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Liver Transplant in India: What You Need To Know?

A liver transplant is a surgical method of replacing a diseased or injured liver with a donated, healthy liver. It is generally recommended when the liver has been damaged so it cannot function normally. This stage is known as liver failure or end-stage liver disease.

A liver transplant in India costs approximately USD 27000 to USD 33000.

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Who Needs a Liver Transplant?

Several diseases can impair or destroy the functioning of a liver to such a level that a transplant is the only treatment option left. 

These conditions include:

  • Scarring of the liver (Cirrhosis)
  • Chronic viral hepatitis B, C
  • Autoimmune hepatitis
  • Bile duct diseases
  • Metabolic & Genetic disorders
  • Autoimmune liver diseases
  • Primary liver cancer
  • Alcoholic liver disease
  • Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH)
  • Primary biliary cirrhosis(PBC) and primary sclerosing cholangitis (PSC)

Types of Liver Transplant

Different types of liver transplants may be offered to a person:

Orthotopic transplant

The most frequently performed liver transplant is the orthotopic transplant. It involves taking the entire liver from a recently passed donor. The donor typically had previously pledged their organs for donation and had no contagious diseases or cancers that could be passed on to the recipient.

The surgery involves an incision in the abdomen to remove the diseased liver and replace it with a donor's liver. The bile ducts and the blood vessels are connected, and the incision is closed using surgical staples or dissolvable stitches.

After surgery, drainage tubes are attached to help remove excess fluids and are typically left in place for several days. Once the tubes are removed, the patient is transferred to the ICU to begin their recovery process.

Living Donor Liver Transplant (LDLT)

A living donor transplant means the donor is a willing living person. The donor has the operation first, in which the surgeon removes the liver's left or right side (lobe). Right lobe transplants are recommended for adults, while left lobes are used for children. This is because the right lobe is larger and more suitable for adults, whereas the left lobe is smaller and more appropriate for children.

Following transplantation, the transplanted lobe quickly regenerates itself. Even for the donor, the removed portion of the liver grows back. The new lobe usually grows to 85% of the original liver size in the recipient within a week.

Split Type of Transplant

Split donation is a liver transplant procedure where one liver from a recently deceased donor is given to two recipients, typically an adult and a child. The liver is divided into left and right lobes, with the larger right lobe going to the adult and the smaller left lobe to the child.

Like living donor transplants, the transplanted liver portions regenerate and return to their original size. This approach provides a benefit to two individuals simultaneously.

Auxiliary Liver Transplantation

Auxiliary liver transplantation is a variety of liver transplantation where the recipient's liver is not completely removed. 

The goal is to preserve the patient's natural liver in the event of spontaneous recovery or the possibility of gene therapy for metabolic liver diseases or hereditary conditions.

Who Can be a Liver Donor?

  • Either be a relative, spouse, or friend
  • A donor with a compatible blood type with the recipient's
  • The donor is in good physical and mental health
  • The donor is between 19-60 years of age

Who Cannot Donate a Liver?

  • History of Hepatitis B or C
  • HIV infection
  • Active substance abuse (drugs and/or alcohol)
  • Psychiatric illness currently under treatment
  • A recent history of cancer
  • An active, severe infection that cannot be completely treated or cured, such as tuberculosis
  • Cancer that has spread outside of the liver
  • Severe pulmonary hypertension

Recovery After Liver Transplantation Surgery

Recovering from a liver transplant is a long & slow process. Most people will be able to return to normal activities within a few months and have a good quality of life.

Long Term Management

  • After getting discharged from the hospital, the patient has to come for regular follow-up visits. Throughout life, the medical team will monitor the patient's health progress.
  • Regular blood tests are recommended to keep track of the new liver. That is, rejection, infections, or problems with blood vessels or bile ducts are not damaging.
  • The initial six months after the transplant is critical as most of the problems are likely to occur at this time. With time, the frequency of lab tests and the doses of medicine are reduced.
  • Patients are advised to have a healthy diet, exercise regularly, and not drink alcohol, especially if alcohol has already been a cause of liver damage.

Returning to Normal Activities

  • After a successful liver transplant, a patient can get back to their normal day-to-day activities. Regaining full strength can take some time, depending on how sick the patient was before the transplant.
  • Patients should avoid driving for up to two months because the transplant procedure and immunosuppressant medication can affect the patient's vision, reaction times, and ability to perform emergency stops.
  • After being able to return to daily work, the patient should engage in normal exercise and can return to normal sex life.
  • Women are advised to avoid getting pregnant during the first year after a transplant. It's best to consult with the doctors about sex and pregnancy.

