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Dr. Bipin Vibhute - Liver Transplant Surgeon, Pune

Dr. Bipin Vibhute

MBBS, DNB ( General Surgery)

Liver Transplant Surgeon, Pune

15 Years Experience  ·  1200 at clinic  ·  ₹300 online
Dr. Bipin Vibhute MBBS, DNB ( General Surgery) Liver Transplant Surgeon, Pune
15 Years Experience  ·  1200 at clinic  ·  ₹300 online
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I pride myself in attending local and statewide seminars to stay current with the latest techniques, and treatment planning....more
I pride myself in attending local and statewide seminars to stay current with the latest techniques, and treatment planning.
More about Dr. Bipin Vibhute
Doctor has been a successful General Surgeon for the last 14 years. Doctor is a MBBS, DNB ( General Surgery). Book an appointment online with Dr. Bipin B Vibhute and consult privately on Lybrate.com.

Find numerous General Surgeons in India from the comfort of your home on Lybrate.com. You will find General Surgeons with more than 29 years of experience on Lybrate.com. Find the best General Surgeons online in Pune. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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Education
MBBS - Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai - 2003
DNB ( General Surgery) - Pushpagiri Medical College Hospital - 2009
Languages spoken
English
Hindi
Marathi

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Sahyadri Hospital

Plot No.30-C, Karve Road, Erandawane Kachare Colony Landmark : Near Gharware CollegePune Get Directions
1200 at clinic
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Liver Transplantation - All That You Wanted To Know About It!

MBBS, DNB ( General Surgery)
Liver Transplant Surgeon, Pune
Liver Transplantation - All That You Wanted To Know About It!

The liver has many functions, including building proteins and other substances for the body to use, removal of waste products and toxins from the blood drug metabolism and energy storage. Liver disease causes these crucial functions to fail and when the failure is too severe to respond to medication liver transplantation may be an option.

Apollo Hospitals is among the few recognized transplantation centers in the country and has one of the largest transplantation registries. As liver transplantation is a major surgical procedure, the patients and family have quite a lot of concern areas. This broucher provides brief answer to frequently asked questions.

The information contain herein is of general nature and should not be construed as specific medical advice. Please consult your doctor for more details.

  • Ascites : A build up of fluid in the abdomen.
  • Autoimmune: A condition that results when the bile ducts inside and outside the liver don’t have normal openings. Bile becomes trapped in the liver causing jaundice and cirrhosis. If this condition is present from birth then without surgery it may cause death.
  • Biopsy: Removing a small piece of tissue to view under a microscope.
  • Cirrhosis: A chronic liver condition cause by scar tissue and damage to cells. Cirrhosis makes it hard for the liver to remove poisons (toxins) like alcohol and drugs from the blood. These toxins build up in the blood and may affect the brain.
  • Cyclosporine: An immunosuppressant used after transplantation to prevent rejection.
  • Immunosuppressant: Medicines that stop your immune system from attacking bacteria viruses and transplanted organs.
  • Jaundice: A symptoms of many disorders. Jaundice causes the skin and white of eyes to turn yellow.
  • Mycophenolate mofetill: An immunosuppressant used after transplantation to prevent rejection.
  • Sirolimus: An immunosuppressant used after transplantation to prevent rejection.
  • Steroids: A group of immunosuppressant used after transplantation to prevent rejection.
  • Tacrolimus: An immunosuppressant used after transplantation to prevent rejection.

What are the donor organ options that are used for transplantation in children?

  • Reduced size liver graft: a piece of a liver is taken from a brain-dead person(cadaver donor)

  • Living donor transplant: A piece of a liver from an adult living donor and is used as a transplant for a child. Over the past 10 years, nearly 1000 of these transplants have been done throughout the world. They have been just as successful as transplants of whole organs. There are some risks of adult donation for transplant to a child. These risks seem to be much smaller than the risks of a living donor transplant to an adult.

Are there technical problems in doing a transplant on a child?

Yes. It is a little more difficult because the blood vessels are very small. Also, the care after surgery must be done in ICUs that can handle such small children.

Do children get the same anti-rejection drugs as adults?

In general, children get the same type of drugs that adults get. However, children may have different side effects. Therefore, only doctors who specialize in this field should handle the follow-up of children after transplants.

What makes a transplant successful?

First, you must have good medical care. Then, families and patients should make every effort to keep in touch with their medical terms. Children who get liver transplants will need to take drugs on schedule, see their doctor often and may need more procedures. All this will help to make transplants successful and will help to give long and healthy lives to the children. So make sure you stay in touch with your transplant team and follow their advice. Ask for counseling when you have any problems.

What does my liver do?

  • It helps digest your food
  • It clears some wastes from your blood
  • It makes proteins that help your blood to clot
  • It helps control the way your body, uses food and works with the body’s defense system
  • It helps use and store vitamins
  • It breaks down many drugs

What are the signs of liver problems?

Some signs of liver problems are:

  • Feeling weak and sick in your stomach and losing appetite
  • Muscle wasting(becoming skin and bones)
  • Fluid build-up in the abdomen(ascites)
  • Yellow skin and eyes(Jaundice)
  • Forgetfulness, confusion or coma(encephalopathy)
  • Swollen hands/ legs
  • Itching
  • Bruising, bleeding easily and nose bleeds
  • Blood in vomitus, bloody/ black bowel movements

What is liver transplantation?

Liver transplantation is surgery to remove a diseased liver and replace it with a healthy one. This kind of surgery has been done for four decades. Across the world thousands of people have had liver transplants and now lead normal lives.

Being tired and losing your appetite can be signs of liver problems. Liver transplants can help adults and children.

PEDIATRIC LIVER TRANSPLANTATION

Liver transplantation is now one of the best treatments for fatal liver diseases in children. New drugs and ways of doing surgery have greatly improved patient survival rates. In the liver transplants for children, there are two main issues.

  • What caused the liver failure in the first place?
  • What is the severity of disease process and how soon does the child need a liver transplant.

Why do children need a liver transplant?

  • Billiary artesia: This is a disease in which a child is born with no bile ducts. It is the most common reason for liver transplants in children
  • Problems in digesting and using food: ‘Inborn errors of metabolism’ including the following conditions:
  • Alpha-I-antitrypsin deficiency tyrosinemia and wilson’s disease.
  • Lipid storage(Gaucher’s disease, Niemann-pick disease, Wolman’s disease, cholesterol ester storage disease)
  • Carbohydrate storage diseases (galactoserria and glycogen storage diseases)
  • Liver Cancers: Some liver cancers are found only in children
  • Sudden liver failure: This is a sudden liver failure that can cause death. It can have many causes. Mostly it comes from too much paracetamol or other drugs. In this kind of liver failure, a liver transplant can cure the problem if done early.

What is involved in the donor-evaluation process?

Donors undergo a thorough check-up that includes:

  1. Blood tests: Determine donor’s blood type, to see that it matches that of the person in need of the transplant. Blood tests are done to test the donor’s liver, kidney, and thyroid. Other tests are done to check for viruses such as hepatitis and HIV(the virus that causes AIDS)
  2. Physical Examination: If donor and recipient blood types are a close match the donor will get physical examination.
  3. Ultrasound: An ultrasound is done for the liver, other organs and the blood vessels
  4. Other Tests: Such as MRI, and CT Scans, help to give a complete view of the donor’s organs
  5. Tests of the lungs and heart may also be done. It takes 2 to 4 days for a donor to go through these tests. In an emergency situation, it can be done in as little as 48 hours

For how long does the donor remain hospitalized?

