Doctor in BLK Super Speciality Hospital
Treatment of Liver Disease
Liver Problems Treatment
Treatment of Liver Cancer
Liver Replacement Treatment
Treatment of Pancreatic Fistula
Treatment of Pancreatic Cancer
Treatment of Gallbladder Cancer
Treatment of Gallbladder Disease
Treatment of Biliary Cirrhosis
Gallbladder Cancer Surgery
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Dr. Ankur Garg provides answers that are very helpful. It is very useful advise sir.
Dr. Ankur Garg provides answers that are very helpful. Yes helpful
Complications! This one word can bring in all the feelings of insecurity, anxiety, and restlessness. If you are having a liver transplant surgery, a very common question that keeps on disturbing you is the surgery complications that might arise. Some of the problems specific to liver transplantation that may be encountered include Primary non-function, or reduced function of the newly transplanted liver occurs in approximately 1-5% of new transplants. If the role of the liver does not improve sufficiently or quickly enough, the patient may urgently require a second transplant to survive.
The following are the Liver Transplant Surgery Complications:
- Hepatic artery thrombosis or clotting of the hepatic artery: Hepatic artery is the blood vessel that brings oxygenated blood from the heart to the liver. This kind of thrombosis occurs in 2-5% of all deceased donor transplants. The liver cells (hepatocytes) themselves usually do not receive blood supply from the hepatic artery. The liver cells (hepatocytes) are nourished by blood by the portal blood flow. The bile ducts, in contrast, depend strongly on the hepatic artery for nutrition. So, loss of the hepatic artery flow ( HAT) may lead to bile duct complications.
- Biliary complications: In general, there are two types of biliary problems: leak or stricture. Biliary complications affect nearly 15% of all deceased donor transplants and up to 40% of all live donor transplants. A biliary leak is a condition where bile is leaking out of the bile duct and into the abdominal cavity. Most commonly, this occurs where the donor and recipient bile ducts were sewn together. This is often handled by placing a stent across the connection through the stomach and small intestine and then providing the connection to heal. Bile can also leak from the cut edge of the liver in the case of living donor or split liver transplants. Typically, along the cut edge drain is placed and left during the transplant operation to eliminate any bile that may leak. Sometimes the bile tends to collect in the abdomen and complications can arise.
- Bleeding: A little bleeding after a liver transplantation is normal because of the widespread nature of the surgery and due to liver failure the coagulation factors are critically depleted. Most transplant patients bleed a minor amount and may get additional transfusions after the operation. It is best to consult a doctor if bleeding is substantial.
- Infection: It is important to take precautions as wound created by any operation can be often lead to infection. Liver transplant receivers are also at danger for infections deep within the abdomen, especially if there is an accumulation of blood or bile from a bile leak.
Liver transplant in the only curative option available for patient who develop cirrhosis of liver due to any cause ( Chronic Hepatitis B , Chronic Hepatitis C, Alcoholic Cirrhosis, NASH etc). Once patient has been diagnosed with cirrhosis it can not be reversed with any non-surgical treatment . Over a period of time patient may develop worsening in liver function resulting in complications of cirrhosis (bloody vomitus, black stools, jaundice , altered sensorium, renal dysfunction, abdominal swelling etc) labeled as “decompensated cirrhosis”. These patients require Liver transplant at the earliest and should be reffered to a liver transplant centre immediately. Ideally all patient diagnosed with cirrhosis should be under the follow-up of a gastroenterologist/Hepatologist. The source of graft liver can be from two sources namely from a deceased brain-dead donor or a Living-related donor and termed respectively as DDLT ( Deceased donor liver transplant) and LDLT ( Living Donor Liver Transplant) . However both DDLT and LDLT have nearly 90% success rate and both the procedures have their own benefits and lacunaes. Also the decision to go for DDLT and LDLT may vary for any particular patient.
Before the Liver transplant
All recipient and Living donor go thorough evaluation before the transplant process that includes blood investigations, Imaging studies, Cardiac and pulmonary fitness tests, multidisciplinary consultation before the clearance for liver transplant is achieved. The healthcare provider will explain the entire procedure. The healthcare provider is also supposed to answer all your questions. You would be needed to sign a consent form that allows the doctor to do the surgery. Eating food is not allowed at least 8 hours before the surgery. If you cannot stay relaxed before the surgery, a sedative will be given.
After the Liver Tranplsant
The recipient surgery lasts for anywhere between 12-16 hrs and donor surgery for 8-12 hrs. After the surgical procedure is complete, you will be taken to the intensive care unit (ICU)and will be closely watched for several days.
Immediately After the Surgery
You will most likely have a tube in your throat. This is so that you can breathe with the help of a machine (a ventilator) until you can breathe on your own. The ventilator tube will be removed on next morning when all parameters are found to be satisfactory. All parameters are monitored by round the clock critical care doctors and staff for a few days. The recipient has to stay in the hospital for three weeks and the donor is discharged in one week.
Blood samples will be collected on a regular basis to check the functioning of the new liver. Antibiotics will be infused via IV channels to prevent you from infections. The area where the operation was done should always be kept clean after you have reached home. Any stitches or surgical sutures will be removed at a follow-up visit.
Complications that may arise
Blocked blood vessels to the new liver, bleeding, an infection, leakage of bile or blocked bile ducts, or the new liver not working for a short time right after surgery are a few complications that may arise. Not to aggravate the condition, in the case of a complication, it is imperative to visit your doctor. In case you have a concern or query you can always consult an expert & get answers to your questions!