Rejection

The risk of rejection is highest after the first three months of the transplant. Hence, the patient is given a relatively high dose at first. Eventually, the dosage is reduced to a level thought high enough to prevent rejection but low enough to minimize unpleasant side effects. After a transplant, two main immunosuppressants are used to treat people. These are mainly:

  • Calcineurin inhibitors – such as cyclosporine and tacrolimus
  • Corticosteroids – such as prednisolone

Side-Effects After Liver Transplant

A liver transplant is a significant operation and carries the risk of some potentially serious complications. These complications can occur during, soon after, or several years after the procedure. Some of the side effects that might occur are:

  • Headache, nausea, and vomiting
  • High blood pressure
  • Diarrhea
  • Anemia
  • Increased appetite & Weight gain
  • Trouble sleeping
  • Swelling and tingling of the hands and feet
  • Acne and other skin problems
  • High cholesterol
  • Hair loss or unwanted hair growth
  • Puffy face
  • Weakened bones, arthritis
  • Mood swings, tremors
  • Body rejecting the new liver
  • Bleeding (hemorrhage)
  • Increased risk of certain types of cancer, specifically skin cancer
  • Problems with blood flow to and from the liver
  • Weakened immunity
  • Kidney function loss

What is the Success Rate of Liver Transplants in India?

Results of liver transplantation are mostly excellent, but they significantly vary depending on the indication for liver transplant and the factors associated with the donor. Presently, the overall estimated patient survival rate is:

  • One year after liver transplant: 88%
  • Five years after liver transplant: 73%

Why Choose India for a Liver Transplant?

  • Indian surgeons are well-known all over the world for their skills and experience. 
  • Many skilled professionals provide various treatments to over 65000 medical tourists every year. 
  • Hospitals in India are well equipped with the latest and most sophisticated technology for a successful transplant. 
  • Many patients consider India the preferred destination, as it allows for more than 52% savings and provides par-excellence medical care.
  • India serves as a regional referral center for liver transplantation in Southeast Asia and other parts of the world for LDLT.
  • Approximately 35% of the LDLTs in India are performed on foreign nationals. 
  • The reduced cost associated with medical care in India is another factor attracting foreign nationals.

Who is the Best Liver Transplant Surgeon in India?

  • Dr. Arvinder Singh Soin: He is one of the best Liver Transplant Surgeons and Hepatobiliary Surgeons with an experience of over 21 years. He has performed over 2500 liver transplants. His expertise is in Liver Cancer, Liver Cirrhosis, Bile Duct Cancer, Gallbladder Cancer, Biliary stricture, Liver Cysts, Liver Metastases, and Biliary Atresia, to name a few.
  • Dr. Vivek Vij: He is a notable Liver Transplant Surgeon with an experience of over 23 years. He has performed over 500 liver transplants with minimum complications and 2000 liver transplants with cumulative experience with his team.
  • Dr. Joy Varghese: He is among the renowned Hepatologists and Liver Transplant Surgeons with over 25 years of experience. He successfully performed over 1500 liver transplantations and has expertise in Chronic Hepatitis B, Chronic Hepatitis C, Hepatocellular, etc.
  • Dr. Vasudevan K.R.: He is among the top Liver Transplant Surgeons with experience of more than 18 years. He has expertise in treating Non-Surgical Fat Loss, Endosurgery, Colonoscopy, Endoscopic Surgery, and Minimally Invasive Surgery.
  • Dr. Giriraj Bora: He is a Liver Transplant Surgeon with an experience of over 16 years. His areas of interest are liver transplantation and liver resections for Hepatocellular cancers, combined liver-kidney transplantation, and Pancreatic Surgery (Whipple's pancreaticoduodenal resections and surgery for chronic pancreatitis). 

To Conclude

The volume of liver transplants varies widely by country, and there has been an important growth in volume in emerging countries. Innovative strategies to incentivize donations have been developed in several countries.

India has evolved as an important contributor to the field of liver transplant with rapid growth and innovations in LDLT over the last ten years.  

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neha Author Name
neha

Neha Jaswal is a researcher and writer at Vaidam Health. Being a fitness freak, she loves to pen down about health and fitness. 
A writer by day and a reader by night, she likes to expand her pensive thoughts health, travel strategies.

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