Liver Transplantation


Prof Mohamed Rela is the pioneer of organ transplant care in India with expertise in liver transplants. The liver transplant program at Dr Rela Institute & Medical Centre is one of the most advanced programs in the country, delivering a wide range of transplant options.


The liver transplant program caters to a wide range of adult & pediatric liver conditions offering expert consultation, accurate diagnosis and appropriate transplant plan for each patient. The treatment plans are tailor made for each patient, and the transplant surgeries include

  • Split Liver Transplant
  • Auxiliary Liver Transplant
  • Swap Liver Transplant
  • Domino Liver Transplant
  • Mono-segmental Liver Transplant
  • Cadaver Liver Transplant


Liver Transplantation also known as orthotopic liver transplantation is a major surgical procedure which has given a new lease of life to thousands of patients suffering from serious liver disease. Research into the possibility of liver transplantation (LT) started before the 1960s with the pivotal baseline work of Thomas Starzl in Chicago and Boston, where the initial LT techniques were researched in dogs. Starzl attempted the first human LT in 1963 in Denver, but a successful LT was not achieved until 1967.The first human liver transplant was performed in 1967 at the University of Colorado. While initial attempts were unsuccessful, persistent efforts by him and a handful of surgeons around the world have standardized the operation. Now most big centres across the world have a success rate of over 90% for this operation.

Who Needs a Liver Transplant?

Here the liver is damaged over a prolonged period by continued and repeated injury. The cause of injury could be chronic viral infections such as hepatitis C or hepatitis B infection, prolonged abuse of alcohol. Recently, fatty liver disease is on the rise due to unhealthy dietary habits and sedentary life style. Over a period of time, fatty liver disease can lead to inflammation (damage) of the liver and this can also cause chronic liver disease. Long-term diabetes is another cause of chronic liver disease due to fat accumulation in the liver.

Uncommon causes of chronic liver disease are primary biliary cirrhosis, primary sclerosing cholangitis, autoimmune liver disease where the own cells damage the liver due to their inability to recognize the liver as its own.

The chronically damaged liver goes through the stages of fibrosis and cirrhosis during which the liver becomes hard and shrunken. This affects the liver function causing jaundice, encephalopathy (confusion, forgetfulness, slowing of thought process), swelling of the abdomen and feet and abnormalities in the ability of blood to clot. The hardened liver increases the resistance to blood flow through the liver causing complications, such as blood vomiting, blood in stools and fluid in the abdomen. The third serious problem with cirrhosis is the development of liver cancer. Liver transplantation cures all these problems of cirrhosis by replacing the damaged liver with a new healthy liver.

Severity of Chronic Liver Disease

Not all patients with cirrhosis need transplantation. Liver transplantation is only advised when the risk of serious complications and death is high enough to justify a major operation such as liver transplantation. In most instances, a careful history, clinical examination and standard blood tests can help in estimating the severity of liver disease and the risk of complications. Symptoms of end stage liver disease include:

  • Accumulation of fluid in the abdomen (Ascites). Infection of this abdominal fluid, called Spontaneous Bacterial Peritonitis, is even more ominous.
  • Deteriorating kidney function along with liver function (Hepatorenal Syndrome)
  • Vomiting of blood or passage of black stools suggestive of bleeding from the stomach and intestine.
  • Altered consciousness, confusion or slow mentation (Hepatic encephalopathy)

Scoring system to assess need for Liver Transplantation:

Child Pugh score (CPT) and the Model for End Stage Liver Disease score (MELD score). As a general rule, patients with MELD score greater than 15 have a survival benefit with transplantation. In addition, presence of liver cancer on a background of cirrhosis is a strong indication for liver transplantation, provided the tumor stage fits into internationally recognized criteria.

Patients with cirrhosis develop liver tumors. Surgical removal of these tumors is complicated by the poor liver function. In such cases, liver transplantation is the ideal cure as it completely removes the tumors and also removes the diseased liver, which is the breeding ground for these tumors. However, all patients with liver tumors are not suitable for transplantation and the liver team, which consists of best liver cirrhosis doctor in Chennai, will carry out a detailed evaluation before suggesting transplant as an appropriate treatment.

Some patients with Acute Liver Failure can deteriorate despite aggressive medical treatment and in these patients, liver transplantation is a true life-saver. These patients qualify for urgent liver transplantation in most organ allocation systems around the world. Since the availability of this surgery, survival of patients with acute liver failure has improved from less than 20% to over 80%.

Other indications for liver transplantation include problems in liver function, which can damage the liver (Tyrosinemia), other organs (Hyperoxaluria damaging the kidneys). These are discussed in greater detail in the section of liver diseases in the childhood age group.

 

PROCEDURE DETAILS

Liver Transplant Procedure

At RILDT, we follow a systempatic process for liver transplant procedure steps, which are in accordance with medical procedures in majority hospitals across the world.