Did you know that liver stands second among the most transplanted organs in the human body? Liver diseases are becoming more prevalent today. A liver transplant becomes necessary when a person’s liver is diseased or injured. Through surgical procedures, a part or the complete healthy liver is transplanted from the donor.
Here are some of the typical reasons for a liver transplant:
- Autoimmune Hepatitis: In this kind of hepatitis, the body's immune system is not able to recognize its own liver tissue. It thus begins to injure the liver cells and that finally leads to scarring, liver cirrhosis, and end-stage liver disease. Unlike chronic viral hepatitis, this disease is not caused by a virus.
- Chronic viral hepatitis B, C, D: Hepatitis is caused by the viral infection which results in swelling, inflammation, and cell damage. All these lead to liver destruction or scarring. The different types of hepatitis are A, B, C, D and E. Hepatitis B is the leading indicator of liver cancer worldwide.
- Non alcoholic fatty liver disease: Fat accumulation in the liver cells causes this disease. It is said that excessive alcohol is the leading cause of a fatty liver. But this condition is also seen in patients with diabetes and obesity. This condition can cause liver cirrhosis.
- Primary sclerosing cholangitis: In this disease, the bile duct becomes progressively damaged by inflammation. This results in scarring that narrows the bile duct and causes obstruction to the flow of bile.
- Biliary cirrhosis: Sometimes there is a blockage in the bile duct. The liver creates bile which passes from the bile duct to the gallbladder. From here it is slowly released into the small intestine and helps in digesting fats. When the bile duct is blocked, all the bile that is produced accumulates in the liver and causes swelling and eventually loss of liver function.
- Active liver failure or toxic exposures: People suffering from acute liver failure caused by other reasons such as viral infection, fatty liver, etc. can undergo liver transplant surgery. Exposure to certain pesticides, herbicides, lead, asbestos and other hazardous pollutants can be the cause of a potentially life-threatening liver disease.
- Caroli's disease and choledochal cyst: The bile ducts become dilated and result in the formation of cysts or sacks. This causes infection and obstruction of the bile ducts. Choledochal Cyst, On the other hand, is a congenital disorder. A choledochal cyst is formed due to a structurally flawed bile duct. In both these scenarios getting a transplant is mandatory.
- Hepatic tumors: Tumors that spread either from other parts of the body or those that develop in the liver itself can cause severe damage to this organ.
It is best to consult an expert to know if a liver transplant is necessary for you. Hence, when you have problems related to liver seek medical advice without delay.
Liver, being the largest gland present inside the body, weighs almost 3 pounds. It is a vital organ of the human body and performs critical functions which are required for the normal functioning of the body. The liver makes protein which is required for blood clotting. The liver also produces many other enzymes which are required in cellular pathways.
In many cases, due to chronic or acute illnesses, a portion of the liver gets injured or damaged. In these cases, liver transplantation or hepatic transplantation under immunosuppressive drugs is a potentially successful treatment which can be performed by surgeons under ideal conditions.
When is a liver transplant necessary?
Liver transplant is a procedure to replace a diseased or necrosed liver with either a whole or a part of a healthy liver from a donor. This may come from a living or deceased donor. The surgery is extremely complicated with an average duration of 10-12 hrs. Before transplantation, liver support therapy might be indicated. A liver transplant is always the last option, for any liver-damaging conditions including alcohol abuse, hepatitis, and cancer.
Any condition leading to acute liver failure requires a liver transplant, provided that the recipient does not have other conditions that will fail a successful transplant.
Other potential causes leading to a liver transplant
A patient is advised for a liver transplant procedure when the liver is damaged to a condition where a cure is not possible. The many potential reasons that would need a person to undergo liver transplant are:
Viral hepatitis which includes all types of hepatitis (A, B, C, D, E) which are blood Bourne or transmitted through oral or fractal route.
- Acute and subacute necrosis of liver
- Alcoholic fatty liver
- Alcoholic cirrhosis of liver
- Chronic hepatitis
- Cirrhosis of liver without mention of alcohol
- Biliary cirrhosis
- Cystic fibrosis
- Benign neoplasm of liver and biliary passages
- Neoplasm of unspecified nature in digestive system
- Pure hypercholesterolemia
- Carcinoma of liver and biliary system
- Neoplasm of uncertain behavior in liver
- Disorders of bilirubin excretion
- Disorders of copper metabolism
- Congenital factor VIII disorder
- Congenital factor IX disorder
- Budd-Chiari syndrome
- Other chronic nonalcoholic liver disease
- Unspecified liver disease without mention of alcohol
- Other sequelae of chronic liver disease
- Other specified disorders of gallbladder
- Cholangitis, obstruction of bile duct
- Biliary atresia
- Perinatal jaundice due to hepatocellular damage
- Other specified perinatal disorders of digestive system
- Injury to liver
- Disorders of purine and pyrimidine metabolism
- Encephalopathy, unspecified
- Portal vein thrombosis
- Deficiencies of circulating enzymes
A liver transplant is suggested if other traditional treatments for liver disease aren’t enough to keep a person alive. Though waiting for a liver transplant is a long process, the surgery coordination happens quickly once you have a match. If you wish to discuss about any specific problem, you can ask a free question.