Donors stay in the hospital for up to 7 days after surgery. They may spend their first night after surgery in the ICU. The next day they often go to the general surgical floor where the nurses have experience in caring for liver donors. Donors are encouraged to get out of bed and walk as soon as they are able.

How long before the liver donor is fully recovered?

For the most part, it takes about 4 weeks to recover from surgery. In the month after leaving hospital donors return to the hospital regularly to be checked. Donors often get back to work within 3 to 6 weeks. The medical staff will let you know when it is safe to return to normal life.

What are the donor’s health care costs?

The health insurance of the person who gets the transplant covers the donor’s health care costs. This includes the costs of the check up, doctor’s fees, hospital costs, and follow-up visits after surgery.

What are the reasons for needing a liver transplant?

In adults, the most common reason for liver transplantation is Liver cirrhosis. Cirrhosis is caused by many different types of liver injuries that destroy healthy liver cells and replace them with scar tissue. Cirrhosis can be caused by viruses such as hepatitis B and C, alcohol, autoimmune liver disease, build-up of fat in the liver and hereditary liver diseases. Sometimes the cause of liver cirrhosis is not known.

In children, the most common reason for liver transplantation is billiary atresia. Bile ducts, which are tubes that carry bile out of the liver, are missing or damaged in this disease and obstructed bile causes cirrhosis. Bile helps digest food.

Other reason for needing liver transplantation is certain liver cancers, benign liver tumors, and hereditary diseases.

Sudden or rapidly developing liver failure may sometimes affect children and adults. The common causes of certain viral illness and reaction to some medicines like excess does of pain killers and even certain herbal/ traditional medicines. A liver transplant can save life if undertaken at the right time.

How will I know whether I need a liver transplant?

Based on your sickness and liver disease status, your doctor may recommend you to the liver transplant unit for further evaluation. You will meet the liver transplant team. The team is usually led by a liver transplant surgeon and includes liver specialists (hepatologists), nurses, and other health care professionals. The transplant team will arrange blood tests, x rays, and other tests to help make the decision about whether you need a transplant and whether a transplant can be carried out safely.

Other aspects of your health like the condition of your heart, lungs, kidneys, immune system, and mental health will also be checked to be sure you’re strong enough for surgery.

Can anyone with liver problems get transplant?

You cannot have transplant if you have

  • Cancer in another part of your body
  • Serious heart, lung or nerve disease
  • Active alcohol or illegal drug abuse
  • An active severe infection
  • Inability to follow your doctor’s instructions

How did living-donor liver transplantation begin and how common is it?

Living donor transplants were first done in children because of the long waiting period for cadaver organs and increasing death rate on the list. It was done in children in the 1980s and is now being done in adults for the last 8 years. In India because of relative lack of cadaveric organs, the majority of transplants are done using living donor organs.

Who can become a donor?

People who want to be liver donor are carefully checked to ensure that they can safely give a part of their liver and that their liver is healthy. The first concern is the safety of the donor as well as being sure that the graft will work for the person in need. The risks to the donor are real. Discuss this with your doctor. In general liver donors must:

  • Be good in health
  • Have a blood type that is a close match to the blood of the person in need.
  • Not have a selfish motive for donating

There should be no pressure of any kind on a person to donate part of his liver nor should there be any money given or received.

What are the major risks in donating?

As with any major surgery, there will be pain from the incision, which will get better with time. Other risks to the donor include bleeding, infection, and temporary bile leaks. Fatalities in transplantation have been reported from certain transplant centers in the world but it is rare. Most have full recoveries and are healthy. Discuss regarding risk to the donors with your transplant surgeon.

What happens during donor surgery?

The incision is the shape of mirror image of ‘L’. The gallbladder is always removed. The donor’s liver is split into two parts. One part is removed for the transplantation. The surgeon then closes the wound with sutures and staples. There are later removed at a follow-up visit to the surgeon’s office. The liver begins to heal and grow new tissue. It takes about 8-21 weeks for the liver to grow back to its normal size.

LIVING DONOR TRANSPLANTATION

What is a living donor liver transplant?

A living-donor transplant is when someone who is alive gives a part of his or her liver to a person who needs a transplant. Family members such as parents, sisters, brothers, adult children or someone close, such as a spouse, may offer to give part of his or her healthy liver. This can be done because a healthy liver can grow new tissues. After the transplant, the liver parts of both the donor and person in need will grow and form complete organs.

What are the benefits of living donor liver transplantation?

The best reason for living donor transplant is that it shortens the waiting time for a liver. The timing of the surgery can be planned. The chance for as successful transplant is increased. Today, thousands of patients await liver transplantation but only handful cadaveric organs become available every year. A living-donor transplant gives those in need an early transplant before their liver failure gets worse and their livers are in danger.

How long does it take to get a new liver?

If the transplant team recommends that you need a transplant, you will be counseled regarding your options of living donor liver transplant or cadaver liver transplant.

If you have a living donor in your family your waiting time could be as short as one week. The living donors and donated livers are tested before transplant surgery. The testing makes sure the liver is healthy, matches your blood type and is the right size so that it has the best chance of working in your body.

In case you do not have a living donor, your name will be placed on a waiting list with your consent. Your blood type, body size and how sick you are, plays a role in deciding your place on the list. Currently the sickest people are at the top of the list, so you may have to wait your turn.

While you wait for a new liver you and your doctor should talk about what you can do to stron for the surgery. You will also start learning about taking care of a new liver.

Where do the livers for transplantation come from?

Whole livers come from people who are brain dead (heart beat still present). These people are on breathing machines in various hospital ICUs. This type of donor is called “cadaveric donor”. Alternatively a healthy person in the family can donate a part of his or her liver for the patient with liver failure. This kind of donor is called a ‘living donor’. More information on living donor liver transplantation is included in the latter part of this booklet.

Financial resources/ Health Insurance

You should check to be sure that you will be able to cover the cost of liver transplantation and prescription medicines. You will need certain medicines after the surgery and some for the rest of your life. Check with your employer, health insurance policy or aid organizations if they can support you in part or full.

What happens in the hospital?

When liver is available, you will be prepared for the surgery. If your new liver is from a living donor, both of you and the donor will be in surgery at the same time. If your new liver is from a person who has recently died, your surgery will start when the new liver arrives at the hospital.

Can I go back to my daily activities?

Yes. After a successful liver transplant, most people can go back to their normal daily activities. Getting your strength back will take some time, depending on how sick you were before the transplant.

You will need to check with your doctor on how long your recovery period will be

  • After recovery, most people are able to go back to work
  • Most people can go back to eating as they eat before. Some medicines may cause you to gain weight others may cause diabetes or rise in your cholesterol. Meal planning and a balanced low-fat diet can help you remain healthy.
  • Most people can engage in physical activity after a successful liver transplant
  • Most people returned to normal sex life after liver transplantation. It is important for a woman to avoid becoming pregnant in the first year after transplantation.

You should talk to your transplant team about sex and reproduction after transplantation.

If you have any questions, you may check with your doctor before starting any activity.

Eating a healthy diet and taking the medications are part of taking care of your new liver.

What are the other problems that can damage the liver transplant?

Return of the problem that made the transplant necessary in the first place in less than 10% of patients with liver transplants. Also, hepatitis C virus may damage a transplant if the patient was infected before the operation took place.

Rarely occurring problems include:

  • Blockage of the blood vessels going into or out of the liver

  • Damage to the tubes that carry bile into the intestine

What if the transplant doesn’t work?

About 90% transplanted livers are still working after 1 year and about 75% livers are working at 5 years after transplant. If the new liver does not work or if your body rejects it, your doctor and the transplant team will decide whether another transplant is necessary.

