Medical Specialities / Liver Transplant
About the Liver
- Cleanses your blood: Metabolizing alcohol and other drugs and chemicals, neutralizing and destroying poisonous substances.
- Regulates your supply of body fuel:strong> Glucose and fat are the major fuels for the body. Producing, storing and supplying quick energy to keep your mind alert and your body active. It produces, stores and exports fat and glucose
- Manufactures many of your essential body proteins involved in: Transporting substances in your blood, clotting of your blood, and providing resistance to infections.
- Regulates the balance of hormones: Including sex hormones, thyroid hormones, cortisone and other adrenal hormones.
- Regulates your body’s cholesterol: Producing cholesterol, excreting it and converting it to other essential substances.
- Regulates your supply of essential vitamins and minerals: Including iron and copper.
- Produces bile: Eliminating toxic substances from your body and aiding with your digestion.
- Alcohol-Related Complications (Alcholic Hepatitis, Cirrhosis)
- Hepatitis A and E
- Hepatitis B
- Hepatitis C
- Liver Disease in Pregnancy
- Non-alcoholic Fatty Liver Disease (NAFLD)
- Nonalcoholic steatohepatitis (NASH)
- Alagille Syndrome
- Alpha-1 Antitrypsin Deficiency
- Autoimmune Hepatitis
- Biliary Atresia
- Cystic Disease of the Liver
- Gilbert's Syndrome
- Lysosomal Acid Lipase Deficiency (LALD)
- Neonatal Hepatitis
- Primary Biliary Cholangitis (formerly Primary Biliary Cirrhosis)
- Primary Sclerosing Cholangitis
- Reye's Syndrome
- Toxic Hepatitis
- Type 1 Glycogen Storage Disease
- Wilson Disease
Liver disease has no symptoms. Liver disease per se is diagnosed when an individual is investigated for some other cause. Only once the complications develop there may be symptoms. There may be malaise, bodyache, weightloss, anorexia, upper abdominal pain and other non-specific symptoms.
Irrespective of the reason responsible for liver damage, the end result remains the same. As the damage increases, it progresses from fibrosis to cirrhosis. Normal liver is soft and smooth; when it becomes hard and irregular, it is known as cirrhosis of liver. What it functionally means that, the liver fails to cope of with the functions of liver. There are no symptoms of liver fibrosis or cirrhosis. You need to undergo tests to diagnose these stages. If the disease is not controlled, the complications of cirrhosis develops – namely jaundice, altered behavior (Hepatic Encephalopathy), swelling on your feet (oedema), accumulation of fluid in your tummy (ascites), blood vomitus (hematemesis), blood in your stools (malena). It can also progress to cancers of liver and bile duct. Once you start developing all these complications, liver is already completely damaged and the injury is beyond point of no return.
Liver disease can often be difficult to diagnose because its symptoms can be vague and easily confused with other health problems. In some cases, a person may have no symptoms at all yet his or her liver may already have suffered significant damage. Risk factors can vary significantly across the 100+ different forms of liver disease. The good news is that many liver diseases can be prevented, managed or in some cases even cured, but early identification is critical so it is important that you ask your doctor for a liver test.
Liver tests or routinely called as Liver Function Tests, are blood tests used to help determine the health of your liver and your bile ducts. Liver tests are used to guide your healthcare provider, along with your history and physical examination, in the diagnosis and management of your liver disease. These tests measure the levels of certain enzymes and proteins in your blood, how well the liver is performing its functions, or measure enzymes that liver cells release in response to damage or disease. Abnormal liver test results don’t always indicate liver disease. Your healthcare provider will be able explain your results and what they mean.
- Alanine Aminotransferase (ALT,previously called SGPT) and Aspartate Aminotransferase (AST, Previously called SGOT)
- Alkaline Phosphatase and Gamma Glutamyl Transferase (GGT)
- Bilirubin Test
- Proteins and Albumin Test
- Prothrombin Time and INR
All above tests are usually clubbed together as LT. Individual values though indicate a liver problem, maynot help in localizing disease and hence the entire battery of tests needs to be done. Based on these results the doctor will be able to take decision on further tests.
