Liver Transplant

The Department of Liver Transplantation at Sir Ganga Ram Hospital was established in 1999 and has since become renowned as a state-of-the-art center in the country. The department is committed to excellence in advanced techniques, state-of-the-art facilities, and outstanding patient care.

A WORD ABOUT LIVER

The Liver is a vital organ located on the right upper side of our stomach (abdomen), directly behind the right rib cage. Our Liver is covered by a few lower ribs on the right side. It is formed like a cone; others describe it as an elegant hat. It weighs between 1kg and 1.5kg, depending on the individual's size. It has two lobes: right and left. The primary liver cell is known as a hepatocyte.

The Liver is the only organ with a twofold blood supply.

• The hepatic artery feeds oxygen to the organ.
• Portal blood flow offers nourishment and absorbed products from the gut.

Portal blood is vital for filtering and absorption. In individuals with cirrhosis, the pressure in the portal system rises, resulting in hypertension.

Hepatic veins carry blood away from the Liver. There are three central hepatic veins. An obstruction in the flow of these veins can cause a sudden reduction in liver function, necessitating hospitalization and prompt care.

The Liver performs numerous vital functions in our body, including:

• Digestion of food
• Bile synthesis
• Clearance of body waste products, metabolites, chemicals, and alcohol
• Assimilation of nutrients and vitamins absorbed after digestion from the intestine.
• Protein synthesis
• Glucose regulation
• Hormone regulation
• Production of clotting factors and more.

Common Bile Duct (CBD): The channel responsible for transporting bile from the Liver to the intestine is called the Common Bile Duct or CBD. It is connected to the gall bladder through a small side channel called the cystic Duct. Occasionally, small stones may pass from the gall bladder through this Duct into the CBD, causing severe pain, fever, and jaundice. This condition is referred to as Cholangitis. In some cases, these stones can also lead to swelling of the pancreas, resulting in a condition called pancreatitis. Both Cholangitis and pancreatitis require immediate medical attention.

Gall Bladder: The gall bladder is a small pouch attached to the Liver. It can store approximately 50-80 ml of bile at a time. When we consume a fatty meal, the gall bladder contracts to release the stored bile into the intestines, aiding digestion. The gall bladder serves to keep and concentrate bile. Some individuals may develop stones in their gall bladder, a condition known as cholelithiasis. 

Symptomatic gallbladder stones typically require surgical removal of the entire gallbladder rather than just the stones.

What sets the Liver apart from other organs? 

The Liver possesses a remarkable ability to regenerate itself. Unlike any other organ in the human body, the Liver can safely have a portion (about 60-70%) removed for medical purposes, such as treating cancer or obtaining a healthy donor. Thanks to its incredible healing capacity, the Liver can grow back to meet the body's needs.

The Liver is vital for life, as it performs numerous crucial functions in the human body. To maintain a healthy liver, we can follow these guidelines:

• Incorporate fruits and green vegetables into our diet
• Avoid consuming fatty and fried foods
• Refrain from alcohol consumption
• Avoid taking over-the-counter medications and other drugs without proper guidance
• Keep diabetes under control
• Engage in regular exercise.

Major Liver Diseases

• Hepatitis – Acute and Chronic
• Viral Hepatitis
• Acute Liver Failure ( ALF)
• Liver Cancer - Hepatocellular carcinoma (HCC)
• Alcoholic Liver Disease
• Fatty Liver Disease
• Biliary disorders
• Wilson disease
• Budd-Chiari syndrome
• Bile Duct Cancer

LIVER TRANSPLANT

1. What is Liver Transplant?

A liver transplant is a complex surgical procedure in which the patient's diseased Liver is extracted and replaced with a healthy liver (either complete or partial) while also reestablishing new anatomical connections.

2. How do I know if I need a liver transplant?

Patients who experience complications resulting from long-standing chronic liver disease or cirrhosis are considered suitable candidates for liver transplantation. These patients are in Child C Cirrhosis. The complications and symptoms commonly observed in patients with cirrhosis include:

• Jaundice
• Ascites
• Hepatic Encephalopathy
• Gastrointestinal bleeding ( Blood in Vomiting or Black stool)
• Spontaneous Bacterial Peritonitis (SBP)
• Kidney failure or Hepatorenal Syndrome (HRS)
• Decreased sodium levels.
• Hepatocellular carcinoma

3. What are the types of liver transplants?

There are two main types of liver transplants:

• Living Donor Liver Transplant (LDLT): This type involves a living donor who donates a portion of their Liver to a needy loved one. The donated Liver is then transplanted into the patient, and the necessary connections are established.
• Deceased Donor Liver Transplant (DDLT): In this type, the donor's Liver is obtained from an individual who is brain-dead after undergoing a thorough evaluation. Typically, the entire Liver is transplanted into the recipient. This type of transplant is sometimes referred to as cadaveric liver transplant in colloquial terms.

