A liver transplant is a procedure involving the removal of a damaged part of the liver and replacing it with a healthy donor liver. The donor liver may be received from a living or deceased donor. The liver is one of the most vital organs as it is responsible for the filtration of the blood and removal of toxins from the body. The liver transplant surgery is the last choice of treatment for chronic liver diseases when all other treatment options have failed.

What is the most common reason for a liver transplant?

The most common diseases that ultimately lead to the requirement of having a liver transplant are listed below:

• Chronic viral hepatitis (B, C, and D) which causes inflammation and chronic damage to the liver.
• Acute liver failure
• Auto-immune hepatitis – involves a compromised immune system and destruction of liver tissue
• Alcoholic liver disease
• Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis
• Primary biliary cirrhosis
• Hepatic or liver tumors
• Metabolic and genetic disorders

Other than the aforementioned reasons, a few signs and symptoms in children can also insinuate the need for a liver transplant in children:

• Portal hypertension along with variceal bleeding
• Failure of liver functions such as decreased albumin, raise clotting time, etc.
• Progressive jaundice
• Malnutrition
• Recurrent cholangitis
• Encephalopathy
• Severe hypersplenism associated with liver dysfunction.

Can you live a normal life after a liver transplant?

Even though, there is a very high success rate of approximately 70-80% with a smooth recovery. However, there are always some chances of having associated risks and complications, some of which are mentioned below:

• Internal bleeding
• Clotting of blood
• Liver transplant failure
• Infection
• Rejection of donated liver
• Mental confusion
• Seizures

These anti-rejection medications can cause a variety of side effects, including:

• Diabetes
• Headache
• High cholesterol
• Diarrhea
• High blood pressure
• Bone thinning

The living-donor liver transplant also holds some of the risks, which are listed below:

• Leakage of bile substances – The bile juices start leaking sometimes outside the liver. This is usually rectified on itself and sometimes can be treated by doctors by inserting a tube in the liver.

• Infection – the spread of infection is another common infection at the site of the surgery.

• Organ damage – The liver can sometimes get damaged by living-liver donation.

What happens during a liver transplant?

The liver transplant is broadly categorized into two types:

• Deceased-donor liver transplant

• Living-donor liver transplant

Deceased-donor liver transplant is performed under general anesthesia. A long incision is made across the abdomen to get access to the liver. The blood supply and bile ducts disconnected and removed from the damaged liver. After placing the new liver in the body, the blood vessels and bile ducts are reattached. This type of surgery takes about 12 hours.

In a living-donor liver transplant, the surgeons transplant a portion of the donor’s liver in the body. The first procedure is done on the donor for the removal of the required liver part. This is followed by placement of the donated liver part into the patient’s body, then connecting the blood vessels and bile ducts to the new liver.

What to expect after the liver transplant?

• You will need to stay in the intensive care unit of the hospital for a few days where you will be monitored for any signs of complications.

• Once your condition is stable, you will be shifted to the transplant recovery area for recovery.

• After 5 -10 days of hospital stay, you will be discharged and asked for frequent checkups with the doctor. The doctor might recommend a few blood tests a few times every week and then less frequently.

• You will then need to take medications for the rest of your life. Medicines such as immunosuppressants help the immune system from attacking your liver. Other drugs are advised to prevent complications from a liver transplant.

How much does a liver transplant cost?

It has been calculated that the overall liver transplant cost in India is 50% less than that in other western countries. This is the reason why most of the international patient across the globe prefer to visit India for their treatment. Moreover, the nation is widely known for its excellent infrastructure and skilled surgeons. For instance,
The approximate cost of liver transplant in India revolves around 26,000 USD. However, the exact cost depends upon several factors such as,

• Fees of the liver transplant surgeon

• Cost of medications

• Type of accommodation

• The city and the hospital

• The Complexity of the case.

Why is a liver transplant done?

The most common reason for liver transplant is chronic liver disease. Another most common cause is cirrhosis. Cirrhosis may take place in the liver due to the following reasons :

• Chronic hepatitis B or C
• Nonalcoholic fatty liver disease
• Alcohol abuse
• Metabolic disorders
• Autoimmune hepatitis
• Biliary atresia
• Metabolic disorders

Why would someone need a Liver transplant?

The final decision to do a liver transplant is determined based on several factors such as, 

• The complexity of the case
• Any associated medical condition
• Any history of tuberculosis
• History of any other chronic infections such as HIV
• The general well-being of the patient

To know about Liver Transplantation, 

Liver transplant in Medanta Hospital, Gurgaon

• Medanta hospital was established in 2009 by an eminent surgeon, Dr Naresh Trehan.
• It is accredited both by NABH, NABL.
• The liver transplant team at the hospital is the first of its kind offering all levels of treatment for liver and biliary diseases, other than the liver transplantation.
• The living donor system at the hospital is the largest in India and the second largest in the world.
• The team of doctors has a collective experience of performing about 2500 liver transplants so far with a success rate as high as 95%.
• Other than the liver transplant, Medanta hospital is also known for liver tumors, bile duct cancer, cysts and blocks and all complex non-transplant liver surgeries.