How do I take care of my liver after I leave the hospital?

After you leave the transplant center at the hospital, you will see your doctor often to be sure your new liver is working well. You will have regular blood tests to check that your new liver is not being damaged by rejection, infections or problems with blood vessels and bile ducts. You will need to avoid sick people and report any illness to your doctor. You will need to eat a healthy diet, exercise and not drink alcohol. You should only use medicines, including ones you can buy without a prescription, after counseling your doctor. It is important to do what your doctor says to take care of your new liver.

During Surgery

The surgery can take from 6 to 14 hours. While the surgeon removes your diseased liver, other doctors will prepare the new liver.

The surgeon will disconnect your diseased liver from your bile ducts and blood vessels before removing it. The blood that flows into your liver will be blocked or sent through a machine to return to the rest of your body. The surgeon will put the healthy liver in place and reconnect it to your bile ducts and blood vessels. Your blood will then flow into your new liver.

After Surgery

You will stay in the hospital for an average 2 to 3 weeks to be sure your new liver is working. You will take medicines to prevent rejection of your new liver and to prevent infections. Your doctor will check for bleeding, infections and rejection. During this time you will start to learn how to take care of yourself and use your medicines to protect your new liver after you go home.

In the hospital, you will start eating again. You will start with clear liquids, then switch to solid food as your new liver starts to work.

What are the likely complications following a liver transplant?

Minor wound infection and discharge of liquefied fat is seen in about 10% of people. This will settle with little or no intervention. Major wound infection needing another surgery is extremely rare.

By now you are aware that liver transplantation involves making a lot of connections. There is an extremely small chance that these connections can become too tight or too loose. We have a very highly trained team of doctors who are able to treat them with minimally invasive techniques without resorting to another surgery.

Hepatic Artery Thrombosis (HAT) / Clotting of the hepatic artery is a rare complication seen in less than 4% of the patients and portal vein thrombosis is even rarer and is seen in less than 1% of the patients. When identified, the clot will have to be removed and it will involve another surgery. In spite of all this, if we are not successful, re-transplantation will be necessary.

What is rejection?

Rejection occurs when your body’s natural defenses, called the immune system, damage the new liver. Your immune system keeps you healthy by fighting against things that don’t belong in your body, such as bacteria and viruses. After a transplant, it is common for your immune system to fight against the liver and try to destroy it.

How is rejection prevented?

To keep your body from rejecting the new liver, you will have to take medicines. These drugs such as tacrolimus, cyclosporine, steroids, sirolimus and mycophenolate mofetil are called immunosuppressant. Immunosuppressants weaken your immune system’s ability to reject your new liver.

Do immunosuppressants have any side effects?

Yes. You can get infections more easily because these drugs weaken your immune system. You will need to stay away from people who are sick. These drugs may also increase your blood pressure, cause your cholesterol to rise, cause diabetes, weaken your bones and may damage your kidneys in the long run. Steroid drugs may also cause changes in how you look by causing weight gain. Your doctor and the transplant team will monitor these effects and treat you for any complications that may occur.

What are the signs of rejection?

Doctors will check your blood for liver enzymes at the first sign of rejection. Often rejection does not make you feel ill. Sometimes rejections can cause- pain, fever, jaundice, and changes in liver function tests.

Often a liver biopsy is needed to diagnose rejection. For a biopsy, the doctor takes a small piece of the liver to examine under a microscope. Blood tests will show if the new liver is being rejected.

2072 people found this helpful

Liver Transplant - FAQs Solved!

MBBS, DNB ( General Surgery)
Liver Transplant Surgeon, Pune
Liver Transplant - FAQs Solved!

1. What are the symptoms of liver disease? When to see a doctor?

Most of the liver diseases present with similar symptoms with some variations. Some of the common symptoms can be loss of appetite, nausea and vomiting, vomiting of blood, jaundice(yellowish discoloration of the eye), abdominal pain, itching, distension of abdomen( accumulation of fluid- ascites), swelling of lower limbs, weight loss, altered sensorium, confusion, and in a late stage- coma.

2. Can liver disease be prevented?

Liver is a crucial body organ which is responsible for processing essential nutrients from the food you eat, synthesizing bile and most importantly removing harmful toxins from the system. To ensure that your liver keeps performing its functions, you need to follow a healthy lifestyle.

Some of the liver diseases are metabolic and hence inherent at the time of birth and manifest later. However, some of the more common liver diseases are preventable like alcohol induced liver disease, fatty liver induced liver disease (NAFLD), Hepatitis A, B and C.

3. What is liver transplantation? What is the average cost of liver transplantation?

Liver transplantation is the treatment for end stage liver disease in both adults and children. In this operation, the diseased liver is removed and replaced by a healthy one. The success rate for the operation is high and terminally ill patient can return to normal lives.

The average cost of liver transplantation is Rs 18 to 20 Lakhs at Sahyadri specialty hospital, Pune Maharashtra. The cost of investigations of the donor and recipient is Rs 90,000. When patients are too sick and require prolonged stay following liver transplantation, the cost of treatment can escalate; hence it is advisable to patients to have the liver transplantation before they develop complications secondary to the liver disease (Cirrhosis).

Most of the patients seek help at a very late stage or referred late to a Surgeon. It is advisable for patients to seek the opinion of a Surgeon at a very early stage of the disease. The patient needs to take medicines for the rest of his life to prevent rejection of the new liver. The cost of medicines and the investigations in the first year is approximately Rs 10-15000/-. The number of medicines and the frequency of blood investigations are much less after the first year of liver transplantation.

The cost of liver transplantation in India is one-twentieth when compared to USA, UK and other European Countries.

4. When should a liver transplant be performed?

When a person’s liver is severely damaged and cannot function properly or complications may develop and liver transplantation should be considered. Conditions like hepatic coma, massive upper gastrointestinal bleeding, and liver cancer is the best treated by complete removal of the liver (cirrhotic liver).

In general, when a patient needs a new liver, the earlier the operation, the higher the success rate is.

Urgent liver transplantation is recommended in patients who have acute liver failure and this could be due to many reasons. The common conditions are Hepatitis B, Hepatitis A, Hepatitis E and drug induced. In such patients, liver transplantation is urgently needed in order to save the life of the individual.

5. What are the advantages/benefits to the recipient of getting a living donation vs cadaver?

A new liver can come from either of the two sources: A living donor or a brain-dead deceased donor.

Living donor transplantation:

It is technically feasible to remove part of the liver from a living person and transplant it to a patient who needs a new liver. The operation has now been done since 1989. Depending on the size matching of the donor and recipient, either the left side (about 35-40%) or the right side (60-65%) of the liver will have to be removed. The liver remnant in the donor will grow to its original size in 6-8 weeks time.

This process helps in an earlier transplantation before the recipients’ conditions deteriorates. It is a planned procedure whilst cadaver liver transplantation is an emergency procedure. It avoids the risk of death while waiting for a deceased donor liver graft(40% overall and 75% for patients in Intensive care units). The survival rate of a living donor transplant is over 90%.

There are risks like complications of the investigations and surgical procedures but the possibility of donor death rate is of 0.2-0.5%. Seventeen donor deaths have been reported in Brazil, France, Germany, Egypt, Hong Kong, Japan, USA and India.

Cadaver transplantation:

This is well established in the Europe and USA. Unfortunately, the availability of deceased donor liver is not very often in India. Depending on your blood group, you may have to wait for 0 to 6 months before you get a new liver.

During this waiting period, you may develop complications like spontaneous bacterial peritonitis (infection of the fluid in the abdomen) which, if repetitive may produce severe adhesions in your abdomen rendering liver transplantation difficult if not impossible.