Assessment for Liver Transplantation

Liver transplantation is a major surgical undertaking. A patient should be considered for transplantation only if the procedure improves his/her chance of survival or quality of life. At the same time, the patient should be well enough to survive the operation. All patients undergo a formal assessment before a decision is made regarding liver transplantation. The aim of liver transplantation assessment is two-fold:

  • To confirm that the patient needs a transplant.
  • To confirm that the patient is fit enough to survive the operation

The assessment process involves a detailed evaluation of the severity of liver disease, evaluation of the function of other organ systems such as the heart, lungs, kidneys. The patient will be seen by consultants of all specialties to identify any problems that can increase the risk of surgery and treat the problems so that he/she is in an optimal condition to undergo the operation. The entire clinical information and reports are discussed in the pre-transplant assessment meeting before the patient is listed for liver transplantation.

Types of Liver Transplantation

Liver transplantation can be undertaken in two ways depending on the origin of the new liver. When a person donates the liver after his/her death it is called deceased donor liver transplantation. If on the other hand, a close family member donates a part of their liver then it is called living donor liver transplantation.
 

Before & During Surgery:

The Liver Transplant Operation

The transplant operation usually takes 8-10 hours. First, the diseased liver is removed by dividing the blood supply. The new liver graft is then placed in the same place as the old liver and new connections are made between the blood vessels of the patient and the new liver graft. The bile duct of the liver is also joined to the patient’s bile duct. The wound is then closed after placement of one or two drains, to drain excess fluid that usually forms after surgery.

Special types of Liver Transplantation

 

RECOVERY & OUTLOOK

Post Operative Care

Liver transplantation is a major operation in a patient who has been unwell for a while. However, most patients tolerate the procedure surprising well and feel a sense of well-being within 2-3 days after the operation. The recipient usually is managed in the ICU for the first 3-4 days. During this period, he/she will have regular blood tests and ultrasound scans to ensure that the liver is recovering well. Once stable, the patient will be transferred to the ward. We encourage the patient to sit up, do deep breathing exercises and slowly start walking in the first few days after transplantation. It is important that the patient cooperates with the medical and nursing team while they put him through the standard course of recovery. The average duration of stay in the hospital after transplantation is about 2-3 weeks. By the time the patient is discharged, he/she is able to eat normally, walk comfortably and will need minimal analgesic medications. During the hospital stay, the patient will also be taught the medications that need to be continued after discharge.

Medications

The post-transplant patient will be on quite a few medications following the transplant. The most important of these are the “Immune-suppressant” medications which are usually three in number. These medications are of utmost importance to keep the liver functioning well and to prevent the body from rejecting the new liver. The dose of these medications will be changed on a regular basis based on the level of the drug in the body. The number and dose will gradually be reduced over a period of moths and eventually the patient will be on a single drug only. It is important to keep in mind that these are live saving drugs to be taken life long after transplantation. The recipient will be familiarized with these medications before discharge. In addition to medications, additional medications to prevent viral and fungal infections, multivitamins and medications to prevent acidity are also given at the time of discharge.

Going home after a Liver Transplant

Patients are discharged from the ward once they are comfortable, pain-free, walking independently, eating normal diet and able to take medications on their own.

 

LIFE AFTER LIVER TRANSPLANTATION

Clinic Visits

Regular follow-up is essential after a liver transplant. The frequency of clinic visits is usually twice a week immediately after discharge. The frequency gradually decreases to once weekly, then fortnightly and later monthly. Once the liver function is stable, frequency of clinic visits can decrease to once in 6 months to one year. However liver function tests should be carried out once in 1-2 monthly even in the long term.

What happens during a clinic visit?

The clinic visit is aimed at checking the function of the new liver and identifying any problems at an early stage, so that measures can be taken to rectify the problem. At each clinic visit, the recipient gives his blood tests – usually liver function tests (LFT) and blood levels in the morning. It is important that the samples are given while the patient is fasting and has not taken his regular transplant medications. The actual clinic is in the afternoon when a panel of doctors will review the test results, medication list and make any necessary modifications. New medications may be added, previous medications discontinued, or their dose changed depending on the clinical status and blood results. The recipient should discuss any new problems with the team at that point.

How to get medical advice in between clinic visits?

For regular queries, it is best to contact through the unit transplant coordinator by email. You can also contact them and your doctors through telephone if required. In case of emergency, it is safest to come to the casualty where immediate care can be given, and the transplant team will be contacted.

Taking care of yourselves after Liver Transplantation

Liver transplantation is a lifelong commitment. The better you take care of your new liver, the better and longer it will serve you. Taking prescribed medications correctly as advised by the transplant team and regular follow-up with the transplant team by clinic visits or e-consultations is very important.

Problems after Liver Transplantation

Transplant patients are at risk of complications related to rejection, the original liver disease or the medications that they need to take after a transplant.

Rejection

Rejection is not uncommon after liver transplant and up to a third of all transplant patients will develop signs of rejection in the first year after transplantation. The diagnosis is suspected based on blood investigations. Usually a liver biopsy under local anesthesia is necessary to confirm the diagnosis. The treatment depends on the severity of rejection. Mild episodes may be treated with some modification of their anti-rejection medications. More severe episodes will need admission and treatment with intravenous steroids. Rejection is completely treatable in over 90% of cases with these measures. Occasionally, stronger medications may be required to treat persistent rejection.

