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LIVER TRANSPLANT

He team at SPS Hospitals, Ludhiana has successfully performed its first liver transplant surgery. Under the stewardship of Dr. Subash Gupta,Director, Centre for Liver and Biliary Sciences, New Delhi, led by Dr. Arindam Ghosh, Senior Consultant, Liver Transplant & G.I. Surgery & Dr. Nirmaljeet Singh Malhi, Senior Consultant & Head, Department of Gastroenterology. As a team they have successfully given a new lease of life to a patient suffering from end stage liver disease, due to chronic HCV infection.

Dr. Gupta is one of the world’s leading Liver Transplant surgeons and a proud recipient of the Dr. B C Roy award. Speaking on the occasion Dr. Subash Gupta added “Our endeavour has been to offer a comprehensive program that takes care of all liver diseases from babies to the geriatric age group. Thought our foray into Ludhiana, we wish to establish a liver transplant program of repute to serve the people of this region and beyond”
    Dr. Arindam Ghosh SPS Hospitals said, “the success of this liver transplant exhibits the high quality, safety, reliability and affordability of our healthcare services. This world class liver transplant program at Ludhiana will not only benefit the people of Punjab but will also cater to the needs of those requiring liver transplants from the neighbouring states of Haryana, Himachal Pradesh, Jammu & Kashmir and Rajasthan.

Dr. Nirmaljeet Singh Malhi expressed his concerns regarding accelerated rise in number of patients of chronic liver disease in Punjab. He informed that Hepatitis C, alcoholism and obesity (metabolic syndrome) are three major culprits for liver damage in our state. According to Dr. Malhi, need for awareness among public, regular testing for disease evaluation and early treatment can reverse/ delay the progression of disease. But in advanced cases, the only ray of hope is liver transplantation.
    End stage liver disease is a potentially fatal condition in which there is a progressive loss in liver function over a period of months or years. According to Dr. Arindam Ghosh, in such situations the liver is no longer able to work at a level needed for day-to-day life.
    According to Dr. Ghosh, with improvement in surgical techniques this operation ensures safety of both the donor and recipient of liver transplant with excellent short and long term outcomes. He further added that liver donation is absolutely safe and remaining liver of donor as well as the liver donated to recipient regenrates to its normal in few weeks and recipient & donor can lead normal life afterwards.
    Commenting on the occasion Dr. Ubaid Hamid, Medical Superintendent, said, “we have established the most up to date and state of
    the art infrastructure geared towards undertaking successful liver transplants with the highest level of clinical excellence and highest standards of patient safety.
     Patient Swaran Kaur (name changed) was diagnosed as decompensated chronic liver disease due to Hepatitis C virus infection. She was admitted multiple times due to various complications. Her chances of survival beyond 3 months looked very bleak due to her advanced liver disease. After proper councelling her daughter Jaspreet Kaur(name changed) gave her half of her liver for living donor liver transplant for her mother.Both recipient mother and donor daughter recovered well after surgery.
    SPS Hospitals,Ludhiana have started Liver clinic where chronic liver disease patients will be jointly seen by Medical gastroenterology & Hepatology and Liver Transplant Team and will be given state of art world class treatment.

1. What is live donor liver transplantation?

A: Live Donor Liver Transplantation (LDLT) is a procedure in which a live donor gives a portion of his or her liver to a family member in need of a liver transplant.

2. Who is a candidate for liver transplantation?

A: Individuals who suffer from end-stage liver disease from various causes are considered for  liver transplantation.

3. How is the decision made to transplant a patient liver?

A:The decision to transplant a patient liver is made in consultation with all individuals involved in the patient care, including the patient, referring physician, and the patient family. The patient and family  input is vital in this decision making process they must clearly understand the risks involved in proceeding to transplantation and the post transplant care. In general, if a person has a poor chance of living in the next 1-2 years from their underlying liver disease, those patients are the candidates for liver transplant.

4. Which diseases are treated by liver transplantation?

A: A large number of diseases are capable of decreasing or interfering with the liver function and threatens the life of the patient. Most of these diseases are potentially treatable with liver transplantation. Heavy accumulation of scar tissue due to the death of liver cells due to various underlying diseases is called cirrhosis of the liver. Various causes of cirrhosis are chronic viral hepatitis such as hepatitis C or hepatitis B, alcohol and Non alcoholic fatty liver disease due to obesity. In children, the disease most often treated by liver transplantation is biliary atresia, which is a failure of bile ducts to develop normally and drain bile from the liver.

