Transplant Services

Liver Transplant

What is liver transplantation?

The procedure of removing a part/whole of diseased liver and replacing it with a new functioning liver is called liver transplantation. Liver transplant requires only blood group matching between donor and recipient.

Who needs liver transplant?

  • Liver has a remarkable capacity to regenerate when it suffers any injury in form of substance abuse, infection, metabolic disease, poisoning or other insults. However, in the event of recurrent insults, the liver's regenerative capability gets impacted, and it regenerates with scarring. This is called chronic liver disease.
  • The liver function starts declining as the scarring progresses. When the liver function declines, it starts impacting other organ systems of the body, which is medically called ‘a decompensated state’.
  • Once the body is not able to compensate the failing liver, one requires a liver transplantation. The following are the common indications of liver transplant :-
    • Refractory ascites - fluid in abdomen which is not controlled by medicines and needs repeated removal
    • Recurrent hepatic encephalopathy – recurrent episodes of altered sensorium and/or coma-like state due to increase in ammonia levels in blood
    • Spontaneous bacterial peritonitis – infection in the fluid in the abdomen
    • Hepatorenal syndrome – deterioration in kidney function due to liver dysfunction
    • Recurrent GI bleeding, not amenable to endoscopic intervention – blood in vomiting or motions due to increased portal pressure in liver cirrhosis
    • Acute liver failure
    • Acute on chronic liver failure (ACLF) – a cirrhotic liver fails acutely and leads to failure of other organs
    • Development of tumor (Hepatocellular carcinoma) in liver in liver cirrhosis

Types of liver transplant

Based on the type of organ donor, there are primarily two types of liver transplant

  • Living donor liver transplant
  • Deceased donor liver transplant

The organ donor in living donor transplant is a healthy person, preferably from the family. The donor in deceased donor transplant is a brain-dead person, whose family has decided to donate his/her organs.One needs to be listed in the state organ recipient list to be eligible for deceased donor transplant.

Liver transplantation is a complex surgery and requires experience and teamwork. The recipient surgery and donor surgery go on simultaneously in two different operation suites. The donor liver is taken out and prepared for implantation. At the same time, recipient liver is also taken out. The donor liver, once prepared, is then placed in recipient’s body. The donor hepatic vein, portal vein, hepatic artery and bile duct are joined with recipient’s blood vessels and bile duct. The whole procedure takes approximately 10-12 hours.

After surgery, the recipient needs to stay in ICU for approximately 5-7 days. The total hospital stay is approximately 2-3 weeks. In a living donor liver transplant, the donor needs to stay in hospital for approximately 6-8 days. There are generally no long- term effects of donor surgery. The livers in donor and recipient grow back to normal size in approximately 2-3 months.

  • Medical management of liver cirrhosis
  • Cadaveric Liver Transplant
  • Living Donor Liver Transplant
  • Pediatric Liver Transplant
  • ABO Incompatible Liver Transplant
  • SWAP Liver Transplant
  • Hepatocellular Carcinoma surgery
  • Cholangiocarcinoma surgery
  • Liver Metastases surgery
  • Neuroendocrine tumors
  • Gastro-Intestinal Stromal Tumors (GISTs)
  • Liver Trauma
  • Liver Cysts
  • Liver Adenoma
  • Hepatolithiasis

Liver transplantation requires only blood group matching between the donor and the recipient. There are situations, where blood group-matched donor is unavailable in the family. It is not the end of the road. There are other alternatives in such situations-

  • Deceased donor liver transplant
    As discussed earlier, one can enlist in the state organ recipient list and wait for an organ to be allocated from the donations by the brain-dead donors
  • ABO-incompatible liver transplantLiver transplant can be done without blood-group matching! However, the cost in such cases may increase. When an ABO-incompatible liver transplant is planned, the patient is administered some medications to suppress the immune reaction. In some cases, the patient may also need to undergo plasma exchanges before and after the transplant to prevent rejection of the grafted liver
  • Swap liver transplant In a swap liver transplant, the donor from the family of recipient A donates a part of liver to blood group matched recipient B and donor B from the family of recipient B donates liver to recipient A. Surgeries of both the donors and recipients are performed simultaneously.
Swap Liver Transplant

What tests are done during the Pre-transplant phase?

Pre-transplant evaluation of the recipient includes an exhaustive list of investigations which includes ;

  • Blood tests: Blood group, Complete blood count, liver function tests, renal function tests, tumor markers, and various viral markers.
  • Radiological tests: Chest X-ray, abdominal ultrasonography, liver doppler, CT scan and/or MRI, and HRCT chest in some cases
  • Evaluation for Preoperative fitness: Tests for cardiac and pulmonary fitness for surgery
  • Some patients may require specific investigations like auto-immune markers, tests for Wilson’s disease, and others. Patients are also evaluated by other specialists like Cardiologist, Pulmonologist, Gynaecologist (for female patients), Anesthetist, and Psychiatrist. In case of a living donor transplant, the donor also needs to be evaluated like the recipient.

    What medicines are given to the patient after undergoing Liver transplant?

    A patient is put on multi-drug immunosuppression regimen after transplant. These medicines are tapered over a period and generally, after 1 year, only one drug (Tacrolimus) is supposed to be taken. This medicine must be taken lifelong in most cases.

    What is the initial duration of post-transplant period?

    A patient needs to be in the hospital for 2-3 weeks after liver transplant in most cases. This includes an ICU stay of approximately 5-7 days. Patient is ambulated generally by 2nd- 3rd postoperative day. He/she is allowed liquids by 2nd to 3rd postoperative day and solids by 4th-5th postoperative day. The surgical stitches are removed generally by 2-3 weeks.

    What is the routine for Follow-up visits post Transplant?

    A patient needs to come for regular follow up visits post discharge. These visits are initially frequent (weekly). As the patient recovers from the surgery, the follow-up visits become less frequent. After 3-6 months, the visits are scheduled at 3–6-month interval which is to be followed life-long. Some blood tests are done during these follow-up visits and an abdominal ultrasound is generally advised at 6–12-month intervals.

    What is the Long-term survival rate of Transplant?

    The overall success rate of liver transplant is somewhere between 90-95%. The estimated 1-year survival is 85-90% and 5-year survival after liver transplant is more than 70%. A person can have a normal quality of life after liver transplant. He/she can resume the normal job activities, work out in a gym, and can pursue any sports activities. He/she can marry, can have normal sexual life, and have kids.

    There is no shelf-life of a transplanted liver. If a person takes medicines regularly, carries out all tests regularly and follows the medical advice, he/she can have a normal life span, with good quality.

    What Medicines are given to the patient after liver transplant?

    A common complication after liver transplant is rejection of the grafted liver by the recipient’s immune system. To prevent this, certain medicines are needed to suppress the recipient immune system. These medicines are called immunosuppressants.

    These medicines are initially given in combination after transplant, usually 2-3 drugs. Over the time, they are reduced in number and dose. After 1 year, only one or two drugs are continued for life. The commonly used immunosuppressants are steroids, Tacrolimus, Cyclosporine, Mycophenolate Moxetil, Everolimus and Sirolimus. These medicines need to be taken, as prescribed by the doctor, and cannot be stopped or modified without doctor’s advice.