Liver Transplant

Overview of Liver Transplant in India

When the liver is so damaged that it cannot be restored to its healthy state or when the liver as a whole dies, a liver transplant is carried out, in which a healthy portion of the liver is given to the patient. Usually, a healthy individual with a family history gives their liver to the recipient of a liver transplant. 

When liver conditions reach their latter stages and are not responsive to medication or other surgical procedures, a liver transplant is a beneficial treatment. The intricacy of a liver transplant varies from patient to patient and is a relatively complicated medical surgery. Before undergoing surgery, the patient's overall health must be carefully considered. Failure of a liver transplant may result otherwise.

To get the patient ready for liver transplant surgery, pre-operative care is typically taken into account. To prevent infection, transplant failure, and other complications, post-operative care is also required after the procedure. To lower the risk of complications and failure, it is crucial to closely monitor the patient's health and select a suitable donor. The liver transplant process can be risky for several people.

After a liver transplant, the patient must continue to take various medications to prevent the body's immune system from attacking the donor cells in the liver. The success of liver transplants in India is attributed to the presence of many reputable hospitals and experienced transplant surgeons performing these surgeries.

In India, a liver transplant will cost an Indian patient about USD 18,000 - 24,000, while for overseas patients, it is between USD 27,000 - 33,000.

What is a liver transplant?

Surgery to remove a diseased liver and replace it with a healthy liver is called a liver transplant. If you had liver cancer or liver failure, you may need a liver transplant. Any patient, children or adults can get liver transplants as treatment.

Liver transplants comprise the third most common organ donation procedure. In 2023, approximately 10,000 liver transplants are expected to be completed in the United States. Each week, almost 200 - 300 people are registered for a liver transplant. 94% of liver transplants are complete livers from deceased donors, and 5% of liver transplants are partial livers from living donors.

When is Liver Transplantation Required?

Liver transplantation is generally considered in end-stage liver disease (ESLD) or end-stage liver dysfunction, when a person's liver is severely damaged, burnt out or impaired. End-stage liver disease typically includes the following conditions.

Cirrhosis and Chronic Hepatitis: If not treated, chronic hepatitis, particularly that from the hepatitis B and C viruses, can result in cirrhosis. Cirrhosis is characterised by the replacement of liver tissue with scar tissue, which progressively compromises the liver’s ability to function as it develops. If cirrhosis related to chronic hepatitis progresses to ESLD and complications such as portal hypertension and liver failure develop, liver transplantation may be considered.

Primary biliary cirrhosis: Also called primary biliary cholangitis, is an autoimmune disease that attacks specifically the small bile ducts in the liver. It can result in liver failure and cirrhosis eventually. If primary biliary cirrhosis has advanced enough to have significant liver damage and consequences, or failed medical treatment, a transplant may be needed.

Biliary Atresia: This is a rare birth defect in which the bile ducts are tiny, clogged, or missing both inside and outside the liver. It is the most common reason for paediatric liver transplants. For biliary atresia, liver transplantation is often the only option when bile duct defects cannot be surgically fixed, (the Kasai operation), nor liver damage stopped.

Chronic Alcoholism: Excessive and persistent use of alcohol can lead to alcoholic liver disease, which can lead to end-stage liver disease and cirrhosis. Under certain circumstances where alcoholism causes liver damage that treatment options are unsuccessful (with continued abstinence from alcohol), liver transplantation will be an option. 

Wilson's Disease: This sporadic genetic disorder is characterised by an accumulation of copper in the liver and other organs. Untreated patients could develop liver failure. Liver transplantation is needed when Wilson's disease has caused severe liver damage and complications (when patients do not respond to copper-chelating medications).

Hemochromatosis: This hereditary condition causes the body to absorb excessive amounts of iron, which overloads the liver and other organs. If hemochromatosis causes significant liver fibrosis, cirrhosis, or other issues and therapeutic phlebotomy or medicinal treatment is not enough, liver transplantation may be considered.

Metabolic illnesses: Organic acidemias and glycogen storage diseases are two examples of metabolic illnesses that can impair liver function and result in liver failure. When severe liver dysfunction, recurring metabolic crises, or other problems from metabolic diseases cannot be controlled with medication or dietary changes, liver transplantation may be an option.

