Transplants

Liver Transplant is the often-recommended option for a patient with end stage liver failure when other modes of treatment are not successful. The purpose is to replace the diseased liver with a healthy liver. Ideally, after a transplant, the patient will be free from the disease and lead a fairly normal life as long as the transplant is successful. Both adults and children can undergo liver transplantation.

End stage Liver Failure may occur due to one of the following conditions:

  • Chronic Hepatitis with Cirrhosis
  • Primary Biliary Cirrhosis – A rare condition where the immune system inappropriately attacks and destroys the bile ducts.
  • Sclerosing Cholangitis – Scarring and narrowing of the bile ducts inside and outside of the liver, causing the backup of bile in the liver
  • Biliary Atresia – A rare disease of the liver that affects new-borns
  • Alcoholism
  • Wilson's disease – A rare inherited disease with abnormal levels of copper throughout the body, including the liver.
  • Hemochromatosis – A common inherited disease where the body has too much iron.
  • Alpha1 Antitrypsin Deficiency – An abnormal build-up of alpha1 antitrypsin protein in the liver, resulting in cirrhosis
  • Liver Cancer

Liver Transplant at Apollo Hospitals, Chennai

The Apollo Institute of Liver Sciences at Apollo Hospitals, Chennai runs one of the largest and most comprehensive organ transplant programmes in India. It offers a wide range of state-of-the-art services, including transplants of the liver, kidney and pancreas. The centre provides medical care on par with international standards for pre and post-transplant management.

The team practises a multidisciplinary treatment approach through curated therapies for each patient that involves minimalistic intervention. The unit has an adept clinical team, ably supported by superior infrastructure, including dedicated, laminar-flow operation theatres with infection-free systems, ICUs, latest instrumentation, sophisticated laboratory, advanced radiology and imaging facilities.

With Clinicians from Medical and Surgical Gastroenterology (adult and paediatric), Endoscopy, Hepatology, Oncology and Interventional Radiology, the treatment offered to a patient at The Apollo Institute of Liver Sciences is holistic, innovative and complete.

At The Apollo Institute of Liver Sciences, the patient can see all specialists in one location, so he/she won't need to schedule multiple visits to meet with all the liver care providers. Our team of highly experienced physicians, nurses and counsellors work together to outline a strategy, tailored for each patient's unique physical, psychological and financial situation. Once the patient's situation is assessed, the type of transplant that would suit his/her condition is suggested. There are three different types of transplants

Living Donor Liver Transplant

With a living donor transplant, the patient may have a waiting period that is shorter and improved life expectancy. A healthy family member, usually a parent, sibling, spouse, or child can volunteer to donate a part of their liver for transplantation. The donor is carefully evaluated by the team to make sure no harm will come to the donor or the recipient. Among other detailed medical evaluations, it is imperative that the donor should be between 18 – 55 years of age, have a compatible blood group with the recipient and most importantly, donates the organ of his/ her own will.

Deceased Donor Liver Transplant

Also known as cadaver donor liver transplant, the liver is harvested from a person who is declared brain dead and his/her family volunteers to donate the organ for transplantation. People who receive cadaver donors wait on the institutional or regional list until a suitable donor becomes available. Deceased donor organ allocation is strictly based on the blood group match, waiting list time and urgency.

Swap Liver Transplantation

Swap liver transplantation might be an option if a donor wants to donate part of his/her liver to the patient but is not a good match for that person. For example, let's say a person wants to be a donor for his/her brother, but their blood types don't match. If that's the case, our doctor will help them find two other people in a similar situation — one donor and one person who needs a new liver. The donor will have the brother's blood type, and the person who needs the new liver will have the donor’s blood type. The person gives a part of his/her liver to the one whose blood type matches yours, and the other donor gives part of his liver to the brother. It's an arrangement that works for all four of them.

Liver Transplantation Process at Apollo Hospitals, Chennai

The approach to patient care at The Apollo Institute of Liver Sciences is unique in the sense that each patient is personally assigned with a transplant coordinator who hand holds the patient right from the beginning till the end – evaluations, tests, registering for the organ, transplant surgery preparation, post-surgery recovery and follow ups, thereby providing a seamless experience.

