Liver Transplant

The liver is the body’s largest organ. It is located on the upper right side of the abdomen, under the diaphragm, and to the right of the stomach. It is a dark reddish-brown organ that normally weighs about 3 pounds (1.4 kg). It holds about 13 percent of the body’s blood supply at any given moment.

The liver carries out many important functions, such as:

• Making bile, a substance needed to digest food.
• Producing certain proteins for blood plasma that aid in clotting, oxygen transport, and immune system function.
• Helping the body store sugar (glucose) in the form of glycogen.
• Breaking down saturated fat and producing cholesterol.
• Detoxifying the blood of drugs and other harmful substances.

A liver transplant is a surgical procedure performed to replace a diseased liver with a healthy liver from another person. If you want to get a liver transplant at Manipal, you have to ensure that the donor is a family member, because this is one of the prerequisites here.
An entire liver may be transplanted, or just a section. Because the liver is the only organ in the body able to regenerate, a transplanted portion of a liver can rebuild normal capacity within weeks.

Liver Transplant Cost in India

We have different liver transplant cost in India based on the patient condition. To get more details on our liver transplant package, you may make an appointment or contact us at mipc@manipalhospitals.com

Local Legal Requirement

No donor will donate his or her liver without clearing the legal formalities formulated by the Government of India. The donor has to be a blood relative of the recipient. The donor is required to present the legal documents for the same. All the test results need to be submitted before the liver transplantation takes place. The patients should also sign a brain death and declaration agreement in the presence of the donor.

Here are the documents needed (all in originals) for the patient to get a go ahead with the transplantation:

• Donor identification letter from the High Court of the country of residence.
• Recipient identification letter from the High Court of the country of residence.
• Age declaration of a donor from the High Court of the country of residence.
• Age declaration of a recipient from the High Court of the country of residence.
• Relationship proof of the donor and recipient from the High Court of the country of residence.
• Referral letter from treating hospital of the country of residence stating that the patient is referred to Manipal Hospital, Bangalore for the renal transplant.
• Consent of donor regarding no objection of donating the liver from the High Court of the country of residence.
• Family photo preferably with all members of the family (including the donor and recipient).
• Family tree document by the issuing authority in the country of residence.
• 30 passport size photographs of the donor, recipient and 2 other family members traveling with them.

Other formalities will be taken care of in Bengaluru, coordinated by The International Patient Care team at Manipal Hospital, Bengaluru.

Reasons for the procedure

A liver transplant is usually recommended when the liver has been damaged to the point that it cannot perform its normal functions, also known as an end-stage liver disease (ESLD). ESLD is a serious, life-threatening liver dysfunction, which may result from various conditions of the liver.

Some diseases that may progress to ESLD include, but are not limited to, the following:

• Liver Cirrhosis – Cirrhosis is a long-term disease in which healthy liver tissue is replaced with scar tissue, eventually preventing the liver from removing toxins and poisonous substances.
• Hepatitis – Blood-borne viruses, including hepatitis B and hepatitis C, which can sometimes cause extensive liver damage.
• Biliary atresia – A condition in which the bile ducts are absent or have developed abnormally.
• Primary biliary cirrhosis – a long-term liver disease in which the bile ducts in the liver become damaged.
• Alcohol-related liver disease – where the liver becomes scarred because of years of persistent alcohol misuse.
• Liver cancers – These are primary tumors (that start in the liver) that have not spread outside the liver.

There may be other reasons for your doctor to recommend a liver transplant.
A liver transplant may NOT be done if you have other chronic illness, such as certain infections, heart, lung, or liver disease, metastatic cancer or other life-threatening diseases, noncompliance with the treatment regimen, or alcohol consumption.

Risks of the procedure

As with any surgery, complications can occur. Some complications from liver transplantation may include, but are not limited to, the following:

• Bleeding.
• Blood clots.
• Infection.
• Blockage of the blood vessels to the new liver.
• Leakage of bile or blockage of bile ducts.
• Initial lack of function of the new liver.
• Memory and thinking problems.
• Rejection of the new liver – The new liver may not function for a brief time after the transplant. The new liver may also be rejected. Rejection is a normal reaction of the body to a foreign object or tissue. When a new liver is transplanted into a recipient’s body, the immune system reacts to what it perceives as a threat and attacks the new organ, not realizing that the transplanted liver is beneficial. To allow the organ to survive in a new body, medications must be taken to trick the immune system into accepting the transplant and not attacking it as a foreign object.

The medications used to prevent or treat rejection can cause a variety of side effects which can be explained by your doctor in detail before the procedure.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before the procedure

If you have a chronic liver failure, you may be referred to a transplant center by your doctor. The transplant center team will conduct a number of tests and procedures to determine whether you are eligible to undergo a transplant. The same tests are conducted on the living donor (at Manipal, it has to be your family member). The potential donor must have a compatible blood type and be in good health. Since a living family member (living-related transplant) is donating you their liver, the transplant may be performed at a planned time.

Tests, procedures, and consultations you may undergo include:

• Psychological and social assessment – Psychological and social evaluation is done to determine whether you fully understand the risks of a liver transplant. Factors involved in liver transplantation, such as stress, financial issues, and support system, are assessed. These issues can significantly impact the outcome of a transplant.
• Laboratory tests – Blood and urine tests are carried out to help find a good donor match and to help improve the chances that the donor organ will not be rejected.
• Diagnostic tests – Diagnostic tests are conducted to assess your overall health especially your liver. These tests may include X-rays, ultrasounds, liver biopsy, heart tests, and dental examinations. Women may receive a Pap test, gynecology evaluation, and a mammogram.