Super urgent liver transplant is offered for following HEPTIC FAI

1. Fulminant Hepatic Failure/ALF
2. Hepatic Artery Thrombosis S/P Liver Transplant

4. Who can donate or be a potential living donor?

In India, only family members are allowed to be potential donors. Donors must be willing and healthy, with compatible blood groups and no major health issues. Broadly, the criteria are as follows: 

• Blood group - The blood group should be either the same as that patient or blood group O 
• Age - 18 to 55 years
• Family member 
• Preferably slim and healthy

The donor can resume normal activities within a few weeks. 

5. Comprehensive Evaluation

This includes various tests and clearances from different specialists. Once the evaluation is complete and the patient is deemed fit for surgery, a date is scheduled pending ethical committee approval.

6. Liver Transplant Evaluation at SGRH

The patient undergoes a comprehensive evaluation by a multidisciplinary team to determine if they are suitable for a liver transplant. If a suitable family member is identified as a donor, they also undergo evaluation. If both patient and donor are deemed suitable, they proceed with a Living Donor Liver Transplant. Patients without a suitable donor are listed for a Deceased Donor Liver Transplant, which can be done at various centers in India without the need for the patient to travel. Dr. Ushast Dhir and the team conduct transplants at these centers, with the period from listing to transplant varying depending on blood group and center.

 7. What Makes Sir Ganga Ram Hospital the Best Hospital for Liver Transplant Surgery?

Liver transplantation was started in India at Sir Ganga Ram Hospital in New Delhi. The transplant team possesses extensive expertise in performing both living and deceased donor transplants, with a dedicated transplant ICU and nursing staff available to provide round-the-clock care for recipients. 

8. What are immunosuppression / Medicines after Transplant?

Liver transplant recipients must take lifelong anti-rejection medications known as immunosuppressants, which prevent the body from rejecting the transplanted organ. Achieving a delicate balance between immunosuppression and infection is crucial. Patients and their families receive detailed explanations about these medications and their potential side effects before surgery and discharge.

9. What should we expect after a liver transplant?

After spending 5 days in the transplant ICU, the recipient is transferred to a regular room. Typically, recipients are discharged within 2-3 weeks to continue recovery at home. Detailed instructions regarding post-discharge medication, nutrition, physical activity, precautions, and don'ts are provided to the recipient and caregiver.

Initially, the recipients visit the OPD and Blood test twice a week, which later is, reduced to a weekly visit. Once the patient's liver function stabilizes, they can return to their hometown and follow up via email at ushast.dhir@sgrh.com / The hospital

10. Liver Transplant Cost in India

Liver transplant costs in India range from $25,000 to $40,000. The estimate includes pre-transplant evaluation of patient recipient and donor stay, surgeon and anaesthesia fees, operation theatre charges for medicines, and medical consumables as allocated. However, certain exclusions apply, and charges may increase in case of unexpected complications.

11. Success Rate of Liver Transplant in India

Sir Ganga Ram Hospital's liver transplant program boasts an impressive success rate of over 90%. However, the success of the liver transplant is influenced by various factors related to both the patient and the donor. Patients with a good performance status tend to have better outcomes compared to individuals with a history of frequent hospital admissions and infections.

Advanced Techniques in Liver Transplantation 

The adoption of multiple technical variations has been a result of the rising number of patients waiting for liver transplantation and high pre-transplant mortality rates. Domino liver transplantation is a type of sequential transplant procedure that involves transplanting a new liver into a patient with a suitable metabolic disorder such as familial amyloid polyneuropathy or Maple Syrup Urinary disease (MSUD) to halt the progression of associated symptoms. The otherwise normal Liver is reserved for selected recipients with end-stage liver disease.