It is important for everyone to register for organ donation, so that when we die, this noble act will help many people to lead normal lives. In the Western world the organ donation rate is between 15-18/million population where as in Indi it is less than 1/million.

6. Who can be a suitable living donor?

The most important criteria is that the donation of portion of the liver is done voluntarily. The donor has to be less than 50 years of age, body mass index of less than 25 and is a near relative of the recipient. Both the donor and the patient should have the same Blood group or O Blood group.

Besides, the potential donor should understand clearly that

  • The donor operation carries complication rate of 10-15%.
  • The recipient is successful in 90-95%, which means that there is 5-10% chance of dying.
  • The donation is done out of his/her own wish and without any coercion.
  • There is no financial gain related to the act of donation.
  • The donor has the right to withdraw at any time without the need of giving any reasons to do so.

7. Which patients are excluded from liver transplantation procedure?

Patients who have cancer in another part of the body, active alcohol or illegal drug abuse, active or severe infection in any part of the body, serious heart, lung or neurological conditions or those who are unable to follow doctors’ instructions are excluded generally.

8. What are the risks to the recipient from the surgery?

The overall success rate of liver transplant is over 94% and the majority of recipients can return to normal activities and achieve 95% of their quality of life which they had prior to liver disease. Since the recipients’ body may reject the new liver, it is essential for them to take immunosuppressive medications and continue follow up at the liver transplant clinic. They will need to continue these medications for life, at a reducing dosage.

The risk for the recipient is the return of the original problem that necessitated the liver transplant in the first place, e.g. hepatitis C, recidivism (return to alcoholism), noncompliance of medications. The other complications that can arise are thrombosis of blood vessels going into or out of the liver, primary or delayed graft non-function, bile duct complications, renal failure and other infections.

9. What are the side effects of having a liver transplant?

After a successful liver transplantation (95% of patients) – the patient is advised to take care of infections and to take anti-rejection medicines for life. The patient can return to normal quality of life and can return back to work in three months time. The patient has to regularly follow up with the surgeon in the first year and later at regular intervals as advised by his doctor. He will require blood tests to determine that his liver functions and to adjust his medications in the beginning and later the tests are infrequent. The patient is advised not to take any herbal or alternative drug treatment.

The transplant patient is assessed regularly for various complications like rejection, infection, narrowing of blood vessels etc., and appropriate treatment is initiated. Post transplantation, he is under the guidance of his doctor throughout his life. Any health problems that do come up have to be investigated and treated, though they are infrequent.

In case you have a concern or query you can always consult an expert & get answers to your questions!

1871 people found this helpful

All That You Wanted To Know About Liver Transplantation!

MBBS, DNB ( General Surgery)
Liver Transplant Surgeon, Pune
All That You Wanted To Know About Liver Transplantation!

The liver has many functions, including building proteins and other substances for the body to use, removal of waste products and toxins from the blood drug metabolism and energy storage. Liver disease causes these crucial functions to fail and when the failure is too severe to respond to medication liver transplantation may be an option.

Apollo Hospitals is among the few recognized transplantation centers in the country and has one of the largest transplantation registries. As liver transplantation is a major surgical procedure, the patients and family have quite a lot of concern areas. This broucher provides brief answer to frequently asked questions.

The information contain herein is of general nature and should not be construed as specific medical advice. Please consult your doctor for more details.

GLOSSARY

  1. Ascites: A build up of fluid in the abdomen.
  2. Autoimmune: A condition that results when the bile ducts inside and outside the liver don’t have normal openings. Bile becomes trapped in the liver causing jaundice and cirrhosis. If this condition is present from birth then without surgery it may cause death.
  3. Biopsy: Removing a small piece of tissue to view under a microscope.
  4. Cirrhosis: A chronic liver condition cause by scar tissue and damage to cells. Cirrhosis makes it hard for the liver to remove poisons (toxins) like alcohol and drugs from the blood. These toxins build up in the blood and may affect the brain.
  5. Cyclosporine: An immunosuppressant used after transplantation to prevent rejection.
  6. Immunosuppressant: Medicines that stop your immune system from attacking bacteria viruses and transplanted organs.
  7. Jaundice: A symptoms of many disorders. Jaundice causes the skin and white of eyes to turn yellow.
  8. Mycophenolate mofetill: An immunosuppressant used after transplantation to prevent rejection.
  9. Sirolimus: An immunosuppressant used after transplantation to prevent rejection.
  10. Steroids: A group of immunosuppressant used after transplantation to prevent rejection.
  11. Tacrolimus: An immunosuppressant used after transplantation to prevent rejection.

What are the donor organ options that are used for transplantation in children?

  • Reduced size liver graft: a piece of a liver is taken from a beain-dead person(cadaver donor)
  • Living donor transplant: A piece of a liver from adult living donor and is used as a transplant for a child. Over the past 10 year, nearly 1000 of these transplants have been done throughout the world. They have been just as successful as transplants of whole organs. There are some risks of adult donation for transplant to a child. These risks seem to be much smaller than the risks of a living donor transplant to an adult.

Are there technical problems in doing a transplant on a child?

Yes. It is a little more difficult because the blood vessels are very small. Also, the care after surgery must be done in ICUs that can handle such small children.

Do children get the same ani-rejection drugs as adults?

In general, children get the same type of drugs that adults get. However, children may have different side effects. Therefore, only doctors who specialize in this field should handle the follow-up of children after transplants.

What makes a transplant successful?

First, you must have good medical care. Then, families and patients should make every effort to keep in touch with their medical terms. Children who get liver transplants will need to take drugs on schedule, see their doctor often and may need more procedures. All this will help to make transplants successful and will help to give long and healthy lives to the children. So make sure you stay in touch with your transplant team and follow their advice. Ask for counseling when you have any problems.

What does my liver do?

  • It helps digest your food
  • It clears some wastes from your blood
  • It makes proteins that help your blood to clot
  • It helps control the way your body, uses food and works with the body’s defense system
  • It helps use and store vitamins
  • It breaks down many drugs

What are the signs of liver problems?

Some signs of liver problems are:

  • Feeling weak and sick in your stomach and losing appetite
  • Muscle wasting(becoming skin and bones)
  • Fluid build-up in the abdomen(ascites)
  • Yellow skin and eyes(Jaundice)
  • Forgetfulness, confusion or coma(encephalopathy)
  • Swollen hands/ legs
  • Itching
  • Bruising, bleeding easily and nose bleeds
  • Blood in vomitus, bloody/ black bowel movements

What is liver transplantation?

Liver transplantation is surgery to remove a diseased liver and replace it with a healthy one. This kind of surgery has been done for four decades. Across the world thousands of people have had liver transplants and now lead normal lives.

Being tired and losing your appetite can be signs of liver problems. Liver transplants can help adults and children.

PEDIATRIC LIVER TRANSPLANTAION

Liver transplantation is now one of the best treatments for fatal liver diseases in children. New drugs and ways of doing surgery have greatly improved patient survival rates. In the liver transplants for children, there are two main issues.

  1. What caused the liver failure in the first place?
  2. What is the severity of disease process and how soon does the child need a liver transplant.

Why do children need liver transplant?

  • Billiary artesia: This is a disease in which a child is born with no bile ducts. It is the most common reason for liver transplants in children
  • Problems in digesting and using food: ‘Inborn errors of metabolism’ including the following conditions:
  • Alpha-I-antitrypsin deficiency tyrosinemia and wilson’s disease.
  • Lipid storage(Gaucher’s disease, Niemann-pick disease, Wolman’s disease, cholesterol ester storage disease)
  • Carbohydrate storage diseases(galactoserria and glycogen storage diseases)
  • Liver Cancers: Some liver cancers are found only in children
  • Sudden liver failure: This is a sudden liver failure that can cause death. It can have many causes. Mostly it comes from too much paracetamol or other drugs. In this kind of liver failure, a liver transplant can cure the problem if done early.

