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Transplant Experts Talk to You

Read about the why , when, how and how long of transplant care. Tips and advise that will help you to better prepare for your care.

Dr. Manish Chandra Varma

MS, DNB, Fellowship in Transplantation (Harvard Medical School)
Senior Consultant and Head of Department
Liver Transplant and Hepatobiliary Surgery
Apollo Hospitals, Hyderabad, India

Liver Disease Is Not A Terminal Disease Anymore

Liver disease is not an uncommon disease. It can affect people of all ages starting from newborn babies to the elderly. The good news is that End Stage Liver Disease (ESLD) need not be considered a terminal disease anymore. This is due to the availability of liver transplantation as a successful treatment option. Liver transplants can be performed with under 5% risk to life and have an excellent long-term survival. Liver transplant patients have a 1-year survival rate of more than 90% and a 5-year survival rate of more than 80%.

What Causes Cirrhosis?

Liver cirrhosis is the most common reason for which liver transplant is performed. Viral infections (Hepatitis B and C), alcohol abuse and non-alcoholic fatty liver disease (NAFLD) are the three commonest causes for liver cirrhosis.

Some genetic conditions like Wilson’s disease, metabolic diseases (i.e. Glycogen storage disease) and auto-immune diseases (i.e. Primary sclerosing Cholangitis, Primary Biliary Cirrhosis, Auto-immune hepatitis) also cause liver cirrhosis and require liver transplant. In general, infection and life-style related causes are more common in adults, while genetic and metabolic diseases are commoner in children. Sometimes drugs, toxins, or infections damage the liver to such an extent that the liver cannot recover and needs to be replaced. This condition is called Acute Liver Failure and requires urgent liver transplant.

How is Liver Transplant Performed?

Liver transplantation is performed at specialized multi-speciality hospitals with the equipment and infrastructure to carry out complicated surgical operations. Liver disease patients have unique and complex medical care requirements which involves specialist doctors from multiple sub-specialities. In addition to Transplant Surgery and Hepatology, specialities like cardiology, pulmonology, infectious disease, nephrology, anesthesia, intensive care, psychiatry, psychology, and dentistry, form the core of the multidisciplinary care team. Specialized nurses, dieticians, physiotherapists, and social workers are also integral part of the liver transplant team.

Patients have to undergo a battery of tests and a multidisciplinary evaluation to assess their fitness to undergo liver transplantation. The operation is carried out by removing the diseased liver from the patient’s body and replacing it with a healthy liver. This liver can be full liver from a dead person (Deceased Donor) or a part of liver from a healthy live person (Living Donor). Living Donor liver transplant is more frequently performed due to the scarcity of deceased donor organs. Potential donors have to undergo tests to evaluate their suitability to safely donate a part of their liver. Donor operation is a safe operation which can be carried out with minimal risks. In the donor, liver grows back to compensate for the donated part. Donors return to normal life without restrictions on physical activity or need for long term medications.

To Sum Up
Liver failure is a serious health condition. Thankfully, the availability of liver transplantation as a curative treatment option has resulted in a paradigm shift in the overall outlook for this condition. A disease which was earlier considered terminal is now considered curable.

Author Details :-
Dr. Manish C. Varma
MS, DNB, Fellowship in Transplantation (Harvard Medical School)
Senior Consultant and Head of Department
Liver Transplant and Hepatobiliary Surgery
Apollo Hospitals, Hyderabad, India