Title: A guide to Liver transplant - Surgery Procedure, Complication, Risk, Recovery Time and Cost Comparison
1A guide to Liver transplant - Surgery Procedure,
Complication, Risk, Recovery Time and Cost
Comparison
2- A liver transplant is a medical procedure that
replaces a patient's diseased liver with a whole
or partial healthy liver from another person.
This article explains the current indications for
liver transplantation, types of donor livers, the
operation itself, and the immunosuppression that
is required after liver transplantation. - Liver transplant is usually kept as an 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.
3When Is a Liver Transplant Needed?
- A liver transplant is considered when the liver
no longer functions adequately (liver
failure). Liver failure can happen anytime (acute
liver failure) as a result of viral hepatitis,
drug-induced injury or infection. Liver failure
can also be the end result of a long-term
problem. The following conditions may result
in chronic liver failure - Chronic hepatitis with cirrhosis.
- Primary biliary cholangitis (it is a rare
condition where the immune system inappropriately
attacks and destroys the bile ducts) - Sclerosing cholangitis (scarring and narrowing of
the bile ducts inside and outside of the liver,
causing the backup of bile in the liver)
4- Biliary atresia (a rare disease of the liver that
affects newborns) - Alcoholism
- Wilson's disease (a rare inherited disease with
abnormal levels of copper throughout the body,
including the liver) - Hemochromatosis (a common inherited disease where
the body has too much iron) - Alpha-1 antitrypsin deficiency (an abnormal
buildup of alpha-1 antitrypsin protein in the
liver, resulting in cirrhosis)
5- The liver has many jobs to do such as to helping
to digest your food, clearing some wastes from
your blood, making proteins that help your blood
to clot, storing glycogen for energy, breaking
down many poisons and medicines and many more
tasks. When the liver is seriously damaged, there
is no treatment that can help the liver do all of
its jobs. - The most common reason for liver
transplantation in adults is cirrhosis, a disease
in which healthy liver cells are killed and
replaced with scar tissue. The common causes of
cirrhosis are alcohol abuse and hepatitis due to
B and C viruses. The most common reason for
transplantation in children is biliary atresia, a
disease in which the ducts that carry bile out of
the liver are damaged.
6Causes of Chronic Liver Injury
- Viral Hepatitis
- Alcoholic Liver Disease
- Metabolic Liver Disease
- Autoimmune Liver Disease
- Genetic Liver Disease
- Vascular Liver Disease
- Hepatocellular Carcinoma
7- Hepatitis B
- Hepatitis B infection accounts for 5 of all
liver transplants performed in the United States
but accounts for a larger proportion of liver
transplants in other parts of the world,
especially Asia and Australia / New Zealand. - Hepatitis C
- Hepatitis C is the most common indication for
liver transplantation in the United States,
affecting nearly 50 of all liver transplant
recipients.
8- Alcoholic Liver Disease.
- Liver failure due to alcohol abuse is the second
most common indication for liver transplantation.
Most centers require at least a six-month period
of abstinence, often within a recognized
substance abuse program such as Alcoholics
Anonymous, as a condition of listing for liver
transplantation. - Metabolic Liver Disease
- Non-alcoholic steatohepatitis (NASH) Deposition
of fat within liver cells may result in
inflammation that injures and scars the liver.
Risk factors for the development of fatty liver
and NASH include obesity and metabolic conditions
such as diabetes and hyperlipidemia (increased
cholesterol). The percentage of patients being
transplanted for this condition has increased 35
fold from 2000 to 2005.
9Hepatocellular Carcinoma
- Hepatocellular carcinoma (HCC) is a primary
cancer of the liver, meaning that it originates
from abnormal liver cells. Hepatocellular
carcinoma (HCC) occurs only rarely in a normal,
non-cirrhotic liver. Its incidence is, however,
strikingly increased in the background of
cirrhosis and, in particular, by certain types of
liver disease that lead to cirrhosis (hepatitis B
and C, hemachromatosis, and tyrosinemia).
Although cancer first starts within the liver, as
it grows it can spread to other organs, a process
called metastasis. Hepatocellular carcinoma (HCC)
most frequently spreads to the lungs or to bones.
10How are candidates for Liver Transplant selected?
- Specialists from various fields are needed to
determine if a liver transplant is appropriate.
Many healthcare facilities assemble a team of
such specialists to evaluate and choose
candidates for a liver transplant. The team may
include the following professionals - Liver specialist (hepatologist)
- Transplant surgeons
- Transplant coordinator or usually a registered
nurse who specializes in the care of liver
transplant patients - Social worker to discuss your support network of
family and friends, employment history, and
financial needs - Psychiatrist to help you deal with issues, such
as anxiety and depression, which may accompany a
liver transplant - Anesthesiologist to discuss potential anesthesia
risks - Chemical dependency specialist to aid those with
history of alcohol or drug abuse
11Which Tests are required before getting a Liver
Transplant?
