

Post surgery, the stay in the hospital is about 30 days to be sure that the new liver is working. Medicines need to be taken to prevent infections and the body rejecting the new liver. The team of doctors will check for bleeding, infections, and liver rejection. During this time, a patient will learn how to take care of himself/herself as part of preparation for care at home including information about the medicines that are to be taken life long.

Possible Complications

  • The new liver may not work
  • The new liver may be rejected by the recipient’s body
  • blockage of blood vessels going into or out of the liver is possible
  • damage to the bile ducts is possible
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About organ rejection

Rejection occurs when the immune system attacks the new liver. After a transplant, it is common for the immune system to try and destroy the new liver.

How to prevent organ rejection?

Immunosuppressive medicines are needed to prevent rejection and it is lifelong.

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Are there any side effects of Immunosuppressive medication?

Immunosuppressive medication can have many side effects. Because these medicines weaken the system, one is more infection prone. Other possible side effects include

  • weight gain
  • high blood pressure
  • high blood cholesterol
  • diabetes
  • brittle bones
  • kidney damage

The doctor and the transplant team will watch for and treat any of these side effects observed.

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What are signs of organ rejection?

Rejection might make the patient feel tired along with loss of appetite. Other signs might include having

  • fever
  • pain around the liver
  • jaundice
  • dark-colored urine
  • light-colored stools

But rejection doesn’t always mean feeling ill. The doctors will check through blood tests for signs of rejection. A liver biopsy is usually needed to confirm rejection. This is a procedure that involves taking a small piece of the liver for observation under the microscope

Care after discharge from the Hospital

Follow-up visits at the hospital will be needed to ensure that the new liver is working well. There will be a need for regular blood tests to check that the new liver is not being damaged by rejection, infections, or problems with blood vessels or bile ducts.

Common Tips for those who have had a liver transplant include

  • avoiding people who are ill and report any illness, no matter how small
  • taking a healthy diet and exercise
  • not smoking cigarettes or drinking alcohol
  • taking all prescribed medicines as directed
  • consulting the doctor before taking any medicines other than those prescribed.
  • following the doctor’s instructions on how to take care of a new liver
  • having blood tests and other tests prescribed by the doctor
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Is life normal after a transplant?

After a successful liver transplant, most people can go back to their normal daily activities, and return to work. Getting strength back may take months, especially if one was very sick before the transplant. The doctor will update you on the recovery period at follow-up.

Some activities that may raise questions

Work. After recovery, most people are able to return to work.

Diet. Most people can eat a normal, regular meal. Some medicines prescribed post transplant may cause weight gain and others may cause diabetes or raise cholesterol. So, eating a balanced, low-fat diet can help maintain a healthy lifestyle.

Exercise. Most people can be physically active after a liver transplant.

Sex. Most people can have a normal sex life after a liver transplant. For women, avoiding pregnancy in the first year after a transplant is recommended. Checking with the doctor when it is alright to have sex again or getting pregnant is a good idea.

Key Points to keep in mind

  • Liver transplantation is surgery to remove a diseased liver and replace it with a healthy one from another person, called a donor.
  • If the liver stops working as it should, a liver transplant is needed
  • In adults, common reason for a liver transplant is cirrhosis. Cirrhosis is caused by many different types of diseases that destroy healthy liver cells replacing them with scar tissue. Some causes of cirrhosis are long-term infection with the hepatitis B and C virus, excessive alcohol over time, autoimmune disorders and metabolic diseases.
  • In children, the most common reason for needing a liver transplant is biliary atresia or any other metabolic cause.
  • Your doctor will decide whether you need to be evaluated for a liver transplant. The transplant team will examine you by running blood tests, x-rays, and other tests to help decide whether you would benefit from a transplant.
  • Livers can come from both living and deceased persons. Transplants involving living donors are those who donate part of their liver, to a family member for love and affection.
  • Liver transplant surgery can take long hours.
  • Problems after surgery may include bleeding, infections, and rejection of the new liver.
  • Rejection occurs when the immune system attacks the new liver. After a transplant, it is common for the immune system to try to destroy the new liver.
  • After a liver transplant, immunosuppressive medication is lifelong to prevent rejection.
  • Liver transplants are usually successful surgeries. Most people are able to return to work and other normal activities after a transplant.