The transplant team will factor in all information from interviews, your medical history, physical examination, and diagnostic tests in determining your eligibility for liver transplantation.

The following steps will precede the transplant:

• Your doctor will explain the procedure to you and offer you the opportunity to ask any questions about the procedure.
• You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully and ask questions if something is not clear.
• For a planned living transplant, you should fast for eight hours before the surgery. In the case of a cadaver organ transplant, you should begin to fast once you are notified that a liver has become available.
• You may receive a sedative prior to the procedure to help you relax.

Based on your medical condition, your doctor may request other specific preparation.

During the procedure

Liver transplantation requires a stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.
Generally, a liver transplant follows this process:

• You will be asked to remove your clothing and given a gown to wear.
• An intravenous (IV) line will be started in your arm or hand. Additional catheters will be inserted to monitor the status of your heart and blood pressure, and for obtaining blood samples.
• You will be positioned on the operating table, lying on your back.
• If there is excessive hair at the surgical site, it may be clipped off.
• A catheter will be inserted into your bladder.
• Liver transplant surgery is done using general anesthesia, so you’ll be unaware during the procedure. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
• The skin over the surgical site will be cleansed with an antiseptic solution.
• The doctor will make a long incision just under the ribs to access your liver. The location and size of your incision vary according to your doctor’s approach and your own anatomy.
• The doctor will carefully separate the diseased liver from the surrounding organs and structures; disconnect your liver’s blood supply and the bile ducts, and then remove the diseased liver.
• Depending on several factors, including the type of transplant being performed (whole liver in case of cadaver organ versus a portion of liver in case of a living donor), different surgical techniques may be used to remove the diseased liver and implant the donor’s liver.
• The doctor will visually inspect the donor liver or portion of liver prior to implanting it.
• The donor liver will be attached to the blood vessels. Blood flow to the new liver will be established and then checked for bleeding at the suture lines.
• The new liver will be connected to the bile ducts.
• The incision will be closed with stitches or surgical staples.
• A drain may be placed in the incision site to reduce swelling.
• A sterile bandage or dressing will be applied.

The transplanted liver portion in your body and the portion left behind in the donor’s body regenerate rapidly.
Surgery can take up to 12 hours, depending on your situation.

After the procedure

After the surgery, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you may be taken to the intensive care unit (ICU) where you will be closely monitored for several days. Liver transplant surgery requires an in-hospital stay of 7-14 days or longer. Upon recovery, you will be discharged from the hospital.
You will most likely have a breathing tube inserted through your throat and put on a ventilator until you are stable enough to breathe on your own. A thin plastic tube may be inserted through your nose into your stomach to remove air that you swallow. You will not be able to eat or drink until the tube is removed, which will be done once your bowels resume normal function.
While you are recuperating, blood samples will be taken frequently to monitor the status of the new liver, and the condition your heart, kidneys, lungs, and blood system. You may be put on special IV drips to maintain normal blood pressure and heart function. As your condition stabilizes, these drips will be gradually reduced.
Once the breathing and stomach tubes have been removed depending on your condition, you may be given a liquid diet, which may be gradually replaced by more solid foods as tolerated.
You will be prescribed drugs called immunosuppressants help keep your immune system from attacking your new liver. Additional drugs help reduce the risk of other complications, such as infection, after your transplant. Your medications will be closely monitored to ensure
You should get out of bed and move around several times a day as per the doctor’s advice. You will be given pain-relieving medication for soreness around the surgical site. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
Nurses, pharmacists, dieticians, physical therapists, and other members of the transplant team will teach you how to take care of yourself once you are discharged from the hospital. However, follow-ups visits the liver transplant department will be required. The transplant team will develop a checkup schedule for you.

Aftercare at home

Once you are home, it will be important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up office visit if they were not removed before leaving the hospital.
You should not drive until your doctor tells you to. Other activity restrictions may apply.

Inform your doctor if you experience the following symptoms, which may indicate rejection or infection:

• Fever.
• Pain or discomfort, such as swelling, tenderness, redness or bleeding, at the incision site.
• Vomiting and/or diarrhea.

Consult your transplant team with any concerns you have. Frequent visits to and contact with the transplant team are essential.

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

Recovery

Recovering from a liver transplant can be a long, slow process, but most people will eventually be able to return to most of their normal activities and have a good quality of life.
It can take up to a year to fully recover, although you’ll normally be able to start gradually building up your activities after a few weeks.

You’ll have regular follow-up appointments to monitor your progress after a liver transplant. These will be frequent at first – usually once a week for the first 4-6 weeks – but may eventually only be necessary once every few months, or even once a year.

During these appointments, you will have tests to assess your liver and kidney function and to check the level of immunosuppressant medication in your blood.

Most people will need to have a normal, healthy diet after a liver transplant. Check with a dietician if you need advice on your diet. You should avoid driving for up to two months because the transplant procedure and immunosuppressant medication can affect your vision, reaction times and ability to perform emergency stops. Speak to your doctor first if you feel ready to drive again.

Exercises, such as walking, are recommended. However, contact sports and swimming should be avoided for several months until you have fully recovered, as there is a risk of picking up an injury or infection.

How long you need to be off work will depend on your job and how quickly you recover. Some people will be able to return to work after three months, although others may need more time off. Your care team can advise you on this.

Remember that you will need to continue taking your immunosuppressant medications after returning to your normal activities, as there is a risk that your body will reject the new liver if you stop taking them.