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Liver

About the Liver

The liver is a marvellously resilient and vital organ that plays an indispensable role in nurturing and protecting your body everyday with clockwork precision. It has several key functions to perform - it helps filter and dispose off toxic materials from the blood, feeds your body the energy it needs to function, wards off viruses and infections, produces blood-clotting factors, regulates sex hormones, cholesterol levels and vitamin and mineral supplies in your body. Merely the tip of the iceberg, for the liver performs over 500 and odd functions, far more than any other organ in your body!

The need of the hour is to fully understand the critical role the liver plays in sustaining complete health. The liver supports almost every organ in the body and is vital for survival. It is tremendously important to understand the indispensable and central role that the liver plays in maintaining overall good health and vitality - only by doing so can you identify activities that help or harm this vital organ and do all you can to help protect it.

There are further advantages to be had from understanding your liver better - one, it helps you know exactly what must be done to keep it healthy and two, you will be able to actually cut down your risk of developing not only liver disease but other related health conditions such as diabetes and heart disease.

The process of caring is dual. Your liver depends on you to take care of it . . . so it can, in its turn, do a better job taking care of you. It is an efficient multi-tasker and performs manifold functions - serves as your body's engine, pantry, refinery, food processor, garbage disposal, trouble shooter and "guardian angel." As you can see, a healthy liver is the key to achieving a healthy life. The trouble lies in the fact that this indefatigable worker carries out its work silently, often there’s no hint of trouble and any damage is usually far advanced by the time it makes its presence felt. Currently, there is no artificial organ or device capable of emulating all the functions of the liver. This heightens the importance of maintaining the continual good health of your liver.

Conditions of the Liver

Liver disease can prevent the liver from performing its numerous, vital functions. There are many kinds of liver diseases. Some common diseases of the liver like Hepatitis A, Hepatitis B and Hepatitis C are caused by viruses that attack the liver. Still other liver diseases can be the result of drug abuse, exposure to poisons or excessive consumption of alcohol.

Hepatitis A causes an inflammation of the liver and is primarily transmitted through contamination of food or drinking water with fecal matter. It can be effectively prevented by vaccine shots and sanitary precautions. Hepatitis B is another infection of the liver, primarily spread through blood or body fluid contact with an infected person. It is easily prevented with vaccination and by avoiding unprotected sex, contaminated needles, and similar sources of infection. Hepatitis C is spread by direct contact with infected blood and blood products. Currently there is no effective vaccine that affords protection against Hepatitis C.

Cirrhosis damages healthy liver cells and replaces them with scar tissue, preventing the liver from functioning efficiently. Liver cancer, caused by abnormal multiplication of cells can result from diseases such as Hepatitis B and C, alcohol abuse, exposure to chemicals, or congenital defects. Liver failure is a potentially life-threatening condition characterized by severe deterioration of liver function as a result of extensive damage to the liver.

Treatment of all liver diseases involves immediate medical care aimed at slowing the progression of the disease, minimizing the symptoms and reducing further complications.

More information on each kind of disease and its causes, symptoms, risk factors and tests and diagnosis are available from the links on the left.

FAQs on Liver Transplants

Liver disease is a common and serious problem in our country. It is important for liver transplant candidates and their families to understand the basic process involved with liver transplants, to appreciate some of the challenges and complications that face liver transplant recipients (people who receive livers), and to recognize symptoms that should alert recipients to seek medical help.

What is liver transplantation?

When does one require a liver transplant?

How are candidates for liver transplant determined?

Can anyone with liver problems get a transplant?

Is Liver transplant Legal in India?

How long does it take to get a new liver?

Where does a liver for transplant come from?

Is liver donation safe?

What about Health Insurance?

What happens in the hospital?

How long would surgery take?

What happens during this recovery period?

When will I be able to go home?

What is rejection?

Do immunosuppressants have any side effects?

What are the signs and symptoms of rejection?

What are the other problems that can damage the liver transplant?

Is a recurrence of the original disease in the transplanted liver likely?

What if the transplant doesn't work?

How do I take care of my liver after I leave the hospital?

Can I go back to my daily activities?

How safe is it for women to become pregnant after transplantation?

Studies have shown that women who undergo liver transplantation can conceive and give birth normally, although they have to be monitored carefully because of a higher incidence of premature births. Mothers are advised against nursing babies because of the possibility of immunosuppressive drugs being transmitted to the infants through breast milk.

How can I donate my organs?

