Centre for Liver Care & Transplant (CLCT), Fortis Hospital Bangalore

Fortis Centre for Hepatobiliary Sciences & Liver transplant

The Liver Transplant Team at Fortis Hospitals, Bangalore is a group of highly skilled professionals who work together to help you have a successful transplant and recovery. At Fortis, Liver Transplants are performed by extremely talented and well-trained doctors who have excellent records for consistently achieving outstanding results with high success rates. The procedure is carried out by a multidisciplinary team consisting of Transplant Hepatologists, Gastroenterologists, Surgeons, Interventional Radiologists, Anesthesiologist and critical care Intensivists, well-trained technical and nursing staff. At various Fortis hospitals, we also run evaluation centres for liver donors and patients.

Please contact - Transplant.coordinator@fortishealthcare.com or 8971564311 for any queries or concerns.

The Multi-disciplinary transplant team at Fortis

Our Multi-disciplinary transplant team comprises of some of the brilliant minds across the nation. They are the best in their field and are well equipped to deal with every situation. We believe that life is of prime importance and therefore ensure that our patients always have access to the best expertise while following the highest standards in health care. We use only the most advanced equipment and the best techniques in a top-notch operation theatre, with minimally invasive techniques.

Importance of Liver and what is Liver Transplant

Just as it is said that the heart is the centre of the circulatory system of the body, our liver heads the chemical processing system of our body. It contributes towards all metabolic processes, has a significant role in digestion and synthesizing of important proteins and enzymes, and plays a crucial role in blood clotting too. Did you also know that the liver is the largest organ of our body?

Thus, it is obvious that a human body needs a healthy liver to function rightly and that it cannot live without it. Although the liver has self-healing capabilities wherein it replaces damaged tissues with new cells, there are cases wherein the damage to the liver cannot be reversed and medical intervention is needed. This is when a liver transplant is spoken about. In very simple terms, a liver transplant is an operation that replaces a patient’s unhealthy liver with a whole or partial healthy liver from another person. It is generally a last-resort measure for chronic and severe acute liver diseases.

What is Liver transplantation?

Liver transplantation is a surgical procedure that is undertaken for surgically replacing a failing or diseased liver with one that is healthy and fully-functional. Currently, a liver transplant is the only definite cure for people suffering from liver cancer (Hepatocellular carcinoma), acute or chronic liver failure. This is because no other machine or device can perform the functions as efficiently and effectively as the liver does.

A liver transplant can easily extend the life span of an ailing person. As per statistics released by The American Liver Foundation, it has been observed that nearly 85- 87 %  of all patients who have undergone a liver transplant and have gone on to live for at least 5 years' post-surgery. In the case of children, the results are even better as nearly 82 % of children who have received a new liver have gone on to live for at least 10 years' after surgery. The most commonly used technique for liver transplant is the Orthotopic liver transplantation. In this procedure, the whole liver is taken out and then replaced by the donated liver.

While in most cases, the donated livers used for transplantation are obtained from patients that are brain dead or patients who are cardiac dead, the liver can also be transplanted from a living donor. We hope to make patients familiar with the various pros and cons of getting liver transplantation through the help of this comprehensive guide.

Who needs a liver transplant?

Treatment is based according to the symptoms on display and as per the results of various diagnostic tests, including blood tests, which help in determining the severity of the liver disease. Treatment may also be based on the various diseases or conditions that caused liver damage and or may not be reversible. Some of the tests or scoring systems which are used universally to help assess the severity and nature of the condition of the liver include:

• Child-Pugh-Turcotte (CTP) score

• Model for End-Stage Liver Disease (MELD) score is a number which prioritizes patients for liver transplantation. It has a complicated formula and it takes in bilirubin, INR (function of liver) and creatinine (function of the kidney) to give us the MELD score.

• PELD score in a pediatric population

Accordingly, low scores on these scoring systems usually mean that the patient does not require to get a liver transplant done. In the case of patients where the liver disease has progressed to an advanced stage with severe symptoms along with high scores on these tests, they will definitely be in need of an early transplant. Listed below are some other candidates who definitely require a liver transplant:

• An early liver transplant may be recommended in case of patients where the liver disease has had secondary effects on other organs including the lungs (hepato-pulmonary syndrome), kidneys (hepato-renal syndrome) and even the brain.

• Patients suffering from liver cancer, also known as hepatic cancer, may need an urgent transplant even if there is no severe underlying liver disease detected.

• Patients suffering from acute liver failure generally tend to have a normal, non-cirrhotic liver which increased the chances for liver regeneration and potential recovery. That being said, once the damage has gone beyond a particular stage, recovery is highly unlikely. In such cases, the urgency of transplant is determined by the doctors.