Adult Liver Transplant: Pre-Liver Transplant

Once the Gastroenterologist is convinced to proceed with liver transplantation for the treatment of liver disease, the patient will be referred to Apollo Liver Clinics at the hospital to undergo evaluation. A number of tests and procedures will be conducted to understand the current condition of the liver. These may include:

  • Laboratory tests: Blood and urine tests to assess the functionality of a patient's organs. It also includes a routine cancer screening
  • Imaging tests: An ultrasound of the liver
  • Heart tests: To determine the health of your cardiovascular system
  • Psychological Evaluation: To ensure that you fully understand the risks of a Liver Transplant
  • Financial Counselling: To help you understand the cost of a transplant and post-transplant care, and to determine what costs are covered by insurance
  • Addiction Counselling to help people with alcohol, drug or tobacco addictions to quit

In a few cases, where the patient has multiple co morbidities and organ dysfunction, a dedicated critical management team is organised to monitor, support and avoid any systemic complications. When the results of the evaluation are available, the selection committee of The Apollo Institute of Liver Sciences convenes to discuss and determine if the best way forward for the patient is a Liver Transplant and if his/ her current health condition permits one. If the committee agrees, then the patient is registered on the transplant waiting list. When placed on the waiting list, based on the prognosis, each patient is assigned a Model for End-Stage Liver Disease (MELD) score. Patients with higher MLED score are given priority. MLED scores may range between 6 and 40. However, there are certain conditions that may prevent the patient from undergoing a liver transplant such as:

  • Chronic use of alcohol
  • Substance abuse
  • Possibility of alcohol or drug abuse after the surgery
  • Having advanced cancer of the liver
  • Having another kind of cancer in the past three to five years
  • Severe heart, lung or kidney disease
  • Severe hardening of the arteries
  • Systemic infections
  • Failing to follow your Doctor's instructions
  • Very little or no support from your family

The wait time for a donor liver is unpredictable – it could be weeks or months. In the meantime, your doctor will keep monitoring and treating your liver for any complication that may arise. With chronic liver failure, it is impossible to predict the seriousness of the disease’s progress and may require frequent hospitalisation. Depending on the condition of your liver, your MELD is constantly updated.

Adult Liver Transplant: Post-Liver Transplant

It is indeed a life transforming experience to have a liver transplant. You will be instructed on how to care for yourself before you leave the hospital. Most patients recuperate fully within the first three months, return to work and have active lives. For a donor, it takes about 7 weeks until you can resume normal activity (except strenuous physical exercise) and return to work. Sexual activity can be resumed as soon as the donor feels well enough. Heavy physical activity, sports including lifting weights can be resumed 3 months after surgery.

The goal is to provide excellent care and follow up in concurrence with your primary physicians in order to make the length and quality of life appreciably better than before.

Paediatric Liver Transplantation

Accepting the fact that your child may need to undergo a liver transplantation will be difficult. We, at Apollo Hospitals, understand your position and will provide you and your child with utmost care through the complete process. Our experienced team will support and guide you during each step of the transplant journey.

Once your child is referred to our program, an initial assessment is done by our transplant surgeon where he/ she understands the severity of the disease and evaluates the need for a transplant. It is during this time that the family can get to know the treating doctor better and can clarify any doubts that they may have on their child’s treatment plan. When the need for a transplant is determined, a pre-evaluation transplant evaluation is scheduled which takes about 2 to 3 days involving clinic visits, blood work, and other diagnostic testing.

After the evaluation process, the selection committee decides if the child should be placed on the waiting list. When a liver is available, the family will be contacted for proceeding with the surgery. The family may be filled with myriad emotions during this phase but you can be rest assured that children who undergo liver transplantation can get a new lease of life with the recent development in techniques, immunosuppressants and the best post-transplant care.

Children who have undergone a liver transplantation will require follow ups through their lifetime. For the best outcomes and minimal complications, it is imperative to frequently stay in touch with the transplant medical team.

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