-Dr. Vivek Vij, Chairman, Fortis Escorts Liver & Digestive Diseases Institute
A liver transplant is a life-saving, major, and complex procedure in which the recipient’s whole damaged liver removed and replaced with a new liver graft procured from a live or deceased donor.
Liver is vital organ situated in right upper quadrant of abdomen. It has more than 500 function in body but most important functions are bile formation which assist fat metabolism, storage of glycogen, fat, minerals and vitamins, formation of clotting factors, removal of toxins and aid in immunity by removal of pathogen including bacteria etc.
There are various causes of liver damage like alcohol, viral infection (hepatitis A,B,C,D & E), High caloric-fatty diet, Obesity, uncontrolled diabetes, Genetic abnormalities etc. There are different stages of liver damage in which healthy liver initially become fatty and related inflammation in which liver enzymes SGOT/SGPT remains elevated in liver function test (LFT). This staged gradually progressed to liver fibrosis over few months or years. In this stage liver function usually similar to fatty liver stage but stiffness will increase which can be assess via “fibroscan or elastography”. This stage finally progress to irreversible stage of cirrhosis of liver in which liver become irregular/nodular at surface. In this stage liver is cirrhotic in imaging (Ultrasound / CT scan) with normal bilirubin and albumin in LFT and no other sign or symptoms related to cirrhosis of liver but on further progression it is known as decompensated stage in which patient might developed jaundice, ascites (fluid in abdomen), vomiting of blood or/ and bleeding per rectum, hepatic encephalopathy (irrelevant talking, drowsiness or unconsciousness), pedal oedema etc. Compensated or decompensated liver cirrhosis and previous Fibrotic stages specially presence of hepatitis B/C/D have risk to develop liver tumour.
Usually compensated stage with tumour (with in a defined international criteria) and decompensated stage with (with in criteria) or without tumour are indication for liver transplantation.
Apart from these chronic indication another situation in which liver transplant could be life saving is “Acute liver failure”. In this situation previously healthy liver suddenly failed due to presence of risk factors like, alcohol, hepatitis A/B/C/E, Ayurvedic or unani medicine, toxins, drugs like anti-tubercular medicine or chemotherapy and paracetamol toxicity etc. in this condition patient suddenly developed progressive deep jaundice, ascites, increase INR (increase tendency to bleed), unconsciousness and cerebral edema. Few or all these sign/symptoms developed rapidly, life-threatening and liver transplants could be life-saving if not respond to conservative treatment.
Nearly 5 lakhs Indians died every year due to unavailability of organs. About two lakhs Indians need a new kidney and one lakh need new liver. Organ donation gradually increased in India in last decade 313 in 2013 to 905 in 2017. This donation is still very low 0.8 per million as compared to USA-31.96 per million and Spain-46.9 per million. one deceased donor can save 8 lives (1 heart+ 2 lungs+ 1 liver+ 1 pancreas+ 2 kidneys+ 1 intestine). So these organ awaiting lives could be save by increase donation of organs. This could be achieve by awareness regarding decease organ donation and living donor transplantation. now the question will arise that who can be a living donor and answer is: compatible blood group, medically healthy, family person or relative adult/middle age person (see figure below).
Living liver donor can donate, Right lobe/Left Lobe for adult and Left lateral lobe for child recipient.
In Living donor residual liver increase to 90-95% of original volume in 3 months. Living donor can resume their normal activities after 3 weeks, gymming and sports activities after 5-6 months, require no long term medicines and have sense of heightened self esteem. Recipient require to avoid heavy activities for 6 moths, avoid outside food, avoid crowds, wear mask and require life long immunosuppressive medicine.
We have done >1500 liver transplant Fortis group of hospitals in Delhi-NCR in last 10 years with 95-97% recipients success and donors 100% success rate.