Advanced Centre For Liver Transplant at Fortis Hospital Bangalore

Pre-transplant - Recipients

How are candidates for liver transplants determined?/ Can anyone with liver problems get a transplant?
Liver transplant is indicated at a stage when the liver is no longer able to support the normal functioning of the body. This can occur acutely over a period of hours or days when it is called acute liver failure, occur over a period of months to years when it called chronic liver failure or be a combination of the two. Liver transplant is indicated when the chances of surviving without the operation are low and the patient is reasonably fit enough to undergo the operation.

What are the common conditions that can affect the liver and lead to a transplant?

The liver can be affected due to viral hepatitis (B, C, A, E), alcohol intake, autoimmune diseases, biliary diseases like primary biliary cirrhosis, primary sclerosing cholangitis, extrahepatic biliary atresia, genetic conditions like Wilson’s disease, hemochromatosis, veno occlusive disease (Budd-Chiari syndrome) and in some instances due to on apparent cause (cryptogenic cirrhosis). Hepatocellular carcinoma (HCC) limited to the liver and meeting certain criteria is another common indication for liver transplantation. 

How is the transplant decision made?

Is there a way to assess if the patient is ready for a liver transplant?
Once the indication for transplant is clear, the patient undergoes a series of tests to objectively determine the risk associated with the procedure. This involves assessment of function of various organs like the heart, lung and kidneys, actively ruling out any focus of infection and identifying areas that need optimization. After this a discussion is held in a multidisciplinary meeting of various specialists. The patient and the treating team then make an informed decision regarding the liver transplantation. 

How much will the liver transplant cost? What about Health Insurance?

Please meet the financial counsellor, transplant co-ordinator for details of the liver transplant package and insurance coverage

Living donors

What are the types of liver transplantation?

Broadly there are two types of transplantation depending upon the type of donors. In living donor liver transplantation, a close relative of the patient donates a portion of his/her liver to the recipient. This operation is possible because the liver has the capacity to regenerate in both the recipient and the donor. In deceased donor liver transplantation, a brain dead donor donates the whole liver. 

Is there any difference between living donor and deceased donor liver transplantation in terms of outcome?

In terms of recipient outcomes there is no difference although the technicalities involved in the operation are different. Obviously living donor liver transplantation involves a finite risk to a living donor which is not the case in deceased donor liver transplantation.

Who can be a living donor?

Any healthy individual aged between 18 and 50 years, without any serious medical problems can be a volunatary living donor

What tests are done to evaluate a potential living donor?

Blood tests to evaluate organ function, CT, MRI scans to evaluate anatomy of the liver, other tests to assess fitness to undergo major surgery are some of the tests done in an step wise manner to evaluate a potential liver donor

How much liver does a living donor have to donate?

For an adult recipient, around 60-65% of the liver of the donor is generally used. For a pediatric recipient, around 20-30% of the donor liver is used. It depends on the weight of the recipient and his general condition. 

Is the living donor operation a safe procedure?/ Is liver donation safe?/ What are some of the major risks post-surgery?

Living donor hepatectomy is a safe procedure in experienced hands. It is however a major procedure with a mortality risk of about 0.5% and risk of complications like bleeding, bile leak, wound complications etc around 10-15%

Is the gall bladder removed routinely during the operation?

Yes the gallbladder is removed routinely during the operation of donor hepatectomy. The surgeon will use it to perform an intra-operative cholangiogram to define biliary anatomy.

How much time does it take for the liver to regenerate?

The liver rapidly regenerates during the first week after surgery. During the subsequent weeks, it regains enough volume to sustain body functions comfortably

How long does a donor have to stay in hospital?

The usual hospital stay is around one week for a living donor who undergoes hepatectomy with an uneventful peri-opeartive course

When can a living donor expect to resume normal activities?

One can resume light work by the end of three weeks and resume all activities by the end of 6 weeks

Are there any long term effects due to liver donation?

If the initial recovery is uneventful, there are no long term effects. Young women can get pregnant and have a normal family. There is no need for any medications

What is the follow up protocol?

After discharge, donors have to follow up after 3 days, at one week, one month, 3 months, 6 months and annually thereafter. Later follow up may be telephonic if everything is fine.

Can a living donor donate his liver again?

No. This is a once in a life time event and all donors have done what many ordinary people would not do—undergo a major surgery solely with the altruistic intent of saving the life of a dear one.