What is involved in the donor-evaluation process?

Donors undergo a thorough check-up that includes:

  1. Blood tests: Determine donor’s blood type, to see that it matches that of the person in need of the transplant. Blood tests are done to test the donor’s liver, kidney, and thyroid. Other trests are done to check for viruses such as hepatitis and HIV(the virus that causes AIDS)
  2. Physical Examination: If donor and recipient blood types are a close match the donor will get physical examination.
  3. Ultrasound: An ultrasound is done for the liver, other organs and the blood vessels
  4. Other Tests: Such as MRI, and CT Scans, help to give a complete view of the donor’s organs
  5. Tests of the lungs and heart may also be done. It takes 2 to 4 days for a donor to go through these tests. In an emergency situation, it can be done in as little as 48 hours

For how long does the donor remain hospitalized?

Donors stay in the hospital for up to 7 days after surgery. They may spend their first night after surgery in the ICU. The nest day they often go to the general surgical floor where the nurses have experience in caring for liver donors. Donors are encouraged to get out of bed and walk as soon as they are able.

How long before the liver donor is fully recovered?

For the most part, it takes about 4 weeks to recover from surgery. In the month after leaving hospital donors return to the hospital regularly to be checked. Donors often get back to work within 3 to 6 weeks. The medical staff will let you know when it is safe to return to normal life.

What are the donor’s health care costs?

The health insurance of the person who gets the transplant covers the donor’s health care costs. This includes the costs of the check up, doctor’s fess, hospital costs, and follow-up visits after surgery.

What are the reasons for needing a liver transplant?

In adults, the most common reason for liver transplantation is Liver cirrhosis. Cirrhosis is caused by many different types of liver injuries that destroy healthy liver cells and replace them with scar tissue. Cirrhosis can be caused by viruses such as hepatitis B and C, alcohol, autoimmune liver disease, build-up of fat in the liver and hereditary liver diseases. Sometimes the cause of liver cirrhosis is not known.

In children, the most common reason for liver transplantation is a billiary atresia. Bile ducts, which are tubes that carry bile out of the liver, are missing or damaged in this disease and obstructed bile causes cirrhosis. Bile helps digest food.

Other reason for needing liver transplantation is certain liver cancers, benign liver tumors, and hereditary diseases.

Sudden or rapidly developing liver failure may sometimes affect children and adults. The common causes of certain viral illness and reaction to some medicines like excess does of pain killers and even certain herbal/ traditional medicines. A liver transplant can save a life if undertaken at the right time.

How will I know whether I need a liver transplant?

Based on your sickness and liver disease status, your doctor may recommend you to the liver transplant unit for further evaluation. You will meet the liver transplant team. The team is usually led by a liver transplant surgeon and includes liver specialists (hepatologists), nurses, and other health care professionals. The transplant team will arrange blood tests, x rays, and other tests to help make the decision about whether you need a transplant and whether a transplant can be carried out safely.

Other aspects of your health like the condition of your heart, lungs, kidneys, immune system, and mental health will also be checked to be sure you’re strong enough for surgery.

Can anyone with liver problems get transplant?

You cannot have transplant if you have

  • Cancer in another part of your body
  • Serious heart, lung or nerve disease
  • Active alcohol or illegal drug abuse
  • An active severe infection
  • Inability to follow your doctor’s instructions

How did living-donor liver transplantation begin and how common is it?

Living donor transplants were first done in children because of the long waiting period for cadaver organs and increasing death rate on the list. It was done in children in the 1980s and is now being done in adults for the last 8 years. In India because of relative lack of cadaveric organs, the majority of transplants are done using living donor organs.

Who can become a donor?

People who want to be liver donor are carefully checked to ensure that they can safely give a part of their liver and that their liver is healthy. The first concern is the safety of the donor as well as being sure that the graft will work for the person in need. The risks to the donor are real. Discuss this with your doctor. In general liver donors must:

  • Be good in health
  • Have a blood type that is a close match to the blood of the person in nedd.
  • Not have a selfish motive for donating

There should be no pressure of any kind on a person to donate part of his liver nor should there be any money given or received.

LIVING DONOR TRANSPLANTATION

What is a living donor liver transplant?

A living-donor transplant is when someone who is alive gives a part of his or her liver to a person who needs a transplant. Family members such as parents, sisters, brothers, adult children or someone close, such as a spouse, may offer to give part of his or her healthy liver. This can be done because a healthy liver can grow new tissues. After the transplant, the liver parts of both the donor and person in need will grow and form complete organs.

What are the benefits of living donor liver transplantation?

The best reason for living donor transplant is that it shortens the waiting time for a liver. The timing of the surgery can be planned. The chance for as successful transplant is increased. Today, thousands of patients await liver transplantation but only handful cadaveric organs become available every year. A living-donor transplant gives those in need an early transplant before their liver failure gets worse and their livers are in danger.

How long does it take to get a new liver?

If the transplant team recommends that you need a transplant, you will be counseled regarding your options of living donor liver transplant or cadaver liver transplant.

If you have a living donor in your family your waiting time could be as short as one week. The living donors and donated livers are tested before transplant surgery. The testing makes sure the liver is healthy, matches your blood type and is the right size so that it has the best chance of working in your body.

In case you do not have a living donor, your name will be placed on a waiting list with your consent. Your blood type, body size and how sick you are, plays a role in deciding your place on the list. Currently, the sickest people are at the top of the list, so you may have to wait your turn.

While you wait for a new liver you and your doctor should talk about what you can do to stron for the surgery. You will also start learning about taking care of a new liver.

Where do the livers for transplantation come from?

Whole livers come from people who are brain dead (heart beat still present). These people are on breathing machines in various hospital ICUs. This type of donor is called “cadaveric donor”. Alternatively, a healthy person in the family can donate a part of his or her liver for the patient with liver failure. This kind of donor is called a ‘living donor’. More information on living donor liver transplantation is included in the latter part of this booklet.

Financial resources/ Health Insurance

You should check to be sure that you will be able to cover the cost of liver transplantation and prescription medicines. You will need certain medicines after the surgery and some for the rest of your life. Check with your employer, health insurance policy or aid organizations if they can support you in part or full.

What happens in the hospital?

When a liver is available, you will be prepared for the surgery. If your new liver is from a living donor, both of you and the donor will be in surgery at the same time. If your new liver is from a person who has recently died, your surgery will start when the new liver arrives at the hospital.

Can I go back to my daily activities?

Yes. After a successful liver transplant, most people can go back to their normal daily activities. Getting your strength back will take some time, depending on how sick you were before the transplant.

You will need to check with your doctor on how long your recovery period will be

  • After recovery, most people are able to go back to work
  • Most people can go back to eating as they eat before. Some medicines may cause you to gain weight others may cause diabetes or rise in your cholesterol. Meal planning and a balance low fat diet can help you remain healthy.
  • Most people can engage in physical activity after a successful liver transplant
  • Most people returned to normal sex life after liver transplantation. It is important for a woman to avoid becoming pregnant in the first year after transplantation.

You should talk to your transplant team about sex and reproduction after transplantation.

If you have any questions, you may check with your doctor before starting any activity.

Eating a healthy diet and taking the medications are part of taking care of your new liver.

What are the other problems that can damage the liver transplant?

