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Liver Transplantation

 

WHO NEEDS A LIVER TRANSPLANT?

In adults, the most common reason for needing a liver transplant is cirrhosis. Cirrhosis can be caused by many different types of diseases that destroy healthy liver cells and replace them with scar tissue. Generally speaking, any patient suffering from liver cirrhosis who is estimated to have a life expectancy of less than a year or so is a candidate for a liver transplant. The severity of liver disease is graded from A to C on the basis of Child’s scoring or calculated according to a newly devised formula known as the MELD (Model for End-stage Liver Disease) score. Usually all grade C and most grade B patients are candidates for transplant. In simple words, if the liver fails due to advanced cirrhosis or acute liver failure, liver transplantation is indicated. Some of the common identifiable symptoms of advanced cirrhosis or liver failure are mentioned below. Initially these symptoms can be controlled with medical or endoscopic therapy but occurrence of these complications clearly indicates limited reserve in the liver and one should start planning for liver transplantation at this time.

Indications for Liver Transplant

Acute/Fulminant liver failure:

  • Seronegative hepatitis (sporadic non A non B hepatitis)
  • Drugs (paracetamol, isoniazid)
  • Viral (hepatitis B)
  • Metabolic (neonatal haemochromatosis, Wilson’s disease)

 Chronic Liver disease:

  • Viral hepatitis B,C
  • Autoimmune hepatitis
  • Cholestatic disorders (Primary Sclerosing Cirrhosis, Primary Biliary Cirrhosis,

Extrahepatic biliary atresia)

  • Alcoholic liver disease (ALD)
  • Budd-Chiari syndrome, veno-occlusive disease
  • Non alcoholic steatohepatitis (NASH)
  • Cryptogenic cirrhosis

Malignancy:

  • Hepatocellular Carcinoma
  • Primary Neuro-endocrine tumour

Metabolic disorders:

  • Wilson’s disease
  • Hemochromatosis
  • alpha-1 antitrypsin deficiency
  • Primary Oxalosis, Familial Amyloid polyneuropathy
  • Crigler – Najjar syndrome Type I

Miscellaneous:

  • Polycystic liver disease

Success rate of Liver Transplantation

Dr Naimish Mehta  is experienced in living donor liver transplantation and is successfully running a liver transplant programme in one of the tertiary referral centre in India. Several national and international patients have undergone LDLT with a success rate of 93% survival. We have the lowest reported rate of biliary complications (5%) as compared to other liver transplant centres in the world. Results in liver cancer are equally good at 85% survival.

Performance

The Liver Transplant unit is one of the foremost state-of-the art facilities of its type in the Indian subcontinent. It provides a world-class service in cadaveric and living related liver transplantation with advanced infrastructure and experienced multidisciplinary team to support all aspects of the speciality. Our key strengths are internationally recognized faculty members who have been previously trained and have worked in the best centres abroad, operating rooms conforming to international standards and a dedicated Liver ICU which is second to none.

Infrastructure (photographs): Hosp, CT scan dept, ICU, Operation theatres, Blood Bank, Nephrology (dialysis), Cardiology, Physiotherapy

Advances/Scope in LT:

Increasing numbers of patients waiting for liver transplantation and high pre-transplant mortality rates have led to adoption of numerous technically variations.Domino liver transplantation: It is a sequential transplant in which a patientwith a suitable metabolic disorder like familial amyloid polyneuropathy or Maple Syrup Urinary disease(MSUD) is grafted with a new liverto halt progressionand palliate associated symptoms. The otherwise normal liveris used for selected recipients with end stage liver disease.

Dual Lobe Grafts: If there is a mismatch between donor weight and recipient weight, leading to low graft to recipient weight ratio, this can be overcome by taking grafts from two donors and transplanting into one recipient. Technically it is a complex procedure involving three operation theatres, several team members working in conjunction. At Sir Ganga Ram Hospital (SGRH) we have performed two Dual lobe transplants.