Deceased donor liver transplantation

Where does a liver for transplant come from? Where does the liver come from for cadaveric/deceased donor liver transplantation?

The offer for a liver from a deceased donor comes from the family members who are keen that their relative’s organs can save someone else’s life. 

How long does it take to get a new liver? What is the usual time on the waiting list for deceased donor liver transplantation?

It is unpredictable. The current frequency of liver donations in Bangalore is 2/week. The requirement is much higher. Therefore the hard reality is that all patients on the waiting list may not receive a deceased donor liver.

How is a liver allotted to a particular patient?

It has to be blood group matched liver. Allocation process is transparent and as per the guidelines listed by SOTTO. Website jeevasarthakathe.karnataka This process ensures that the sickest and the neediest get the liver which is currently a scarce resource

How much notice will I get before I am called for transplantation?

Generally most tests and preparations will be done before a patient is placed on a waiting list for liver transplantation. You may be called for a liver transplantation at any time of the day or night. It is therefore advisable to make arrangement so that you can reach within 4-6 hours of intimation. 

Recipient operation

1.    What are the overall chances of surviving a liver transplant?/ What is the success rate of liver transplantation?

 Liver transplantation is an established procedure with success rates of over 85-90% at 1 year and 80% at 5 years. Success rates are better in chronic liver disease than acute liver failure and depend on the general condition and fitness of the patient.

2.    What complications are associated with Liver Transplantation?

Liver transplantation is one of the most major procedures performed in medical science. It is associated with a risk to life of around 15-20% and risk of complications in about 30-35% of patients. Complications that can occur are rejection, sepsis, narrowing or leakage of vascular and biliary anastomosis performed, wound complications. Generally these are managed with escalation of care or additional procedures.

3.    How long does the operation take?/ How long would surgery take?

The living donor operation takes around 8 hours while the recipient operation can take around 12-16 hours. The surgical team will give you first-hand information at the end of surgery and let close relatives meet the patient.

4.    What happens in the hospital?/What happens during this recovery period?

Liver transplant recipients will be taken care of in a specially designed ICU with one is to one nursing. After a few days they will be shifted to a ward again equipped with dedicated nursing and treating facilities.

5.    When will I be able to go home?

You will be ready for discharge when liver function has stabilized, you are ambulant, taking diet and able to take reasonable care of yourself. This is expected to happen at around 3 weeks after surgery in a reasonably fit patient.

6.    What is rejection/How is rejection prevented?

Rejection occurs due to the body rejecting the new liver or the liver rejecting the body. The latter is more dangerous and is called graft versus host disease. Acute rejection can occur in one in five patients and is eminently treatable with immunosuppression which usually includes steroids. Chronic rejection is rare (1-2%) and if irreversible may necessitate re-transplantation. It is therefore imperative not to stop any immunosuppression without the doctor’s advice.

7.    Do immunosuppressants have any side effects?

Yes. Immunosuppressants do have side effects. They can affect the kidney, cause weight gain, increase risk to diabetes, hypertension, alter lipid profile among other things. The predispose the individual to infections. However their benefits far outweigh their side effects and the treating team will adjust your medications periodically for optimal effect. 

8.    Do recipients of liver transplant have to take these medicines for the rest of their lives?

Yes with current medical knowledge this is the rule. There are exceptions where operational clinical tolerance is achieved and immunosuppression can be omitted; this is under very select circumstances in a clinical trial setting

9.    What are the other problems that can damage the liver after transplant? How do I take care of my liver after I leave the hospital?

One should not indulge in alcohol. No medications should be taken without informing the liver transplant team. One should lead a healthy life style without gaining weight. Immunosuppression should not be missed and prompt medical attention should be sought for medical problems, seemingly minor infections

10.    What if the transplant doesn't work?

In the very rare event that the transplant does not work, this will be categorized as a Class I emergency and the patient can be listed for a transplantation if the logistics permit.

11.    Can I go back to my daily activities?

Yes by the end of three months most recipients are able to resume normal activities and be employed productively in the long run.

12.    What is the follow up protocol?

It is advisable to make arrangements to reside near the hospital for the first three months after transplantation. This is to facilitate regular follow up and timely care in case of emergencies. One should follow twice weekly in the first two weeks; weekly in the first month, fortnightly in the second month, monthly thereafter with increasing duration of follow up as advised by the treating team.