Return of the problem that made the transplant necessary in the first place in less than 10% of patients with liver transplants. Also hepatitis C virus may damage a transplant if the patient was infected before the operation took place.

Rarely occurring problems include:

  • Blockage of the blood vessels going into or out of the liver
  • Damage to the tubes that carry bile in to the intestine

What if the transplant doesn’t work?

About 90% transplanted livers are still working after 1 year and about 85% livers are working at 5 years after transplant. If the new liver does not work or if your body rejects it, your doctor and the transplant team will decide whether another transplant is necessary.

How do I take care of my liver after I leave the hospital?

After you leave the transplant center at the hospital, you will see your doctor often to be sure your new liver is working well. You will have regular blood tests to check that your new liver is not being damaged by rejection, infections or problems with blood vessels and bile ducts. You will need to avoid sick people and report any illness to your doctor. You will need to eat a healthy diet, exercise and not drink alcohol. You should only use medicines, including ones you can buy without a prescription, after counseling your doctor. It is important to do what your doctor says to take care of your new liver.

During Surgery

The surgery can take from 6 to 14 hours. While the surgeon removes your diseased liver, other doctors will prepare the new liver.

The surgeon will disconnect your diseased liver from your bile ducts and blood vessels before removing it. The blood that flows into your liver will be blocked or sent through a machine to return to the rest of your body. The surgeon will put the healthy liver in place and reconnect it to your bile ducts and blood vessels. Your blood will then flow into your new liver.

After Surgery

You will stay in the hospital for an average 2 to 3 weeks to be sure your new liver is working. You will take medicines to prevent rejection of your new liver and to prevent infections. Your doctor will check for bleeding, infections and rejection. During this time you will start to learn how to take care of yourself and use your medicines to protect your new liver after you go home.

In the hospital, you will start eating again. You will start with clear liquids, then switch to solid food as your new liver starts to work.

What are the likely complications following a liver transplant?

Minor wound infection and discharge of liquefied fat is seen in about 10% of people. This will settle with little or no intervention. Major wound infection needing another surgery is extremely rare.

By now you are aware that liver transplantation involves making a lot of connections. There is an extremely small chance that these connections can become too tight or too loose. We have a very highly trained team of doctors who are able to treat them with minimally invasive techniques without resorting to another surgery.

Hepatic Artery Thrombosis (HAT) / Clotting of the hepatic artery is a rare complication seen in less than 4% of the patients and portal vein thrombosis is even rarer and is seen in less than 1% of the patients. When identified, the clot will have to be removed and it will involve another surgery. In spite of all this, if we are not successful, re-transplantation will be necessary.

What is rejection?

Rejection occurs when your body’s natural defenses, called the immune system, damage the new liver. Your immune system keeps you healthy by fighting against things that don’t belong in your body, such as bacteria and viruses. After a transplant, it is common for your immune system to fight against the liver and try to destroy it.

How is rejection prevented?

To keep your body from rejecting the new liver, you will have to take medicines. These drugs such as tacrolimus, cyclosporine, steroids, sirolimus and mycophenolate mofetil are called immunosuppressant. Immunosuppressants weaken your immune system’s ability to reject your new liver.

Do immunosuppressants have any side effects?

Yes. You can get infections more easily because these drugs weaken your immune system. You will need to stay away from people who are sick. These drugs may also increase your blood pressure, cause your cholesterol to rise, cause diabetes, weaken your bones and may damage your kidneys in the long run. Steroid drugs may also cause changes in how you look by causing weight gain. Your doctor and the transplant team will monitor these effects and treat you for any complications that may occur.

What are the signs of rejection?

Doctors will check your blood for liver enzymes at the first sign of rejection. Often rejection does not make you feel ill. Sometimes rejections can cause- pain, fever, jaundice, and changes in liver function tests.

Often a liver biopsy is needed to diagnose rejection. For a biopsy, the doctor takes a small piece of the liver to examine under a microscope. Blood tests will show if the new liver is being rejected.

Why liver is an important organ of the body?

The liver is one of the largest organs in your body. It helps digest the food you eat and convert it into energy. It also helps fight infections and cleans your blood, thus making it a very vital organ.

How lifestyle can affect the health of liver?

Due to our changing life style patterns, alcohol is consumed either as a status symbol or to cope up with stress. Alcohol puts a lot of stress on the liver, such continuous state of stress usually results in liver damage.

What are the different common diseases related to liver?

Cirrhosis, Viral hepatitis (Most common form across the world are Hepatitis A, B & C), fatty liver disease and alcoholic liver disorders are the common disease of liver.

What is a liver transplant and why is it done?

Simply put ‘Liver Transplantation’ is surgery to remove a diseased or injured liver and replace it with a healthy one from another person, also called as a donor.In adults, the most common reason for needing a liver transplant is ‘Cirrhosis’. This is caused by various different types of diseases which destroy the healthy liver cells and replace them with scar tissues.

What are the types of liver transplants?

There are two types of liver transplants – Living Donor and Deceased Donor Transplants. In case of the 'living donor' Liver Transplant, a portion of Liver from the living donor is removed and transplanted in the recipient patient. In both recipient and donor, the liver regenerates to necessary size in about 6 to 8 weeks. Only near relatives can donate. In deceased donor liver transplants, the donor is a brain dead person.

How much time is needed for patient to recover after liver transplant?

Recovery time ranges from 1 to 2 weeks. Proper care, follow-up and life-long medications are required for the new Liver to function properly.

Can liver grow back to normal after the transplant?

Yes. Liver is the only organ which can regenerate in case of living donor liver transplant, a portion of liver from the living donor is removed and transplanted in recipient patient. In both recipient and donor, liver regenerates to necessary size in 6-8 weeks. Only near relatives can donate liver in this case.

What does Sahyadri Hospital has in offering for Liver care?

Sahyadri Hospitals has an A-Z Liver Wellness Clinic dedicated for management of all types of diseases related to Liver, Pancreas, Bile ducts & Gall bladder. It Offers state-of-the-art facilities for Liver, Kidney & Pancreas Transplant with 24/7 availability of dedicated multi-disciplinary ‘Liver Team’, including Hepatologist, Critical Care Physicians and Liver Transplant Surgeons, a well-equipped Intensive care unit with dedicated nurses, physiotherapist and nutritionist.

What are the major risks in donating?

As with any major surgery, there will be pain from the incision, which will get better with time. Other risks to the donor include bleeding, infection, and temporary bile leaks. Fatalities in transplantation have been reported from certain transplant centers in the world but it is rare. Most have full recoveries and are healthy. Discuss regarding risk to the donors with your transplant surgeon.

What happens during donor surgery?

The incision is the shape of mirror image of ‘L’. The gallbladder is always removed. The donor’s liver is split into two parts. One part is removed for the transplantation. The surgeon then closes the wound with sutures and staples. There are later removed at a follow-up visit to the surgeon’s office. The liver begins to heal and grow new tissue. It takes about 8-21 weeks for the liver to grow back to its normal size.

In case you have a concern or query you can always consult an expert & get answers to your questions!

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Understanding Liver Cancer Surgery!

MBBS, DNB ( General Surgery)
Liver Transplant Surgeon, Pune
Understanding Liver Cancer Surgery!

What is Liver Cancer Surgery?

The liver is an extremely instrumental organ in the human body. It not only aids in proper digestion but also fights outside infections that threaten the immune system in the body. Liver cancer and failure of it to perform its assigned functions are extremities of diseases faced by the liver. Hence, to avoid further complications such as spread of cancer, liver cancer surgery is the best option available.

Why is Liver Cancer Surgery Required?

