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Liver Transplant Treatment in India

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A liver transplant is a surgical procedure that removes a liver that no longer functions properly (liver failure) and replaces it with a healthy liver from a living or deceased donor.

Your liver is your largest internal organ and performs several critical functions like Removing bacteria and toxins from the blood, Preventing infection and regulating immune responses, Processing nutrients, medications and hormones, Producing bile, which helps the body absorb fats, cholesterol and fat-soluble vitamins, Making proteins that help the blood clot, Liver transplant is usually reserved as a treatment option for people who have significant complications due to end-stage chronic liver disease. In rare cases, sudden failure of a previously normal liver may occur.

The human liver regenerates and returns to its normal size shortly after surgical removal of part of the organ. This makes living-donor liver transplant an alternative to waiting for a deceased-donor liver to become available.

How It Works

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  • Digestive care, Gastric SleeveLiver Transplant ,MBBS, MS, MRCS (Ed.), DNB, 20 Years
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  • Hematology, Liver TransplantProstate Cancer Chairman, MBBS, MS, FRCS, FRCS, 30 years of experience
  • Hematology, Liver Transplant Chief, MBBS, MS, FRCS, 31 years of experience

Liver transplantation  is the replacement of a diseased liver with the healthy liver . It is essential when damage to liver is  severe leading to liver failure .The liver is the second most commonly transplanted major organ after Kidney .

The liver is located on the right side in the abdomen  , performs  many vital functions like

  • Producing  Glucose, Proteins, Blood-clotting factors, Bile,
  • The liver also acts as a storehouse of  vitamins and minerals.
  • It also acts as a filter, removing impurities and metabolizes and detoxifies substances ingested by the body.
Types of Liver Transplants

1. Deceased donor transplants

Most livers for transplants come from people who have just died, called deceased donors. Adults typically receive the entire liver from a deceased donor. Sometimes a donated liver may be used for two different  recipients. The larger part may go to an adult, and the smaller part may go to a child.

 

2. Living donor transplants

When  a healthy living person  donates  part of his or her liver, most often to a family member it  is called a living donor. During a living donor transplant, surgeons remove a part of the living donor’s healthy liver.

Signs of liver disease
  • Yellowing of the skin or eyes known as Jaundice,
  • Itching of skin
  • Dark colored urine clay-colored bowel movements
  • Ascites  i.e collection of  fluid in abdomen
  • Bleeding tendency
  • Mental confusion, forgetfulness
Diagnosis for Liver Transplant

Liver failure is the reason for liver  transplant , however it could be acute onset  i.e acute  or chronic liver failure

Acute liver failure– sudden onset liver failure  could  be due to

  • viral hepatitis,
  • drug-induced due to some  reaction to pain killers , or prescription medication , herbal medicines
  • injury / clots in vessel supplying blood to liver
  • infection.

Chronic  Liver failure–  can also be the end result of a long-term problem

  • Alcoholic liver disease
  • Cancer
  • Cirrhosis , fatty liver disease
  • Biliary atresia common reason in children
  • Auto immune , genetic disorders
Tests for liver transplant
  • CT scan of the abdomen:  to determine the liver size and to identify any abnormalities, including liver tumors.
  • Ultrasound of the liver:  study of liver and the surrounding organs. Doppler ultrasound  determines how well the blood vessels that carry blood to and from the liver are working
  • Blood tests: These include liver function  tests , clotting factors , routine blood tests and culture.
Procedure of liver transplant
Before Procedure

Presurgical studies, including blood tests, urine tests, chest X-rays ultrasound ,CT abdomen , ECG  etc, are performed, these  tests are done to evaluate the severity of the liver disease ,Once this is complete patient is accepted as candidate for liver transplant and put on Wait list for transplant

Pre transplant tests are performed ,  The testing makes sure the donor liver has good chance of working in body

  • Liver is healthy,
  • Matches your blood type
  • Right size

Donor livers function best if they are transplanted within 8 hours, although they can be used for up to 24 hours. Before surgery the patient also receives a dose of steroids to prevent rejection of the new liver-and a dose of antibiotics to prevent infection.

Procedure

Transplant process takes approximately 6-8 hours & is performed under a general anaesthesia.

  • Incision is made in the upper part of the abdomen.
  • Segregation of important structures (the inferior vena cava above, behind, and below the liver, the portal vein, the common bile duct, the hepatic artery)
  • Removal of the natural, diseased liver.
  • Placement of the new & healthy liver, which is then reconnected to the bile ducts and blood vessels. Blood will now flow into this new liver.
  • Adequate control of bleeding is established.
  • Finally closure of the incision
  • The liver begins to regenerate itself almost immediately.
After the procedure:

After the transplant is complete patient is moved to an intensive care unit (ICU).

A machine called a ventilator  assists the patients breathing, and a tube is inserted through the nose and into the stomach to provide the patient with fluid and nutrients.

Antibiotics are prescribed after procedure to protect against infections.

Transplant patient  with a new liver must take medications for the rest of his life to avoid Rejection syndrome .

Regular follow ups are important for successful transplantation initially weekly  and  gradually reducing the frequency of testing to ascertain how well the Liver is functioning and early detection of rejection episode .

Complications of Liver Transplant 
  • Rejection syndrome , the body’s immune system attempts to destroy the newly transplanted liver. Immunosuppressive  medications are  used to prevent rejection of the transplanted liver but these medications  have a general weakening effect on the immune system. This is why transplant patients are more likely to get certain infections.
  • Bleeding after surgery, formation of clots
  • Infection – fever
  • Jaundice  indicating  that bile is backing up and not draining from the liver properly.
  • Side effects of immunosuppressant medicines like bone thinning osteoporosis and bone damage (osteonecrosis ),increased risk of infections esp skin cancer , oedema and weight gain .
Factors Affecting Cost Of liver Transplant

The cost to the patient depends on a variety of factors like

  • The hospital, the patient chooses.
  • Room –Standard single room, deluxe room, super deluxe room for the number of nights specified (including nursing fee, meals, room rate, and room service).
  • Fee for the team of doctors and OT charges
  • cost of  medications
  • Standard tests and diagnostic procedures.
  • Cost of the follow –up care and immunosuppressive medications required after the procedure

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