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Liver Transplantation And Hepato-Pancraetic Biliary Surgery

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How does a Liver Transplant happen

How does a Liver Transplant happen

April 20, 2020

A Liver Transplant is a surgery in which the entire liver or just a part of it, may be transplanted. In a liver transplant surgery, an unhealthy or a diseased liver of a person is replaced with a healthy liver from another person.

In most cases, the healthy liver comes from an organ donor who may have just passed away.

In some cases, a healthy living person, also donates a part of their liver. It could be a family member, or someone whose blood type is a good match. This person may not necessarily be a relative.

Since the liver regenerates, a living donor can have a healthy life, even after donating a part of it.

The donor’s liver grows back to it’s normal size after surgery. Since the liver is the only organ that can replace lost or injured tissue, the part of the liver that gets donated, also grows back to its normal size within a few weeks.

Why is it necessary to get a liver transplant?

A person cannot survive if the liver stops functioning properly, which is why a liver transplant is needed.

A liver transplant is usually advised in chronic liver failure or last stage of liver disease.

Liver Cirrhosis happens when scar tissue replaces the healthy tissue of the liver. Thereby, reducing the liver’s ability to function properly. Cirrhosis is the chief cause of end stage liver disease.

Apart from liver cirrhosis, other causes of end stage liver disease can also be caused due to:

  • Autoimmune Hepatitis – Happens when the body’s immune system attacks the liver and causes inflammation.
  • Biliary Atresia – This happens in newborns, it is a rare disease of the liver and bile duct
  • Non-alcoholic Fatty Liver (NAFLD) or Non Alcoholic Steatohepatitis (NASH) : This is not caused due to alcohol. The liver is damaged due to excess fat built up on the liver. NASH is a type of NAFLD which includes hepatitis, fat build up and liver cell damage.
  • Viral Hepatitis – Caused due to Hepatitis B or C
  • Metabolic diseases – Disorders that alter the chemical activity in cells affected by the liver
  • Primary liver cancer – are cancer tumors that originate in the liver
  • Acute Hepatic Necrosis – Toxins, illegal drugs, medicine reactions and acute infections can also cause the the liver’s tissue to die

What is the evaluation process for liver transplant?

Liver Helpline India team will decide if you are a good candidate for a liver transplant. The team makes you undergo a series of tests, to place you on the national transplant waiting list. The transplant centre team consists of the following:

  • Transplant surgeon
  • Transplant nurses
  • Transplant provider as well as a hepatologist
  • Psychologist
  • Social Worker
  • Other team members like anaesthesiologist, chaplain, dietician etc.

The Liver transplant evaluation process includes:

  • Blood Tests – Blood tests help determine the chances that the donor’s liver will not get rejected by your body. Hence they help find a good donor match and also determine your priority on the waiting list.
  • Psychological and social evaluation – This helps you and the team assess various issues like your finances, post surgery support from your family and friends and also your stress levels.
  • Diagnostic tests – These let your doctor check your liver and your general health. Tests may include, Ultrasound, X-Ray, heart and lung test, dental exams, colonoscopy and liver biopsy. Women may need few more tests like mammogram, Pap-smear, gynaecology exam.

The liver transplant team assesses if the test results and information it has received, meets all the criteria required for the liver transplant.

Liver transplant may be denied in case you have the following conditions:

  • If you have heart problems or other health problems which may be severe
  • If you are unable to follow a treatment plan
  • If you have serious conditions apart from liver disease which may further deteriorate after the transplant
  • If you have an infection that cannot be treated
  • If you consume alcohol excessively
  • If you have metastatic cancer, where the cancer has spread from it’s main location to other parts of the body

How does your name come on the waiting list for liver transplant surgery

  • You will feature on the waiting list of the transplant basis your liver and health condition
  • The list is usually long, patients who need a new liver urgently are given priority and their name’s put on the top
  • The organ is available for transplant when a donor dies. When this happens our team at Liver Helpline India informs the candidate, who will then need to come to the hospital immediately and undergo the liver transplant surgery
  • If the candidate has a living donor, then the day of the transplant can be planned in advance. It is important for the donor to be healthy and have a blood type which is a good match for the recipient. To be assured of the donor’s decision and their comfort with it, liver India also conducts a psychological test with the donor. Both, the donor as well as the recipient undergo the surgery at the same time.