Besides these tests, your doctor will order tests to determine the cause of liver disease as well as the stage of liver disease. The tests like HBsAg, Antibody against Hepatitis C, Antinuclear antibody, Anti Smooth muscle antibody, immunoglobulins, caeruplasmin and others guide in determining the etiology for liver disease. They would also test for your hemogram and renal functions to guage the doses of medicines.
The use of fibre-optic endoscopy has greatly facilitated the management of all patients with chronic liver disease. Upper endoscopy plays a pivotal role in the diagnosis and management of oesophageal and gastric varices. Endoscopic ultrasound is increasingly being used to detect varices and in the staging of gastrointestinal tumours. Endoscopic retrograde cholangiopancreatography (ERCP) plays an important role in the diagnosis of recurrent pyogenic cholangitis and endoscopic sphincterotomy is a useful form of treatment. Laparoscopy, with the aid of ultrasound and biopsy is helpful in staging chronic liver disease, identifying focal lesions, and diagnosing peritoneal disease.
It is a diagnostic procedure used to obtain a small amount of liver tissue, which can be examined under a microscope to determine what is causing the liver disease and the degree of fibrosis (scarring) of the liver. This test is rarely performed and has very specific indications.
Liver transplantation is a surgical procedure performed to remove a diseased or injured liver and replace it with a whole or a portion of a healthy liver from another person, called the donor. Since the liver is the only organ in the body able to regenerate, a transplanted segment of a liver can grow to normal size within a matter of few weeks.
History of Liver Transplant
The first LT was attempted in University of Colorado in 1963 by a surgical team led by Dr Thomas Starzl. After 7 unsuccessful attempts, the first successful transplant was performed in July 1967 while first successful split liver transplant in 1988. In 1998, the first living related liver transplantation in India was done in Delhi. From that time onwards, transplant program has greatly picked up in the Indian subcontinent with states like Gujarat, Tamilnadu, Telangana, Maharashtra, NCR and Odisha offering the facility.
A liver transplant is recommended when a person’s liver no longer functions adequately enough to keep them alive. The indications for liver transplant were previously broadly divided into two categories – Chronic Liver Disease and Fulminant liver failure. Third and fourth indications have come up in recent years between the two extremes – Acute on chronic liver failure and severe alcoholic hepatitis. A successful liver transplant is a life-saving procedure for people with acute/fulminant liver failure. Liver failure can happen suddenly –as a result of infection or complications from certain medications, for example. Liver failure resulting from a long-term problem – called chronic liver failure – progresses over months, years or decades.
- Alcohol related liver disease is the most common etiology for patients requiring liver transplant in India and worldwide
- Chronic hepatitis, including hepatitis B and Hepatitis C These hepatitis predominate as the cause of liver transplant in developed countries.
- Autoimmune hepatitis Disease caused by abnormality of your immune system
- NASH, or nonalcoholic steatohepatitis, a disease caused by a buildup of fat in the liver resulting in inflammation and damage to liver cells. It is the most rising cause of liver transplant and is expected to become the number 1 cause of liver disease requiring liver transplant within next decade
- Some genetic conditions, including Wilson disease where dangerous levels of copper build up in the liver, and hemochromatosis where iron builds up in the liver.
- Disease of vessels – Budd Chiari Syndrome
- Diseases of the bile ducts - Primary biliary cholangitis, Primary sclerosing cholangitis, and biliary atresia. Biliary atresia, a disease of absent or malformed bile ducts usually identified shortly after birth, is the most common cause of liver failure and transplant in infants.
- Primary liver cancer, meaning cancers that originate in the liver, such as hepatocellular carcinoma are also amenable to liver transplant if they present within established criteria. Unfortunately most individuals in India are diagnosed late and hence cannot be transplanted.
Referral by your Liver physician / GI physician / Medical Gastroenterologist for transplant is the first step. You are evaluated to determine if you are a suitable candidate. Evaluation will include assessment of your:
- Liver disease and other conditions you may have;Mental and emotional health
- Other vital metabolic support systems
- Ability to adhere to the complex medical regimen required after transplant and
- Likelihood of surviving the transplant surgery
Liver transplant surgery is complex and generally takes between 6 and 10 hours. During the operation, surgeons will remove the entire injured or diseased liver and replace it with the donor liver. Several tubes will be placed in your body to help it carry out certain functions during the operation and for a few days afterward.