What are the indications for liver transplant and what is the success rate?

A liver transplant is generally done for End-Stage liver failure.

• ALF (Acute Liver Failure)
• CLF (Chronic Liver Failure)
• Cirrhosis
• NAFLD (Non-alcoholic Fatty Liver Disease)
• Toxic Exposures
• Metabolic and genetic disorders

For some patients, liver disease brings secondary effects on other organs like the lungs (hepato- pulmonary syndrome), kidneys (hepato-renal syndrome) and even the brain and increases the complications. To avoid such complexities, an early liver transplant may be recommended for them. Patients who suffer from liver cancer (hepatic cancer) may require an urgent liver transplant even if they have no severe pre-existing liver disease.

Who Are Not Candidates for a Liver Transplant

There are several people who are deemed unsuitable or inappropriate candidates for a liver transplant before any operation, the concerned surgeon or physician weighs ups the pros and cons of the operation after taking the patient's personal history and circumstances into account. In that regard, a liver transplant will only be offered if the medical teams believe that the benefits of a liver transplant outweigh its risks. That said, here are some of the conditions which usually determine whether a person is fit or unfit for liver transplantation.

• Patients with a history of active alcohol abuse.

• Cancer which has gone on to spread beyond the liver.

• Severe, untreatable diseases affecting the brain, heart or lung which has shortened life expectancy.

• Uncontrolled or severe active infections.

• A prior history of refusing to adhere to a medical regime.

• Individuals afflicted with psychiatric diseases or conditions which are severe and uncontrollable in nature.

Types of donors: Finding a suitable donor includes finding a match in the following aspects:

• Right blood time

• Similar body weight

It is crucial that once on the list, a patient should maintain good health by eating nutritious food, exercising well and by undergoing regular checkups and other preventive measures. This is important because the wait time for finding the right donor can be a long one. There are 3 types of donors that doctors essentially scout for:

Living donors

It is possible to donate a portion of the liver to a patient since a liver has the capability to grow back to its original size and does so in the donor’s as well as the patient’s body post operation. Although this process was envisioned for young children since finding a donor for them was tougher, it is now being used for adult-to-adult transplants too. A family member or loved one can volunteer to give a part of his/her liver. Right tests and measurements need to be done before considering this route and hence its best to meet your doctor with the volunteer and discuss this possibility in detail.

Brain dead organ donors

These cases result in a maximum number of donors for a liver transplant. Brain dead organ donors are those for whom a massive trauma has stopped all brain functions even though other organs including the liver continue to function normally. The organ is procured from the body and due diligence is taken in preserving it till it reaches the rightful recipient.

Cardiac death organ donors

After a family takes the tough decision of taking the patient off life-sustaining medical support to let him/her expire, an operation is performed to quickly remove organs for preservation and eventual transplant.  

Do note that in none of the above cases, does the gender or the race of the donor impact the patient/recipient in any way. It is gender/ physical attributes agnostic procedure. Possible risks and complications post-transplant include:

• Rejection of new liver by the recipient’s body due to undeterminable reasons
• Internal bleeding
• Damage to the bile ducts
• Blood clots
• Lower immunity

The Transplantation Process:

The process starts by evaluating the person and assessing if the person is deemed suitable for the transplant. If found suitable, the transplant team then proceeds to analyze if the potential donors in the family are compatible and eligible for the transplant. Once an appropriate donor is zeroed, a clearance certificate from the authorization committee is issued, following which a date is fixed for the transplant.

What is the duration of liver transplantation surgery?

From the time you move into the operation theatre till we finish the surgery, it takes about 8 to 10 hours. After making an incision resembling the inside of ‘Mercedes Benz’ sign, the liver is mobilized and disconnected from its blood vessels and the bile duct. Then the new liver is put in and all the necessary connections are made, which include inferior vena cava, portal vein and hepatic artery. The bile duct is either connected to the recipient’s bile duct or to a loop of the small intestine. Drains are then placed and the abdomen is closed in layers.

Why FORTIS?

As much as there is hope and optimism, it is crucial that patients and their families understand the process in detail, appreciate the challenges that are generally faced and learn to recognize symptoms that need to be escalated to the doctor at an urgent basis. It is reassuring to know there are few hospitals in India that leave no stone unturned in keeping all up to speed by doing the right diagnosis, having detailed discussions with the patients and their families to explain the procedure in detail, and then performing transplants with international standards of accuracy and success rate.

Why Choose This Team?

This team brings together the best brains in the country who have worked at various centers across the globe under one unit.

• Patient Centric, Safe, high quality care outcomes
• Proven track record of donor safety
• Affordable packages
• Significant expertise in living donor liver transplantation
• Protocol based post transplant management
• 24 hour multidisciplinary input