Does liver transplant have any risk?

There are risks in all procedures. Following are the complications that may happen due to the liver surgery:

  • Bile leakage or blocked bile ducts
  • Infection
  • Blood vessels that may be blocked to the new liver
  • The new liver may not work for a short time post surgery
  • Bleeding

The body’s immune system may also reject the new liver, as the immune system treats any foreign object or tissue as a threat and starts attacking it.

Anti-rejection medicines or immunosuppresive medicines are prescribed for the rest of your life to weaken your immune’s responce, and help the new liver survive in your body.

Some liver diseases may reoccur even after a transplant. You may be prescribed Hepatitis B or C medicine to increase the success rate of your transplant.

How to prepare yourself for a Liver Transplant Surgery?

  • Feel free to ask any questions and clarify your doubts about the surgery during the explanation session with the team in liver India
  • You will be provided with a consent form, you should read it carefully and clarify your doubts, if any, before signing it and giving the permission for the surgery
  • In case of a planned living transplant, follow the instructions provided to you, of not eating or drinking before the surgery. If the transplant is facilitated through a donor, who has just died, then you should not eat or drink, once your informed about the liver’s availability
  • A sedative may be given to you, to help you relax before the surgery

Based on your health condition, Our team of experts may also give you some additional instructions, which are important for your to follow.

What happens during a Liver Transplant Surgery?

Liver transplant surgery requires hospitalization, and usually happens in the following process:

  • You will need to change into the hospital gown
  • Intravenous or an IV line will be started in your hand
  • Catheters will be put in your neck and wrist, or in the groin area or under your collarbone to check your heart and blood pressure, and to get samples
  • You will be placed with your back on the operation table
  • Hair on the surgical site will be clipped or removed
  • A catheter will be inserted into your bladder to drain off urine
  • You will be given sedatives, and once sedated, the anaesthesiologist puts a tube into your lung to help you breathe with a ventilator. During your surgery, the anaesthesiologist constantly monitors your blood pressure, breathing, heart rate and oxygen levels in the blood.
  • The skin on the surgical site is cleaned with a sterile antiseptic solution
  • An incision is made by the doctor, under your ribs, on both sides of your belly. The incision goes straight up, over the breast bone
  • The doctor separates the diseased liver from the nearby organs and structures, with utmost care
  • To stop the blood from flowing into the diseased liver, the attached arteries and veins are clamped
  • To remove the diseased liver and implant the donor liver, there are various surgery methods, depending on your condition and the doctor’s practices, the doctor decides the one best suited for you.
  • The diseased liver is removed after it is cut-off from the blood vessels
  • The surgeon checks the donor liver before implanting it on your body
  • The donor liver is then attached to your blood vessels, and blood flow to the new liver is started. The surgeon checks for any bleeding on the stitches
  • The new liver is then attached to the bile ducts
  • The incision is closed with the help of stitches or surgical staples
  • To reduce swelling, a drain may be placed into the incision site
  • Dressing or a sterile bandage is applied

What happens after a liver transplant?

When the liver transplant surgery is over, you may be taken to the recovery room for a few hours and then taken to the ICU for a few days, which has monitors that show your heartbeat, breathing rate, blood pressure, oxygen levels and other readings. You will be hospitalized for 1-2 weeks or more, depending on your recovery.

A breathing tube which helps you breathe through the ventilator is inserted in your throat. Depending on your condition, the same may be kept for a few hours or a few days.