If you wish to be an organ donor, ensure that you carry an organ donor card and paste an organ donor sticker on your medical identification card. It is also important to discuss your views on organ donation with immediate family members since the process cannot be carried out without their consent. An organ donor card is easily available at the MOHAN Foundation.

FAQ's - Pediatric Liver transplant

What is liver transplantation?

Liver transplantation is the surgery to remove a diseased liver and replace it with a healthy one.

Who is a candidate for a liver transplant?

Children who suffer from end-stage liver disease due to various causes may be considered for liver transplantation. The most common indication in children is biliary atresia.

How is it decided that my child needs a liver transplant?

Eligibility is determined by a comprehensive medical evaluation by the transplant team.

Who can be the donor for transplantation?

There are two sources: cadaveric and living donors.

  • Cadaveric donors are individuals whose organs have been made available after brain death. As few cadaveric donations take place in India, living related liver transplantation is the only feasible option in our country. For living related transplants, a relative (usually parents) with a compatible blood type donates a portion of their liver to the child. Fortunately, the liver of the donor is able to grow back to full size in 812 weeks.
  • Living liver donors should be healthy adults, with a near normal body mass index (not obese) who have the ability to understand the procedure. The donor should have no medical, emotional, or psychological condition that could potentially increase the risk of this surgery.

What does a pre transplant evaluation process consists of?

This consist of checking all the body systems with regards to optimal function and presence of unexpected disease. Your child's immunization records will be reviewed. Following transplantation, some vaccines cannot be given and others may not be as effective.

A detailed nutritional assessment will also be performed. Several tests will be performed:

  • Laboratory blood and urine tests.
  • Electrocardiogram (ECG) and a chest X-ray.
  • CT ofthe liver and blood vessels

What are the pros and cons of living donor transplantation?

The advantage of living related donor transplant is that the procedure can be scheduled effectively so that it works best for the donor and recipient. The disadvantage is that there is a very small risk of complications to the donor. Out of the 40 pediatric living related liver transplants performed at our center, there has been no significant complication in the donor population.

What is the average hospital stay for a donor?

Most donors are hospitalized for 7-10 days after surgery. The incision staples are usually removed about 7-10 days postoperatively.

How does donation affect the donor's ability to work?

The recovery time for this type of surgery varies, but most donors are advised that they will require up to 3 months for complete recovery of normal health and activity.

How long will the operation take?

A typical liver transplant can last from 8-12 hours. The surgery for the donor lasts approximately 5-6 hours.

What are the risks of transplant surgery?

There are risks with transplant surgery just as with any major surgery. Some immediate complications can include bleeding and blood clotting problems, respiratory problems and malfunction of the donor liver. Long term complications include rejection (when the child's immune system does not accept the new liver) and infection. Fortunately, most of these complications are treatable.

What is the postoperative period like for the child who undergoes liver transplantation?

After your child's surgery, he/she will be taken to transplant ICU where he/she will stay for a week. After your child is transferred out of ICU to the pediatric floor, the length of stay will depend on how quickly he/she recovers. Average length of hospital stay is about 3 weeks.

What medications will my child take at home after transplant?

Your child will take 2 major types of medications in addition to multivitamins and health supplements to prevent rejection. If your child misses a dose, you need to contact our team immediately.

Once my child leaves the hospital, what happens?

Initially your child has to come to the transplant clinic twice a week for laboratory work up and physical examination or as frequently advised by our team. As recovery progresses, these visits become less frequent.

Who will look after my child long term?

Your child will be looked after by the primary pediatrician who will be supported by our team. Reports will be communicated to us via e-mail or fax.

What restrictions will my child have during her recovery?

For the first six weeks after surgery, your child should avoid strenuous exercises.

What lifestyle changes are associated with liver transplants?

Most patients can return to a normal or near-normal lifestyle six months after a successful liver transplant. Recipients should avoid exposure to people with infections. Maintaining a balanced diet, and staying on prescribed medications are vital to stay healthy. Children can attend school and participate in sports and other age-appropriate activities and can have a normal married life with no fertility issues.

What is the survival rate for children with liver transplants?

Our centre performed the first successful pediatric liver transplant in India in 1998. Our survival rate in the 241 liver transplants (215 adult and 26 pediatrics) performed in the last 3 years is 90%. Survival rates vary from centre to centre around the world. Our results are comparable to the most well established centers from across the world.

What is the cost of a liver transplant?

A pediatric liver transplant at our center costs between 12 to 15 lakhs, which is roughly one-tenth of what it would cost in the West. Subsequently, a patient requires Rs.8-10,000 month for lifetime immunosuppression.