These include a breathing tube, intravenous lines to provide fluids and medications, a catheter to drain urine from your bladder, and other tubes to drain fluid and blood from your abdomen. You’ll be kept under close observation in a specially designed intensive care unit for a few days and then moved to a regular room. The length of your hospitalization depends on your specific circumstances and if complications arise, the stay could be extended.
The two main risks following liver transplant are infection and rejection of the new liver by your body’s immune system. Your immune system attacks unwanted foreign substances – like bacteria and viruses – that invade your body. But the immune system can’t distinguish between the transplanted liver and unwanted invaders, so it may try to attack – or reject – your new liver.
To prevent rejection, all transplant patients must take anti-rejection medications, called immunosuppressant. These drugs are given to suppress your immune system in an effort to ward off rejection of the new liver. However, by suppressing your immune system you become more susceptible to infections. Fortunately, this problem usually lessens as time passes and most infections can be treated successfully with other drugs.
The other thing to be aware of is that liver disease can recur in the transplanted liver. One of the primary problems with hepatitis C patients was universal recurrence of the virus after transplantation. However, with the advent of newer, more effective treatments, hepatitis C can be cured before or after liver transplantation.
Patients with advanced liver disease from hepatitis B require lifelong medication to suppress the virus both before and after transplantation. Autoimmune diseases such as primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) may also recur.
Rejection does not always cause noticeable symptoms. In fact, sometimes the only way rejection is detected is from routine blood tests. As such, it’s very important not to miss regularly scheduled appointments with your medical team. If there are symptoms, each individual may experience them differently. Some of the more common signs and symptoms of rejection include:
- loss of appetite
- itchy skin (pruritus)
- dark-colored urine
- jaundice (a yellowing of the skin and whites of the eyes)
- abdominal tenderness or swelling
Myth 1 – Liver Transplant is only for elite class
Liver transplant is 100 times cheaper in India than any other developed country of the world. The overall cost varies from 12 -25 lakhs for the operation. But the most important fact that people do not know is that there are a lot of social organizations and NGOs that help people financially for liver transplant. What people fail to understand that you end up spending more than the cost of transplant after cirrhosis just for repeated admissions with complications. It is advisable to get transplanted rather than getting admitted multiple times in Intensive care unit. A lot of individuals who present to hospitals have spent more than 30-35 lakhs for treatment before even thinking of liver transplant.
Myth 2 – Liver Transplant is not successful
The survival rate in India in whichever center of India you take is equal to the rest of the worlds. In fact when we compare the data from majority of our centers, as we do LDLT, the survival is superior. We expect 90% patients to walk home after a transplant and the survival rate of 5 years is 70 percent which is 5 times that of the patient who is in need for liver transplant.
Myth 3 – You have to travel out of Gujarat to get a liver
We have fully functional transplant set ups in Ahmedabad. The transplant service is offered at Civil Hospital, Sterling Hospitals, Shalby Hospitals as well as Apollo Hospitals. We, at Zydus Hospitals have a complete in house team for Liver Transplant unlike other centres with a combined experience of more than 1000 transplants. You no longer need to travel out of the state to get a liver.
Any person from the family (1st degree relatives- spouse, siblings, parents, children/ 2nd degree relatives- all others) who is blood group compatible can donate his/ her liver.
The living donors are assessed in 4 stages for ruling out any liver disease and any other systemic diseases. This helps the liver team in deciding the suitability of the living donor.
With the present availability and expertise in surgery and anesthesia, the surgery for living donor is very safe. The risk of surgery for the donor is 0.2 to 0.5 %.
Zydus Hospitals, Ahmedabad offers end to end Liver Care solutions. We offer our services right from Clinical Assessment → Disease Detection → Disease Management.
A dedicated team of Gastroenterologists, Liver & Hepatobiliary Transplant Surgeon, Transplant Anaesthetist, Transplant Dietary Specialists & experienced team of co-ordinators.
Together our Liver Care Team will provide you information, guidance & support. More than a team of medical specialists we wish to be a part of your extended family.
The best is to protect your liver from developing cirrhosis. Even if you develop cirrhosis, it is not the death sentence nowadays and you can still expect to survive a functional life with good quality after a liver transplant.