To remove the air that you swallow, a thin tube may be inserted into your stomach, through the nostrils. The tube is removed when the bowel regains it’s normal functioning. Food and drink is allowed only when the tube is removed.

All systems like the circulatory system, kidney, lungs etc. will be checked for smooth functioning. To check on the new liver, blood samples will be taken frequently.

Intravenous drips (IV drips) are given to help maintain your blood pressure, heart, and to also manage any bleeding problems. The drips are reduced when you slowly start recovering, and will be taken off post which antibiotics are given.

Once you are stable, the breathing and stomach tubes will be removed. You can now drink liquids, and slowly progress to solid foods as adviced by your doctor.

To ensure the right dose and mix of the anti-rejection medicine, our team of experts will monitor you closely

You will be moved from the ICU to a private room once your condition improves. Activities like getting out of your bed and walking for a longer time will slowly be introduced. Slowly, you will also be given more solid foods.

At the time of your discharge, your transplant team guides you thoroughly on how to take care of yourself at home, after a liver transplant surgery.

How to take care of yourself at home after your liver transplant surgery?

  • Follow the bathing instructions provided to you. Keep your surgical area clean and dry.
  • It is important to follow the activity restrictions. Do not drive till adviced by your doctor.
  • Call your doctor if you have redness, bleeding or swelling or any other drainage from the incision site
  • Call your doctor if you experience more pain around the the site where the incision has been made as this may be due to infection or rejection
  • Call your doctor immediately if you have fever as this may be due to an infection or rejection
  • Speak to your doctor if you have vomiting or diarrhoea
  • Call your doctor immediately if you notice your skin and eyes turning yellow, as this may be due to jaundice

A follow up visit will be required, and stitches or surgical staples which were not removed during your discharge from the hospital, will now be removed. Depending on your condition, your doctor may give you any further advice, as necessary.

How to prevent rejection of the new liver after a liver transplant surgery?

You will be prescribed immunosuppressive medicines or anti rejection medicines to weaken the immune system and help the new liver survive in your body. These medicines have to be taken for the rest of your life.

Since each body is unique and reacts differently to the medicines, the transplant team will create a treatment plan that is best suited for you.

In most cases, a few immunosuppressants are prescribed, and the dosage is changed based on the responce.

Our team of experts, at Liver Helpline India, will watch for any signs of rejection actively, through blood tests. You may need to undergo Liver Biopsy, in case there are any signs of rejection.

Since anti-rejection medicines suppress the immunity system, you may be more prone to the following infections post your liver transplant surgery

  • Respiratory Viruses
  • Thrush or Oral yeast infections
  • Herpes

Avoid crowded places or meeting anyone with any infection, during the first few months of your surgery.

What are the symptoms of rejection?

Following may be a sign of rejection:

  • If you develop jaundice and notice yellowing of the skin and eyes
  • If your urine is dark in colour
  • If you have fever
  • If there is itching
  • If you are easily irritated or annoyed
  • If you have a headache
  • If your belly is swollen or sore
  • If you experience extreme tiredness or fatigue
  • If you have an upset stomach

Since the symptoms are unique to each patient, call our team of experts, even if you experience any one of the above mentioned symptoms.

Next Steps

Ensure you know the following, before agreeing to the test or procedure

  • What is the test or procedure called
  • Why the test or the procedure is needed
  • What type of results may be expected and what they may mean
  • What are the benefits and risks associated with the procedure or the test
  • Are there any complications or possible side effects
  • The date and place where procedure or the test will be conducted, and the time taken for the same
  • Qualifications of the person doing the test or the procedure
  • What are the consequences of not undergoing the procedure or the test
  • Is there an option or an alternative for the test or the procedure
  • When and how will you see the results
  • If you have any questions or problems, who should you call, after the test or procedure
  • What are the cost implications of the test or procedure

One of the best hospitals for a liver transplantation in India. Our team comprises of the best liver surgeons in india, who are highly experienced and very approachable. For any queries, or to book an appointment, Call (+91)- 9650915455