Infection

Patients who undergo liver transplantation have an increased susceptibility to infections due to the anti- rejection medications. The risk is high in the early post- transplant period and gradually decreases after the first 6 months. We advise patients to maintain good hygienic practices, avoid improperly cooked food, and avoid close contact with persons with active infection. They should seek early medical attention in case of any new symptoms. Some routinely prescribed antibiotics interact strongly with anti-rejection medications and should be avoided. It is best to discuss any new medications with the transplant team before starting them.

Tumours

Transplanted patients have a slightly increased risk of tumours. This is related to the intensity of immune-suppression used in them. Skin tumours are the most common type of tumours occurring in the transplant population and are also completely curable if identified and treated early enough. Measures to decrease the risk include avoiding unnecessary sun exposure and using sunscreen when going out. Monthly self-examination of the entire body using a mirror will help in identifying any new skin lesions such as moles, patches etc or change in the appearance of existing moles should be reported to the transplant team. Head and neck tumoursand lymph-gland tumours can also occur with higher frequency in liver transplant patients.

Other Drug related complications

These include kidney dysfunction, diabetes, cataracts, high blood pressure, thinning of bones. Regular checkups will help in identifying and treating them early and prevent permanent damage.

Complications related to the original Liver Disease

Patients who undergo liver transplant for hepatitis B or hepatitis C viruses and autoimmune liver disease should be monitored for the recurrence of the disease. Blood tests are usually the earliest indicator of disease recurrence, but a liver biopsy may be required to confirm the diagnosis.


Looking to the future: Living with a Liver Transplant

Liver transplant completely changes the life of a patient who is suffering from end- stage liver disease. The initial post-transplant period may be difficult due to frequent blood tests, clinic visits and the occasional hospital admission. However, by around six months most patients will be able to enjoy an active life, get back to their studies or work, take holidays. Unlike a kidney transplant, there is no time limit for a liver transplant and patients who have received liver transplants over thirty years ago in the West are still well. This is particularly important for children who have needed liver transplant. They have been able to lead a normal healthy life, complete their education, have a career and start a family as anyone else.

WHY RIMC?

Pioneers of India’s Most Advanced Liver Transplant Centre

Rela Institute of Liver Disease & Transplantation is headed by Professor Mohamed Rela, a World-renowned Liver Transplant Surgeon, with over 25 years of experience and has more than 4000 liver transplant surgeries to his credit. He is considered a true pioneer and an authority in this challenging field of surgery Top Master’s in Healthcare Administration recognized as one of the 20 most innovative paediatric surgeons alive. He is an academic powerhouse and has published over 500 original articles and reviews in the subject of liver transplantation & HPB in international peer-reviewed journals and has written 19 book chapters.

Highly Experienced Liver Transplantation Team

RIMC has highly experienced liver transplantation team with high success rate in both Cadaver and Living Donor Transplantation and has specialists in Pediatric Liver Transplantation, Split Liver Transplantation and Auxiliary Liver Transplantation. ILDT’s exceptional liver transplant team has performed over 500 Liver transplant surgeries and delivers advanced care for complex hepatology cases.

Systematic & Global Standard of Transplantation

RIMC follows a systematic process for liver transplant procedure. The steps are in accordance with medical procedures in majority hospitals across the world.

Pre & Post Transplantation Care

RIMC is known for the excellent care it provides to the recipients and donors before and after the transplantation by our comprehensive liver team of Hepatologists, Medical Gastroenterologists, Surgical Gastroenterologists and HPB Surgeons and other qualified doctors & staff.

Advanced Technology

Innovative technology is integral to delivering advanced health therapies that help the patients get treated more efficiently and recover quickly. RIMC offers cutting-edge technology and state-of-the-art treatment facilities designed to deliver superlative healthcare.

Specialized Operation Theaters

To successfully execute some of the most complex & complicated transplant surgical procedures

Advanced Post-Op ICUs

The best post-surgical care with state-of-the-art equipment and highly trained personnel

World’s Largest Dedicated LICU

The world's largest dedicated Liver Intensive Care Unit with cutting-edge technology and advanced infrastructure.

India’s first dedicated Integrated Liver Ambulance

India's first dedicated Integrated Liver Emergency Care Ambulance Service. The mobile ICU will have specialist on board at your doorstep when liver emergency calls.

24/7 Liver Emergency

A 24/7 Helpline - LiverEmergencyDirectConnect: - to connect you directly with a Liver Intensive Care Team Specialist for immediate advice, in case of any emergencies related to liver disease.

International Patient Service

We offer a unique environment with its courteous attitude of the staff. Leading-edge technologies, extensive research resources and best-in-the-world treatment options make the institute the healthcare destination of choice for a great number of international patients coming to India.



Rela Institute & Medical Centre is one of the best liver transplant hospitals in Chennai, India. It has provided new lease of life to individuals in desperate need of liver transplantation in order to survive. With the best liver transplant surgeon in Chennai, RIMC’s Liver team provides the best care possible before, during and after the transplant surgery.

We, perhaps, are the best liver transplant specialist hospital in Chennai that can take care of patients with acute liver diseases who desperately need transplant to get a new lease of life.

Call us today, we are here to help you!

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