Additional Chronic Liver Diseases: Advanced cirrhosis and additional liver decompensation can result from conditions such as autoimmune liver diseases and non-alcoholic fatty liver disease (NAFLD). Fatigue, fluid retention, and jaundice are the symptoms of these issues.

Acute Liver Failure: Acute liver failure is a rapid loss of liver function that several things, such as specific poisons, drug-induced liver injury, and viral hepatitis, can cause. To survive, patients with acute liver failure frequently need an emergency transplant. They may also have severe symptoms like confusion, bleeding, and hepatic encephalopathy.

Liver tumours: In certain situations, liver tumours, especially hepatoblastoma and hepatocellular carcinoma (HCC), may require a liver transplant. When a tumour is limited to the liver, no major blood vessels are involved, and it satisfies specific size and number requirements, transplantation may be an option. The possibility of removing the cancer and the damaged liver in these situations is provided by a transplant.

Who Is Not Eligible For A Liver Transplant?

Not every person with liver cancer or failure will be a good fit. You cannot receive a liver transplant if you have specific medical issues. These consist of:

• Cancer that does not originate in the liver. If the cancer is cured by treatment and subsequent tests reveal the malignancy has not returned, you might be eligible for a liver transplant.
• Heart failure with congestive heart failure.
• Infections that cannot be cured by liver transplantation or controlled by medicines.
• Dementia.
• Severe lung conditions.
• Severe hypertension in the lungs.
• Severe, untreated mental illnesses that include psychosis.

Types of Liver Transplant:

In clinical and medical settings, some liver transplant procedures are frequently performed. Among these kinds are:

Deceased Donor Liver Transplant (DDLT) 

The deceased person's liver is donated to the patient who has liver disease in this kind of liver transplant treatment. It is required to obtain the approval of the deceased, which typically occurs before the deceased or their relatives are involved. To reduce the likelihood that the liver transplant would be rejected, the dead donor should have a healthy liver and a blood type that matches the recipient.

Living Donor Living Transplant (LDLT)

During this medical operation, the patient receives a portion of the liver, rather than the entire liver, from a healthy living donor. In this case, the donor is primarily a close relative. After a transplant, the liver portion grows back to form a whole liver. In a few months, the donor's liver will regenerate.

Split Liver Transplant

This kind of transplant involves dividing a deceased person's liver in half and donating it to two distinct recipients. A youngster typically receives a small portion of the liver as a donation, while the majority of the liver is transplanted into an adult.

Paired Donation Transplant

If you would like to give a liver to someone who is not a good fit, the hospital will find a donor for you and then take a portion of your liver for someone whose blood type matches yours. All four participants in this surgical process gain from the swap agreement.

Domino Transplant

A liver transplant from a deceased person is given to a young person who has some form of liver illness. After that, a young person's liver is donated to an elderly person who has liver cancer, extending that person's life expectancy by 20 years.

Procedure:

Evaluation: Both the donor and the receiver undergo a general assessment and screening in this step. It includes imaging studies, blood type screening, and other diagnostic procedures.

Preoperative care: This phase involves additional screening for the recipient, including imaging investigations, blood type testing, and liver cross-matching with the donor. A client undergoing liver transplant surgery is discussed in detail by the team of doctors, surgical specialists, and anaesthesiologists.

Incision: Physicians made incisions in the upper abdomen while under anaesthesia to dull pain and irritation.

Removal of the injured liver: The recipient's surrounding structures are severed from the deceased liver. The liver is then removed from the body by medical professionals.

Transplanting a healthy liver: The process of transplanting a healthy liver involves attaching the liver from a healthy donor to the surrounding ducts and blood arteries. Sometimes the drainage bag is temporarily attached by the doctor.

Recovery: Sutures are used to close the incision following the transplant, and the patient is moved to the intensive care unit (ICU) for careful observation of their recuperation.

Post-operative care: immunosuppressive drugs are administered to the patient to reduce the likelihood of liver rejection following the transplant. After discharge, proper follow-up is also essential to avoid problems.