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Liver Transplantation in India

Liver transplantation, a life-saving surgical procedure, is a beacon of hope for individuals suffering from severe liver diseases. In this operation, a diseased or damaged liver is replaced by a healthy liver obtained from either a deceased donor (whole liver) or a living donor (part of the liver).

Given the essential role of the liver in bodily functions such as processing nutrients, producing bile, synthesising proteins for blood clotting, and detoxifying harmful substances, this procedure is critical. The liver transplantation cost varies but is typically substantial due to the complexity of the procedure.

What is Liver Transplantation?

Liver transplantation involves the replacement of a malfunctioning or damaged liver with a healthy one from a donor. The replaced liver can be an entire organ from a deceased donor or a part of a liver from a living donor.

The operation theatre (OT) procedure, known as hepatectomy in medical terms, sees the removal of the diseased liver and the grafting of the new one in its place. The blood vessels and bile ducts are then meticulously connected to ensure proper functioning.

Why is Liver Transplantation Done?

Liver transplantation is typically carried out as a last resort when other treatments fail to effectively control symptoms or halt the progression of liver disease. It may be recommended if you have:

• End-stage liver diseases such as cirrhosis, which replaces healthy liver tissue with scar tissues, impairing liver function. Common causes include alcoholic liver disease, chronic viral hepatitis (specifically hepatitis B and C), nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), as well as autoimmune hepatitis.

• Acute Liver Failure, which can occur suddenly due to factors such as an overdose of acetaminophen, viral infections, toxins or drugs, or severe autoimmune diseases.

• Liver Cancer. Liver transplantation may be an option for patients when the cancer is confined to the liver and has not spread.

• Rare Genetic Disorders. Certain metabolic disorders affecting liver function may necessitate a transplant.

Preparation for Liver Transplantation

Liver transplantation is an intricate process that requires careful preparation, followed by a meticulous surgical procedure, and then a dedicated post-operation care plan. The below information provides a detailed insight into what you can expect before, during, and after undergoing this life-altering procedure. The aim is to ensure that you are well-informed and prepared for the journey towards improved liver health.

Before a Liver Transplantation

Before you undergo a liver transplantation, there are several crucial steps that must be taken:

• Evaluation: An extensive assessment is carried out to determine if a liver transplant is the best treatment option for your case. This includes various tests to evaluate your liver function, kidney function, nutritional status, and other vital organ health.

• Detailed Medical Tests, which include blood tests; imaging techniques like ultrasounds; cardiopulmonary assessments to evaluate heart and lung health; psychological and social evaluations; nutritional counselling; and additional consultations with specialists as needed.

• Waiting List: If you're deemed suitable for a liver transplant, you will be placed on a waiting list by liver transplantation doctors.

• Preoperative Preparations: You'll need to stop using alcohol or drugs at least six months prior to the transplant. Regular screenings for substance use are conducted to ensure compliance.

• Psychosocial Assessment: A psychological evaluation may be carried out to identify any factors that could affect the outcome of the transplant.

During a Liver Transplantation

The liver transplantation surgery involves several crucial stages:

• Anaesthesia and Preparation: You will be placed under general anaesthesia to ensure you remain unconscious and pain-free during the surgery.

• Surgical Procedure: The surgeon makes an incision in your abdomen to access your liver. Your diseased liver is removed and the donor liver is then placed in your body. The surgeon reconnects your blood vessels and bile ducts. The length of the procedure varies depending on the complexity of the case.

• Postoperative Transition: After the surgery, you'll be moved to the Intensive Care Unit (ICU) for close monitoring during your initial recovery. The surgical team will regularly check on you and keep your family informed about your condition.

After a Liver Transplantation

Recovery from a liver transplantation involves:

• Initial Recovery: Typically, you would remain in the hospital for liver transplantation for about five to ten days post-surgery. Gradually, you'll be encouraged to begin physical activity like sitting up and walking to promote healing and prevent complications.

• Monitoring and Follow-Up: Regular follow-up appointments will be necessary to monitor your liver function and adjust medications, particularly immunosuppressants that prevent organ rejection.

• Long-Term Care: Ongoing care and lifestyle adjustments are crucial for the long-term success of the transplant. This includes maintaining a healthy diet, avoiding alcohol, and adhering strictly to the medication regimen prescribed by your doctor.

Recovery & Care After Liver Transplantation

Post liver transplantation surgery, recovery and care are paramount. The journey post-transplant includes:

• Hospital Stay: Patients tend to stay hospitalised for several days to monitor recovery and manage complications.

• Medications: Immunosuppressants are administered immediately after surgery to prevent organ rejection, adjusted based on regular blood tests.

• Monitoring for Complications: Regular check-ups are essential to detect any signs of organ rejection or infection.

• Follow-up Appointments: Frequent visits for blood tests and evaluations are necessary to ensure optimal liver function.

• Lifestyle Adjustments: Healthy diet, avoidance of alcohol and tobacco, and regular exercise are vital for long-term health.

• Psychosocial Support: Support from doctors, family, and friends is crucial for emotional well-being and medical regimen adherence.

Financial Counselling: Understanding the costs associated with ongoing care and medications is crucial, as many patients may require assistance with insurance and financial resources.

Types of Medication Post Liver Transplantation

Liver transplantation is a life-altering procedure that demands careful aftercare. A critical part of this is the administration of specific categories of medication to ensure a successful transplant. These include:

• Immunosuppressants: These essential drugs help your body accept the new liver and stave off potential rejection.

• Antibiotics and Antivirals: These medications prevent possible infections during the initial months following the transplant when your immune system is exceptionally vulnerable.

• Additional Drugs: You might need other medications to manage side effects or monitor other health conditions. These could be antihypertensives for blood pressure control, antacids for stomach issues, diuretics for fluid retention, and supplements like calcium and vitamin D.

Diet & Lifestyle Changes Post Liver Transplantation

A vital aspect of care post liver transplantation procedure involves adopting a health-oriented diet and lifestyle. Here are some recommendations:

• Balanced Diet: A post-liver transplantation diet brimming with fruits, vegetables, whole grains, and lean proteins can bolster your overall health and immune function.

• Low Sodium: Curtailing sodium intake helps manage blood pressure and avert fluid retention.

• Limit Saturated Fats and Sugars: By limiting these elements in your diet, you can maintain a healthy weight and reduce the risk of metabolic syndrome post-transplant.

• Hydration: While staying well-hydrated is important, consult your doctor regarding appropriate fluid intake.