• Dual lobe transplants: We have performed two Dual lobe transplants at Sir Ganga Ram Hospital (SGRH). If the graft-to-recipient weight ratio is low due to a mismatch between the donor and recipient weight, two donors' grafts can be transplanted into one recipient to overcome this. This technically complex procedure involves several team members working together in three operation theatres.
• Simultaneous Liver-Kidney Transplant: Performing a Simultaneous Liver-Kidney Transplant is necessary for patients with end-stage Liver and renal diseases. In living donor cases, simultaneous transplants are rarely performed. At SGRH, we have carried out 8 simultaneous liver and kidney transplants, where each organ was procured from a different donor.
• Paired donor exchange: Four paired donor exchange transplants have been performed at SGRH. This technique is useful when the donor cannot donate due to size or blood group incompatibility. Two pairs of complementary donor-recipients can exchange donors to enable both transplants. This method has been reported in kidney transplantation but has not been previously reported in living donor liver transplantation.
• Domino Liver Transplantation: A liver transplant procedure called Domino Liver Transplantation involves a deceased donor (Patient A) providing a new liver for a patient who has Familial Amyloid Polyneuropathy (FAP) (Patient B). Patient B, who has FAP, donates their Liver to Patient C, who is usually in their 60s or 70s. Patient B can donate their Liver with FAP because the symptoms of FAP take several decades to appear, making it unlikely that Patient C will develop FAP during their lifetime.
• ABO-incompatible liver transplant: Is done when a compatible blood group is available.

New technology and advances offered by the team

• ABO-incompatible Liver transplant
• 3D Laparoscopic Donor surgery 
• ICG guided surgery
• Robot-Assisted Surgery
• State Art Operating Theaters equipped with the latest gadgets and systems
• Dedicated Liver Transplant ICU and HDU with the LATEST patient monitoring systems 
• Dedicated Liver transplant Floor 
• Treatment for Operable and advanced Liver cancer (HCC)
• Treatment for Gall Bladder, Bile duct, and Liver cancer
• Intestinal transplant

About Liver Transplant Doctor Profile

The Liver Transplant Surgery team Director, Dr. Ushast Dhir, and Co-Director, Dr. Suresh K. Singhvi are committed to providing world-class patient care.

The transplant surgery faculty has more than 18 years of combined experience. The faculty has trained and worked in leading institutes in India and the world, including the USA, UK, Germany, and South Korea. The team has vast experience in Living Donor and Deceased donor liver transplants for adult and pediatric populations.

The center has performed and assisted over 1800 transplants and over 8000 hepatobiliary and GI surgeries. The team offers both laparoscopic and Robot-assisted surgeries to the patients. The team has performed complex liver transplants, including ABO incompatible LT, donor swap, Domino Liver transplant, and dual lobe liver transplant. The team offers Laparoscopic donor surgery for select donors with favorable anatomy.

The department offers state-of-the-art operating rooms with the latest surgical and anaesthesia equipment to facilitate surgery and ensure patient safety. The post-operative recovery for the donor and recipient starts in the dedicated Liver ICU. The Liver ICU is planned to ensure utmost sterility for post-liver transplant recipients, facilitating smooth recovery. The Liver ICU has experienced Intensivists and dedicated staff nurses to ensure the best outcomes for our patients. The patient is transitioned to a dedicated organ transplant ward from the Liver ICU for recovery before discharge.

An equally experienced Transplant hepatology team complements the surgical team under the leadership of Dr (Prof) Anil Arora and Dr(Prof) Piyush Ranjan. The transplant hepatology team supervises the pre-transplant optimization and workup of the patient team. The hepatology team takes over the post-transplant care after surgical recovery is complete.

The surgical team offers a spectrum of complex Liver and bile duct surgery. These surgeries are offered in open, laparoscopic, and robotic platforms. The key services offered are:

 Services offered:

1. Living Donor Liver Transplant
2. Deceased Donor(Cadaveric) Liver Transplant
3. Combined liver and kidney transplant
4. Liver Cancer Treatment (HCC)/ Gall Bladder cancer
5. Bile Duct Cancer/pancreatic cancer/GI cancer
6. Liver Cirrhosis/ Alcoholic liver disease/ Acute liver failure
7. Choledochal cyst/ Hydatid cyst/ Polycystic liver disease 
8. Bile Duct (Cholangiocarcinoma) Cancer
9. Laparoscopic / Robotic Liver Surgery / Gb/ pancreas/ biliary and GI tract

We have a dedicated liver transplant coordinator and staff to make the treatment process smooth. They help the patient in every step of evaluation, work, and follow-up.