5. Is liver transplantation a common treatment for cancer of the liver?

A: Liver tumours that start in the liver, such as hepatocellular carcinoma, that have not spread to other organs can be cured by transplantation. However, if the liver cancer has spread outside the liver, the patient is not a candidate for liver transplantation. Patients with a single tumour that is less than 5 cm in size or have no more than three tumours all less than 3 cm in size can be cured with liver transplantation and have excellent long term survival.

6. Do you have an age limit?

A: The age limit is individualized as it varies with a patients overall health condition. However, it is rare to offer liver transplant to someone greater than 70 years old.

7. Who can qualify as a liver donor?

A: Live liver donors are relatives or close acquaintances of the recipient. They must have a compatible blood type and body size, as determined by the recipients height and weight. In addition, donors must be between the age of 18 and 60. They must also test negative for liver diseases and can have no serious medical conditions such as diabetes, cancer or heart disease.

8. How is the liver transplant surgery performed, and how long will it take?

A: Simultaneously, two separate surgical transplant teams perform the donor and recipient surgeries. As one team works on removing the diseased liver from the recipient, the other is working on removing a portion of the donors healthy liver. Once the portion of the donors healthy liver has been removed, it is immediately implanted into the recipient. The live liver donor surgery typically takes about 5-6 hours, and the recipient surgery of removal of diseased liver followed by implantation of new liver takes 12-14 hours.

9. How long will donor and recipient be in the hospital after surgery?

A: The average donor will be in the hospital for 4-7 days. The recipient will remain in the hospital for about 14-21 days. It is very important to tell that the liver regenerates in the donor as well as the recipient to its full functional capacity as well as size in few weeks.

10. What are the risks involved to the donor ? 

A: With the evolution in preoperative planning and surgical techniques, better intraoperative and postoperative care, the donor surgery is quite safe nowadays. There are still chances of some minor complications in 15-20 percent of cases and major complications in about 1-2 percent of cases. 

11. How long does it take to recover from liver transplantation?

A: Recovery after liver transplantation depends in part on how ill the patient was prior to surgery. Most patients need to count on spending a few days in the hospital in the intensive care unit and another few days on the ward; about a minimum of 2 weeks in the hospital is our estimate. The range of days spent in the hospitalization is from 10 days to maybe even six weeks. 

12. What side effects do patients who have had liver transplantation commonly experience from the medicines they take to treat or prevent rejection?

A: All the medications used to prevent rejection increase a patient's susceptibility to infections. Various medicines are used, and each has its own set of effects and side effects..

13. What is the overall success rate of a liver transplant?

A: The answer to this question depends on many factors, but overall success rate nowadays is 85% to 95% .

14. Do the patient who is donating the liver/donor and the patient who will receive the liver/recipient have to be matched by tissue type/sex/age etc? 

A: No. At this time for liver transplantation, the only requirements are that the donor and recipient need to be approximately the same size and have compatible blood types. No other matching is necessary such as gender or age. Now blood incompatible transplants are also being carried out successfully.

15. Can individuals have physical activity after receiving a new liver?

A: The liver transplant recipient can lead absolutely normal life after liver transplantation. We encourage patients to get out of bed as soon as feasible. Most patients can return to a normal or near-normal existence and participate in fairly vigorous physical exercise six to 12 months after successful liver transplant. 

16. Please give the final words of advise to the general public

A: The liver diseases are potentially treatable diseases, its better if these are diagnosed and treated in the initial stages. Liver transplantation is the final answer for the decompensated liver disease with very good results.

Dr. SUBASH GUPTA

MBBS, MS (AIIMS), FRCS (Edin), FRCS (Glas) Chief Liver Transplant & Hepatobiliary Surgeon. Centre for Liver & Biliary Sciences

Dr. ARINDAM GHOSH

M.B.B.S., M.S. (Gen. Surgery)

M. Ch. (Gastroenterology Surgery)

Senior Consultant

Surgical Gastroenterology G.I. & H.P.B Oncosurgery Weight Loss & Metabolic Surgery (Surgery for Diabetes) Advance Digestive Laparoscopy

Dr. Nirmaljeet Singh Malhi 

M.B.B.S., M.D., (Medicine) PGI, Chandigarh D.M. (Gastroenterology) PGI, Chandigarh Senior Consultant & Coordinator

For more Information please contact Mr. Kalpesh Chand: +91 - 8872027303 

kalpeshchand@pshospitals.com

 

LIVER TRANSPLANT

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