Liver cancer surgery usually is for life-saving purposes. In some cases, cancer is totally removed from the liver, but in some cases, surgery helps in making the patient survive for longer than expected. Also, surgery is useful in stopping the advancement of cancer to the remaining parts of the body from liver. Depending on the condition, doctors decide the type of surgery method to be adopted.

Pre-operative Preparation

When doctors come to a conclusion that surgery is the only respite left for treating cancer, the surgery decision is confirmed for the patient. There are certain diagnostic tests that the patient is made to undergo before surgery. Few of them are as follows:

  • Biopsy: Entails excision of a small amount of liver tissue for analysis. It is ordered so that the extent of progression of the tumor before the surgery is known.
  • ECG: An electrocardiogram is ordered before the surgery for examining the overall functioning of the heart.
  • CBC: A Complete Blood Count (CBC) provides an idea of the platelet count along with red and white blood cell count. A difference in the CBC from the normal range may alert the doctor about any possible infections and so he/she may reschedule the surgery totally.
  • Blood sugar testing: Blood sugar levels are also needed to check before the actual surgery.

Following given are the instructions patient needs to follow once surgery date is decided. The date for surgery is also then scheduled.

Day Before Surgery

Having to undergo surgery for liver cancer or for that matter any other cancer is a very distressing time for the person and his family members. Therefore having an idea as to what goes into the preparation stage can brace the person for taking precautions and then going in for the surgery. Following given are some other steps you can take to help ensure a better surgical outcome on your end:

  • Rest and diet: Make sure to get plenty of rest. A healthy diet can help prepare your body for surgery.
  • Smoking: You need to stop smoking at once when you get a go ahead for the surgery. Smoking can really delay recovery and slow the healing process. Lung complications can also be an after effect of the surgery.
  • Pre-surgery tests: The doctor will make you undergo few requisite tests before surgery to know the levels of your physical well-being.
  • Instructions: It is better to ask your doctor beforehand about the things necessary for looking after the incisions post surgery and the dosage of medication. Follow these instructions carefully. Know which side effects after surgery are normal and which may be signs of a complication.
  • Leg exercises: The physiotherapist will teach you few leg exercises you need to immediately start doing post surgery for preventing formation of blood clots in your legs along with the medication prescribed.
  • Breathing exercises: Knowing few exercises for breathing correctly post surgery is necessary to prevent contracting lung infections.

Procedure Day

The probability of getting back to a fit and fine body like before depends on many factors like - the progression and growth of the tumors to other parts of the body, whether the person is having cancer for the first time, or whether his earlier cancer has relapsed. It also has got a lot to do with the person's general health, whether he has any other liver condition, and lastly if the person is a likely candidate for liver transplant if the cancer is not possible to go away by removal of the affected part of liver.

While the above mentioned were the types under which cancer is classified and the chances of recovery, the line of treatment varies according to patient. There are few types of standard treatments that are used for treating any person suffering from liver cancer. They are as follows:

Methods/Techniques of Liver Cancer Surgery

  1. Liver Resection: 
Surgery for resection of the liver to remove affected parts is called liver resection. The surgery for it is also referred to as partial or full hepactectomy. Surgical resection of liver is feasible because liver is an organ that has regenerative capacity. A liver transplant becomes compulsory when the liver function is very poor and not up to the mark. At such times, removing the affected portion of liver would only result in liver failure, transplant from a donor is helpful. In such liver cancer cases, the old liver is removed and fitted with a new one.

    • Minimally-Invasive Laparoscopic Liver Tumor Resection A laparascopic procedure is decided based on the size and location of the tumors. In this minimally invasive approach of surgery for liver cancer. One or multiple incisions are made for being able to insert the laparascope. The incisions enable the doctor to insert the cameras and surgical instruments for performing the resection surgery. The minimally-invasive surgery involves faster recovery, less blood loss and lesser postoperative pain, fewer and smaller scars as compared to an open surgery. Depending on your condition, you may need only a short hospital stay.

  2. Cryosurgery: 
This technique commences with the patient getting a general anesthetic injected. A thin metal probe then freezes the tumor with the help of cold gases that destroy the cancerous cells. The probe is inserted through the abdominal skin during this technique which is used for treating liver cancer.
 This method is also called as Percutaneous technique. The metallic probe may sometimes be inserted in the abdominal cavity for operating on the tumor. This technique is termed as intra-abdominal surgery. 



  3. Liver Transplant: 
A liver transplant is another surgical technique for elimination of liver cancer from the body. This method is not advisable for people suffering from bile duct cancer.
 Also, only people with one or multiple small liver tumors are considered for this treatment. It involves removing the entire liver for eventually replacing it with a healthy liver taken from a donor. 
People suffering from liver cancer and those who qualify for a liver transplant need to wait for a long time for getting the correct donor. As a result, cancer continues to grow and at that time, tumor ablation therapy is considered suitable for the patient till time being.

  4. Isolated Liver Perfusion: 
This method is only used in rare liver cancer cases wherein the cancer is failing to respond to other surgical techniques. The name comes from, the procedural step wherein highly concentrated chemotherapeutic drugs are infused into the liver. As a result, hepatic circulatory system is separated from other sources that supply blood to the body. 


Other than the above treatments, targeted therapies, chemotherapy, palliative treatment and radioembolization are used for treating patients suffering from liver cancer. That is decided of course on the basis of type, staging and progression of tumors.

Post Procedure

The surgery duration depends on the complications and progression of the liver cancer inside. The time will differ from patient to patient.

  • Recovery area - You will be moved to the recovery area from the operation theater once your surgery is done.
  • IV-drip - An intravenous fluid drip is connected to a vein in your neck for giving you fluids and medicines.
  • Oxygen mask - An oxygen mask is attached externally to your body to maintain a constant oxygen supply.
  • Catheter - A catheter is left in your bladder for proper urinary functioning for 2-3 days from the surgery. Thereafter, the patient is kept in a High Dependency Unit to be kept under observation for few more days till he is declared fit to go home.

Do's and Don'ts... Post-Liver Cancer Surgery

Following listed are the recovery tips to be followed in the period post undergoing any of the above treatments listed for liver cancer of any stage.

  • Incision care - The dressing placed to seal the incisions used during procedure need to be kept clean and infection free.
  • Fatigue - It is normal to feel tired and upset over the few days post surgery. Memory retention and concentration is also very difficult; let it pass.
  • Plenty of rest - You should allow yourself plenty of rest once you get the discharged from the hospital.
  • Heavy physical activities - Avoid lifting heavy objects and attempting any pressuring tasks anywhere in the house.
  • Driving - Avoid driving your vehicles for at least 6 weeks after surgery.
  • Return to work - 3-4 weeks time is enough for cooling off the effects of surgery and returning to work thereafter. However, your doctor can be the best judge to advice about getting back to work.
  • Alcohol - You should stay away from alcohol consumption for at least 6 weeks after surgery.
  • Diet - It is advisable that you avoid eating hard or crunchy foods in the early part of your recovery period. Prefer juices, soups and related fluids that will keep you hydrated as well as energetic.
  • Frequency of food intake - The gaps between food intake in the entire day should not be too much. This is so as to not disturb the liver functioning further more, as the functioning post surgery is obviously disturbed.
  • Adequate nutrition - Make sure to include a balanced diet and nutrition categories in your everyday food post surgery. This is helpful not only in improving liver functioning but also in promoting regeneration of liver post any surgery for cancer elimination.
  • Laxatives - You may be requiring laxatives for the first few days to have a smooth bowel movement. Emphasize on eating specific fruits like kiwifruit and prunes to clear the bowel properly without medication.

Risks and Complications

There are few complications associated with liver cancer surgeries mentioned above.