- You will need to bring all previous doctor
records, X-rays, liver biopsy slides, and a
record of medications to your pre-evaluation for
a liver transplant. Some or all of the following
studies are generally performed during an
evaluation. - Computed tomography, or CT, which uses X-rays and
a computer to create pictures of the liver,
showing its size and shape to rule out
hepatocellular carcinoma. CTs and chest x-rays
will also be taken to evaluate your heart and
lungs. - Doppler ultrasound to determine if the blood
vessels to and from the liver are open. - Echocardiogram to help check the heart function.
- Pulmonary function studies to determine the
lungs' ability to exchange oxygen and carbon
dioxide - Blood tests to determine blood type, clotting
ability, and biochemical status of blood, and to
gauge liver function. HIV, other viral testing
and hepatitis screening are also included.
12Where does a Liver for a Transplant Come From?
- There are two types of liver transplant
options living donor transplant and deceased
donor transplant. - Living donor
- Living donor liver transplants are an alternative
for some patients with the end-stage liver
disease. This involves removing a segment of
liver from a healthy living donor and implanting
it into a recipient. Both the donor and recipient
liver segments will grow to normal size in a few
weeks. - The donor, who may be a blood relative, spouse,
friend or even unrelated "Good Samaritan," will
have extensive medical and psychological
evaluations to ensure the lowest possible risk.
Blood type and body size are critical factors in
determining who is an appropriate donor. ABO
blood type compatibility is preferable as well as
donors less than 60 years of age.
13- Deceased Donor
- In deceased donor liver transplants, the donor
may be a victim of an accident or head injury.
The donor's heart is still beating, but the brain
has stopped functioning. Such a person is
considered legally dead, because his or her brain
has permanently and irreversibly stopped working.
At this point, the donor is usually in an
intensive-care unit and life support is withdrawn
in the operating room during the transplant. - The identity of a deceased donor and
circumstances surrounding the person's death are
kept confidential.
14The Liver Transplant Operation
- A liver transplant involves the removal of and
preparation of the donor liver, removal of the
diseased liver, and implantation of the new
organ. The liver has several key connections that
must be re-established for the new organ to
receive blood flow and to drain bile from the
liver. The structures that must be reconnected
are the inferior vena cava, the portal vein, the
hepatic artery, and the bile duct. The exact
method of connecting these structures varies
depending on specific donor and anatomy or
recipient anatomic issues and, in some cases, the
recipient disease.
15Types of Liver Transplant Procedure
- Orthotopic Liver Transplantation.
- Heterotopic Liver Transplantation.
- Reduced size Liver Transplantation.
- In Orthotopic Liver Transplantation, the
recipient's diseased liver is completely replaced
with the healthy liver. - In Heterotopic Liver Transplantation, the
diseased liver is kept remain intact at its place
and donor's liver is placed at the nearest site
to the diseased liver. Heterotopic Liver
Transplantation is done when the doctor is of the
opinion that the diseased liver might recover, if
the liver recovers, the other organ shrivels
away, if not, then the original one shrivels and
the donor's liver performs the body functions.
16- Reduced Size Liver Transplantation is done on
children and involves the transplanting a part of
the healthy donor liver into a patient. Reduced
Size Liver Transplantation is performed when
15-20 of the original liver is intact. This way,
one donor liver can be used for two successful
transplants.
17What complications are associated with Liver
Transplant?
- Rejection.
- Infection.
- Recurrent Disease.
- Post-Transplant Lymphoprolipherative Disorder
(PTLD).
18Best hospitals in India for liver transplant are
- Medanta- The Medicity, Gurgaon
- Fortis Escorts, New Delhi
- Apollo Hospital, Bangalore
- Kokilaben Dhirubhai Ambani Hospital, Mumbai
- Jaypee Hospital, Noida
- BLK Hospital, Delhi
- Global Hospital, Delhi
- Artemis Health and Research Institute, Gurgaon
- Dr. L. H. Hiranandani Hospital, Mumbai
- Breach Candy Hospital, Mumbai
19- Lilavati Hospital, Mumbai
- Sir Ganga Ram Hospital, Delhi
- KEM Hospital, Maharashtra
- Sri Ramachandra Medical Center, Chennai
- Aster MIMS, Calicut
- Continental Hospitals, Hyderabad
- Apollo Chennai, Chennai
- Yashoda Hospitals, Malakpet, Hyderabad
- Jaslok Hospital, Mumbai
- KIMS Hyderabad
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