Read: How quality of life improves after Liver transplant surgery.

Cost of liver transplant in Medanta hospital, Gurgaon

Theliver transplant cost in India usually ranges from 38,000 USD to 44,000 USD (2735240 INR to 3167120 INR). The hospital stay is usually 22 days and 40 days outside the hospital. The donor also has to stay for at least 3-4 days in the hospital.
The investigations required before the liver transplant are blood tests, chest x-ray, lung function test, ECG, echo, coronary angiography, kidney function test, ultrasound scan, MRI, CT scan, liver biopsy, and endoscopy.

Recommended: What is the cost of Liver transplant in India?

Factors affecting the final cost of treatment in India are:

• Immune-deficient patients
• Fees of the liver transplant surgeon
• Cost of investigations and medications
• Any associated medical illness
• The reputation of the hospital
• Cost of living
• Number of days in the hospital

Liver transplant surgeons in Medanta Hospital, Gurgaon

Dr Arvinder Singh Soin

• Chairman of the liver transplant department at the hospital.
• Has performed 2500 liver transplants with a 95% success rate.
• In a span of 21 years, Dr Soin has performed more than 12,000 other complex surgeries of liver, gallbladder, and bile duct surgeries.
• He leads India’s largest and the world’s most successful liver transplant program at the hospital.

Dr Amit Nath Rastogi

• Senior consultant at the Medanta Hospital, Gurgaon.
• He has completed a two-year fellowship in liver transplant surgery at Shri Ganga Ram Hospital, New Delhi.
• He is also trained in robotic liver surgery and robotic advanced HPB.

Dr Prashant Vilas Bhangui

• Works as a senior consultant at the Medanta Hospital, Gurgaon
• Holds an experience of 15 years and specialized training in the management of colorectal liver diseases, hepatocellular carcinoma, liver transplants, and hepatobiliary surgeries.

Dr Narendra Singh Choudhary

• Senior consultant at liver transplantation department
• Holds an experience of 11 years.
• Specializes in liver transplant, endoscopic ultrasound, treatment for non-alcoholic fatty liver disease and liver cirrhosis.
• Member of Indian National Association for the Study of the Liver and International Liver Transplant Society.

Special provision for International patients at Medanta Hospital

The hospital has specialized provisions for international patients coming to India for the treatment. Some of these include:

• Organize treatment packages
• Visa assistance
• Airport pickup and drop off
• Hotel reservations
• Sightseeing trips during the recovery period
• A dedicated buddy system to provide personalised help to all the patients.
• Hospital admissions
• Lounge facility for the patients and their families where they can also meet patients from other countries.

Liver failure has become the most common cause of mortality across the globe. The process of replacing the damaged liver by a healthy one is known as a liver transplant. The donor’s liver is either taken from a brain dead patient or from a living patient. According to recent research, nearly 8000 people in the US have received a liver transplant.

The liver is one of the most vital organs situated behind the rib cage. Its main function is to do the processing of proteins, fats, and carbohydrates along with break down of toxic substances such as drugs and alcohol. The chemical substances needed for clotting of blood are also produced by the liver. In addition to this, it excretes a digestive juice known as bile, which gets accumulated if the liver does not function properly.

What are the conditions that require a liver transplant?

There are several conditions that may eventually require a liver transplant after reaching a terminal stage:

• Liver cirrhosis at the final stage, which may occur as a result of alcoholic cirrhosis, primary biliary sclerosis, hemochromatosis, chronic hepatitis, etc.

• Liver cancer such as cholangiocarcinoma, hepatic adenomas, hepatocellular malignancies, primary hepatocellular etc.

• Fulminant viral hepatitis (A, B, C, D) and hepatic thrombosis may also lead to fulminant hepatic failure.

• Liver conditions that are congenital.

Procedure

Conducted under the general anesthesia, the procedure usually takes 5-6 hours. After making an incision in the abdomen, the donor’s liver is inserted and attached to the blood vessels and other bile ducts of the liver.

What are instructions that need to be followed after the surgery?

• Visit the surgery 1-2 times a week for the next 3 months after the transplant.
• Take medications as prescribed by the surgeon. You may need to take immunosuppressive medications to prevent any rejection symptoms by the body. Also, you may need some antihypertensive drugs and antibiotics.
• It is advised to have low salt and low-calorie diet. At the same time, the diet should also be well-balanced.

What is the success rate of liver transplant surgery?