Liver Resection Risks

Bleeding post surgery is a common complication. Also, development of blood clots in legs post operation which is also known as deep vein thrombosis is another possibility. Infections developing at the site of surgery and leakage of bile from liver are 2 other complications coming with the liver resection procedure.

Liver Transplant Risks

Liver rejection is the most common side effect. It happens because the transplanted liver is relatively new to the body and also to the immune system. As a result, diarrhea, reduced energy levels, yellowing of skin and fever with high temperature are experienced by the patient. Also, there are likely side-effects because of medicines used during transplant that may cause high cholesterol, high blood pressure, weakened bones and kidneys etc.

Cryosurgery Risks

Cryosurgery done for treating the liver cancer may cause hemorrhage, infection, damage to major blood vessels and bile ducts and at times also relapse of the cancer

This page included information on liver cancer surgery types and every detail a patient ought to know about what happens during, before and after surgery. The treatment method; whether surgical or non-surgical, depends on the age, grade of tumor, overall health and extent of progression of the tumor in the person's body.

In case you have a concern or query you can always consult an expert & get answers to your questions!

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Frequently Asked Questions on Liver Care

MBBS, DNB ( General Surgery)
Liver Transplant Surgeon, Pune
Frequently Asked Questions on Liver Care

1. Why liver is an important organ of the body?

The liver is one of the largest organs in your body. It helps digest the food you eat and convert it into energy. It also helps fight infections and cleans your blood, thus making it a very vital organ.

2. How lifestyle can affect health of liver?

Due to our changing life style patterns, alcohol is consumed either as a status symbol or to cope up with stress. Alcohol puts a lot of stress on the liver, such continuous state of stress usually results in liver damage.

3. What are the different common diseases related to liver?

Cirrhosis, Viral hepatitis (Most common form across the world are Hepatitis A, B & C), fatty liver disease and alcoholic liver disorders are the common disease of liver.

4. What is a liver transplant and why is it done?

Simply put ‘Liver Transplantation’ is surgery to remove a diseased or injured liver and replace it with a healthy one from another person, also called as a donor.In adults, the most common reason for needing a liver transplant is ‘Cirrhosis’. This is caused by various different types of diseases which destroy the healthy liver cells and replace them with scar tissues.

5. What are the types of liver transplants?

There are two types of liver transplants – Living Donor and Deceased Donor Transplants. In case of the 'living donor' Liver Transplant, a portion of Liver from the living donor is removed and transplanted in the recipient patient. In both recipient and donor,the liver regenerates to necessary size in about 6 to 8 weeks. Only near relatives can donate. In deceased donor liver transplants, the donor is a brain dead person.

6. How much time is needed for a patient to recover after liver transplant?

Recovery time ranges from 1 to 2 weeks. Proper care, follow-up and life-long medications are required for the new Liver to function properly.

7. Can liver grow back to normal after the transplant?

Yes. Liver is the only organ which can regenerate in case of living donor liver transplant, a portion of liver from the living donor is removed and transplanted in recipient patient. In both recipient and donor, liver regenerates to necessary size in 6-8 weeks. Only near relatives can donate liver in this case.

8. What does Sahyadri Hospital has in offering for Liver care?

Sahyadri Hospitals has an A-Z Liver Wellness Clinic dedicated for the management of all types of diseases related to Liver, Pancreas, Bile ducts & Gall bladder. It Offers state-of-the-art facilities for Liver, Kidney & Pancreas Transplant with 24/7 availability of dedicated multi-disciplinary ‘Liver Team’, including Hepatologist, Critical Care Physicians and Liver Transplant Surgeons, a well-equipped Intensive care unit with dedicated nurses, physiotherapist and nutritionist. If you wish to discuss about any specific problem, you can ask a free question.

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Who Needs A Liver Transplant?

MBBS, DNB ( General Surgery)
Liver Transplant Surgeon, Pune
Who Needs A Liver Transplant?

The liver is responsible for filtering blood from the digestive system, metabolizing drugs and detoxifying the body. It also produces a number of proteins that help blood clot properly. Some diseases such as hepatitis, cirrhosis, cancer or gallstones can restrict the liver’s ability to function properly. In such cases, a liver transplant may be needed. This involves replacing the patient’s own liver with a part of a healthy liver or an entire liver from a donor.

A liver transplant can help save a person’s life. Without the liver, toxins will accumulate in the body and cause damage to other internal organs as well. It can also lead to bacterial peritonitis or a bacterial infection in the abdomen or cause blood to flow back in the stomach or accumulate in the spleen. Hence when a person suffers from a chronic liver disorder, a liver transplant is suggested. Some conditions under which such a procedure may be advised include:

  1. Cirrhosis or scarring of the liver caused by hepatitis C, biliary disease, excessive alcohol consumption
  2. Biliary atresia or the incomplete development of bile ducts
  3. Acute liver failure caused by viral infections or an overdose of certain drugs

However, not everyone suffering from these conditions is eligible for a liver transplant. A person’s eligibility for a liver transplant is determined by any other health problems the patient might be suffering from, age and the results of laboratory tests such as blood clotting tests, blood tests, liver and kidney function tests and electrolyte tests. In cases where an infection is suspected, blood, urine, sputum and bile cultures may also be grown to check for bacteria, viruses, fungi and other such organisms.

Donor livers are not always readily available and hence if a liver transplant is recommended, further tests will be needed to see where the patient will be placed on the liver transplant waiting list. This includes:

  1. Live Ultrasound- This test checks how well blood flows to and from the liver by using soundwaves to create a picture of the liver.
  2. Electrocardiogram or ECG- This tests the electrical activity of the heart and determines whether the heart will be able to take the stress of an operation.
  3. Dental Tests- A dental clearance is also required before undergoing a liver transplant as many types of Immunosuppressive drugs may increase chances of infections in cavities and periodontal disease.
  4. Purified Protein Derivative (PPD) Skin Test- This test is performed on the arm to check for tuberculosis exposure. If you wish to discuss about any specific problem, you can ask a free question.
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Alcohol And Liver!

Fellowship in Liver , Clinical hepatobiliary pancreatic surgery, Fellowship in Minimal Access Surgery
Liver Transplant Surgeon, Pune

The truth is, alcohol and your liver don’t mix. For some people, consuming as little as one glass of wine or beer a day can cause liver problems to develop. 

If there’s one thing that most people understand about the liver it’s that it serves as the body’s liquor control board. When you have a glass of wine, beer or other liquor, the liver is in charge of processing this alcohol and detoxifying the blood.

Liver can only handle a certain amount of alcohol at any given time, so if you drink more than the liver can deal with by drinking too quickly, or drinking too much, your liver cells struggle to process it. 

If you continue to drink excessively, either through binge drinking or by having multiple drinks on a daily basis, you’re making your liver work continuous overtime. The consequences of this abuse may be the destruction of liver cells, a build-up of fat deposits in your liver (fatty liver), or more seriously, liver inflammation (alcoholic hepatitis), permanent scarring (cirrhosis) or even liver cancer

When alcohol reaches the liver, it produces a toxic enzyme called acetaldehyde which can damage liver cells and cause permanent scarring, as well as harm to the brain and stomach lining. But that’s not all. 
 
Your liver also requires water to do its job effectively. When alcohol enters the body it acts as a diuretic and as such dehydrates you and forces the liver to find water from other sources. The severe dehydration is part of the reason why, after a big night of drinking you can wake up nursing a whopping headache. 

Regular and heavy drinking over time can strain or upset the way alcohol is metabolized within the body, which can lead to alcoholic liver disease

So think twice before drinking!

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