Liver Transplant in India

A liver transplant is a surgery during which a diseased liver which has stopped functioning properly is replaced with a healthy liver, either from a living donor or a deceased donor.
The liver is one of the most vital organs of the body, whose primary functions include the elimination of toxins, protein synthesis, blood sugar regulation, fat metabolism etc. During the detoxification of the body from harmful agents like drugs, alcohol etc, the liver is subject to constant abuse. Due to an overload of toxins or certain diseases, the liver may stop functioning in the optimal level necessary to maintain a healthy body.
Treatment for liver failure or end-stage chronic liver disease is a liver transplant. Similarly, liver cancer or Hepatocellular carcinoma treatment also relies on liver transplant as a last resort.

The outcomes for liver transplants are excellent, and young recipients can go on to live a healthy normal life for about 25-30 years after the operation. The initial three months after the surgery are the hardest, since the body is getting used to the new liver and there will be some amount of pain and discomfort associated with it. Medications will be prescribed by the doctor to help heal the wound and for pain management. Once the patient has recovered, they can go about their normal life as before with very less restrictions. Getting back to work, indulging in sports activities, travelling, driving and entertaining are all possible with 4-6 months from the surgery.

Certain lifestyle adjustments that are required after the surgery:

·       Avoiding alcohol and other toxins, as much as possible

·       Avoiding contact or inhalation of toxic fumes such paint fumes, pesticides and insecticides

·       Maintain a healthy weight through proper intake of healthy food

·       Avoid drinking water from contaminated sources

·       Avoid people who are suffering from, or recently suffered from contagious diseases

In liver transplant surgery, a portion of a healthy liver from a living donor (live donor transplant) or a liver harvested from brain dead or just dead person (cadaver transplant) is transplanted into the recipient after the removal of the diseased liver. Once transplanted, the new liver will start functioning and carries out all the duties of a healthy liver. 
Although liver transplants come with its own share of significant risks, the success rate for it is quite high. 

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the survival ratesfor a liver transplant are:

·       86 percent at 1 year

·       78 percent at 3 years

·       72 percent at 5 years

The 20-year survival rate is about 53 percent.

The risks involved with a liver transplant surgery are:

·       Rejection of the liver

·       Failure of the new liver

·       Infections 

·       Bleeding

·       Side effects of medications

Our body’s immune system is constantly trying to protect our body from foreign objects and tissues. By detecting the antigens which coat these harmful substances, our immune system recognizes them as foreign objects and work towards destroying them. Similarly, when a new liver is placed inside our body, our immune system detects it as a foreign body and tries to destroy it. This process of the recipients immune system trying to attack and destroy the transplanted organ is known as rejection.
One of the reasons, why doctors try to match the livers between the donor and the recipient as much as possible – the more similar the antigens between the two livers, the lesser the chance that the liver will be rejected.

There are three types of rejections:

·       Hyperacute rejection, which occurs within minutes of the transplant. This could be due to various reasons, common one being a mismatch of blood group, between the donor and the recipient. For such a rejection, the liver needs to be removed immediately or the patient may die.

·       Acute rejection, which can occur anytime from the time of surgery up-to three months. Acute rejection can be treated, and it does not mean that the recipient will lose the liver. However, it is very important that this be detected early.      

·       Chronic rejection, which can take place over years. The body’s continuous effort at destroying the transplanted liver can cause a lot of permanent damage, over the years. Chronic rejection is much more difficult to treat, and the liver may eventually lose its function.

Symptoms of rejection:

·       Fever

·       Discomfort, uneasiness

·       Dark urine

·       Jaundice – the skin and the white of the eyes become yellow

·       Flu-like symptoms

·       Pain and swelling in the abdomen

Steps to follow to decrease the chance of a rejection or infection:

Dos:

·       Strictly keep up your follow-up appointments. This will be twice or thrice a week initially, then taper down to once a week, once in two weeks, once a month, once in few months, once a year etc. 

·       Never ever forget to take the medicines especially immunosuppressant, on time, for the rest of your life

·       Inform your doctor about any after-effects of the surgery or side effects of medicines like headaches, mood changes, tremors etc. 

·       Undertake an exercise regimen as advised by the doctor.

·       Always stick to the prescribed diet

Don’ts:

·       Never take alcohol, even if the condition that warranted the transplant was not alcohol related.

·       Don’t expose yourself to situations where it is easy to pick up infections

·       Never neglect even a small sign of infection starting from a mild skin infection.

Liver transplant surgery is a major surgery and involves two surgeries – the surgery to remove the liver from the donor and the transplant surgery on the recipient.

Liver transplant surgery, on an average, would cost between 30,000 to 40,000 USD in India. This cost includes that of donor surgery, recipient surgery, medications and hospital stay. 

The factors which can influence this pricing are:

·       The type of procedure required such as TIPS, TACE etc.

·       The duration of the stay in the hospital

·       The type of room selected – shared or private or deluxe

·       The hospital selected

·       The city where the surgery will take place – this will influence the additional costs such as airfare, stay for the recipient’s travelling partner(s) etc.

Liver transplant is carried out in people who suffers from liver failure and whose condition cannot be managed any longer with medications. This type of liver failure can be acute (liver failure that occurs quickly) or chronic (liver failure that happens over a long period of time, due to constant abuse), with liver transplants usually being used for chronic failures. Liver transplant is also used to treat certain cancers of the liver.

Liver failure can occur due to the following reasons:

·       Cirrhosis

·       Autoimmune disease

·       Hepatitis

·       Metabolic diseases

·       Intrahepatic Cholestasis

·       Obstructive Biliary Tract Liver Disease

·       Alcohol abuse

·       Genetic liver diseases

·       Vascular liver diseases

·       Hepatocellular Carcinoma

Take care of your liver:

·       Drink alcohol moderately, if at all

·       Exercise regularly and eat a healthy diet

·       Avoid contact with unknown people’s body fluids, which can spread hepatitis

·       Maintain a healthy weight

·       Do not share razors, toothbrushes, or needles

·       Try not to come in contact with harmful and toxic fumes, or expose your skin to them

·       Limit usage of painkillers

Food for a Healthy Liver:

·       Oats

·       Almonds

·       Spinach

·       Yoghurt

·       Broccoli

·       Coffee

·       Green Tea

·       Blueberries

·       Lots of water

During a liver transplant a diseased liver is replaced with a healthy liver. This healthy liver can come either from a living donor or a cadaver(deceased) donor. 
Our liver is the only organ that can regenerate lost or wounded tissue; hence the recipients do not need a full liver transplant at all. Only a small part of the liver (around 10-15%) is harvested from the donor during the transplant procedure. A healthy living donor can actually donate up to 60% of their liver without any side effects. 

In the case of the donor, the lost portion of the liver will be regenerated within a period of 2-3 months. For the recipient, the transplanted portion will grow to its normal size within a period of 6 months. However, since normal functions of the body can be carried out even with a liver that is around 20% of the original size, the benefits of liver transplant will be evident within 2-3 weeks after the surgery