Even though the exact success rate of a patient varies from patient to patient, some results have been extracted based on the study of larger masses of people. According to a study, there are,
86% survival rate for 1 year after the surgery
75% survival rate for 3 years after the surgery
70% survival rate for 5 years after the surgery
50% survival rate for 20 years after the surgery.

Factors affecting the success rate of liver transplant surgery

There are several factors that may affect the success rate of a liver transplant in India. These factors include,

1. Age– younger people have more ability to recover and adapt to the new changes in the body as compared to the old age people.
2. BMI – people with high BMI rate are able to recover easily as compared to those who are overweight.
3. Immunocompromised patients – Patients who are already suffering from immunodeficiency disorders have an increased tendency to develop rejection symptoms in the body.

Cost of liver transplant in India

India has been a preferred choice for liver transplant by a number of international patients. This is attributed to the highly skilled and experienced hepatologists working in the top-class hospital having state-of-the-art infrastructure. Moreover, the cost of the liver transplant in India is highly affordable as compared to other countries. The cost usually revolves around 35,000 USD including the cost of investigations and other things.

What is Hepatitis?
Hepatitis is defined as the inflammation of the liver. It can either be self-limiting or may also make its way to other conditions such as fibrosis, cirrhosis or even liver cancer. The most common causes of hepatitis include:

• Viral infection
• Excessive consumption of toxic substances such as alcohol or certain other drugs.
• Autoimmune diseases

How does Hepatitis affect liver function?

The function of the liver is to do detoxification of blood, storage of vitamins and production of certain hormones. Hepatitis can cause disruption of these functions which can lead to severe health issues in the body.  For example, Hepatitis C triggers an immune response, which causes inflammation in the liver. The inflammatory response of the liver starts causing further damage to the liver.

Type of Hepatitis

There are 5 types of hepatitis – Type A, B, C, D, and E.
Hepatitis B and C are the most common causes of liver cirrhosis and liver cancer.

Hepatitis A
The most common source of this virus is the excreta of infected patients, which can be transmitted through contaminated water or food. Certain infections are mild and patients can be treated and recovered well. On the other hand, there are certain cases which can even be life-threatening. The most common areas that are affected by Hepatitis are those with poor sanitation.
Vaccines are available for hepatitis A, known as Havrix and Vaqta.

Hepatitis B
This infection is transmitted through infection in the blood, semen, and other body fluids. It can either be transmitted from infected mothers to infants at the time of birth or through the blood transfusions by infected needles and other contaminated blood products. People who are prone to have Hepatitis B are most commonly the healthcare workers who tend to have needle stick injury while taking care of an infective HBV patient.
Vaccines for Hepatitis B are present such as Engerix-B and Recombivax HB.

Hepatitis C
This is also commonly transmitted through infected blood with the help of HCV contaminated blood and blood products. Another common source is sexual intercourse. There is no vaccine available for HCV.

Hepatitis D
Hepatitis D only occurs in patients who are suffering from Hepatitis B. This becomes a severe infection which can have several worse outcomes. The vaccines used to prevent Hepatitis B can also be used to prevent Hepatitis D infection.

Hepatitis E
The most common mode of transmission for Hepatitis E is contaminated food and water. This is the most common cause of worldwide deaths in both developing and developed countries. Vaccination has been invented but not available across the globe.

Signs and symptoms

The initial phase of hepatitis is known as the acute phase. The symptoms may include :

• Diarrhea

• Fatigue

• Loss of appetite

• Mild fever

• Muscle or joint aches

• Nausea

• Slight abdominal pain

• Vomiting

• Jaundice

• Weight loss

The condition can be treated when the patient is at the acute phase. In some cases, the condition can also progress to acute liver failure or even death. As the disease progresses, it can lead to chronic hepatitis, progressive liver failure, confusion, blood in the stool or vomit, jaundice, swelling in lower extremities, etc

How is it diagnosed?

After taking a detailed medical history about all the signs and symptoms, any past medical history or family history, a clinical examination is conducted.
This is followed by a series of diagnostic tests which include:

1. Blood tests – These tests are used to check whether the body is producing antibodies or not. Also, these tests are used to analyze the liver function by detecting the levels of liver proteins and enzymes.

2. Nucleic acid tests – Tests such as HBV DNA and HCV RNA are done to confirm the speed at which the virus is reproducing in the liver.

3. Liver biopsy – This is done to measure the extent of liver damage and cancer risk.

4. Paracentesis – The surgeon extracts the abdominal is removed and tested to identify the cause of fluid accumulation.

5. Elastography – This is used to measure the amount of stiffness in the liver by using sound waves.

6. Surrogate markers – This is specifically used to access cirrhosis and fibrosis.

Early detection and treatment are important for complete recovery. Several hospitals have some of the top hepatologists in India, who are highly experienced and skilled in treating such conditions by providing accurate treatment. These conditions can also be prevented by maintaining good hygiene, eating clean food and also by using sterilization methods while getting the blood work done.