Simultaneous Liver- Kidney Transplant: This is performed in patients with end stage renal disease in addition to end stage liver disease. Simultaneous transplants rarely reported in living donor situation. We have performed 8 simultaneous liver and kidney transplants using different donors for each organ at SGRH.

Paired Donor Exchange (Swap): In cases where donor cannot donate because of size or blood group mismatch. Two such complementary donor recipient pairs can exchange donors to make both transplants possible. Although reported in kidney transplantation, this has not been previously reported in living donor liver transplantation. At SGRH, 4 paired donor exchange transplants has been performed.

 

Liver Transplant2

Twenty six years in Cardiac Surgery provided him an opportunity to amass rich and varied experience of more than nine thousand cases across a wide spectrum of varieties and complexities. As Head of Department of Cardiac Surgery at Batra hospital he had to perform both as administrative leader and clinical mentor; sharing knowledge, and honing the skills of future cardiac surgeons. Several cardiac surgeons trained under his aegis and are presently heading units at various premier centers. Heading a dept. of nearly 75 medics and paramedics developed a different management perspective.

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Liver Transplant3

Twenty six years in Cardiac Surgery provided him an opportunity to amass rich and varied experience of more than nine thousand cases across a wide spectrum of varieties and complexities. As Head of Department of Cardiac Surgery at Batra hospital he had to perform both as administrative leader and clinical mentor; sharing knowledge, and honing the skills of future cardiac surgeons. Several cardiac surgeons trained under his aegis and are presently heading units at various premier centers. Heading a dept. of nearly 75 medics and paramedics developed a different management perspective.

Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nost rud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proidentsunt in culpa qui officia deserunt mollit anim id est laborum. Lorem ipsum dolor sit amet, conse

Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nost rud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proidentsunt in culpa qui officia deserunt mollit anim id est laborum. Lorem ipsum dolor sit amet, conse

Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nost rud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proidentsunt in culpa qui officia deserunt mollit anim id est laborum. Lorem ipsum dolor sit amet, conse

Liver Transplant4

Twenty six years in Cardiac Surgery provided him an opportunity to amass rich and varied experience of more than nine thousand cases across a wide spectrum of varieties and complexities. As Head of Department of Cardiac Surgery at Batra hospital he had to perform both as administrative leader and clinical mentor; sharing knowledge, and honing the skills of future cardiac surgeons. Several cardiac surgeons trained under his aegis and are presently heading units at various premier centers. Heading a dept. of nearly 75 medics and paramedics developed a different management perspective.

Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nost rud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proidentsunt in culpa qui officia deserunt mollit anim id est laborum. Lorem ipsum dolor sit amet, conse

Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nost rud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proidentsunt in culpa qui officia deserunt mollit anim id est laborum. Lorem ipsum dolor sit amet, conse

Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nost rud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proidentsunt in culpa qui officia deserunt mollit anim id est laborum. Lorem ipsum dolor sit amet, conse

Liver Transplant5

Twenty six years in Cardiac Surgery provided him an opportunity to amass rich and varied experience of more than nine thousand cases across a wide spectrum of varieties and complexities. As Head of Department of Cardiac Surgery at Batra hospital he had to perform both as administrative leader and clinical mentor; sharing knowledge, and honing the skills of future cardiac surgeons. Several cardiac surgeons trained under his aegis and are presently heading units at various premier centers. Heading a dept. of nearly 75 medics and paramedics developed a different management perspective.

Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nost rud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proidentsunt in culpa qui officia deserunt mollit anim id est laborum. Lorem ipsum dolor sit amet, conse

Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nost rud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proidentsunt in culpa qui officia deserunt mollit anim id est laborum. Lorem ipsum dolor sit amet, conse

Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nost rud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proidentsunt in culpa qui officia deserunt mollit anim id est laborum. Lorem ipsum dolor sit amet, conse