Institute For Digestive & Liver Diseases

Liver Transplant involves removing the whole or part of the Liver from a deceased or living donor and planting it in a patient suffering from an end stage Liver disease, after removing their diseased Liver. The Department of Liver Transplantation at BLK-Max Super Specialty Hospital (New Delhi) comprises of Surgeons, Anesthetists, Intensivists, Transplant Hepatologists & Gastroenterologists, Diagnostic Radiologists, Interventional Radiologists, Hepatopathologist, Clinical Microbiologists & Infectious Disease Specialists, Nephrologists, Cardiologist, Pulmonologist, Endocrinologist, Dentists, Gynecologists, Transfusion Medicine Specialists, Transplant Coordinators, Clinical Nurses, Clinical Psychologist, Dieticians, Physiotherapists, Medical & Radiation Oncologist, Technicians, Counselors, Specialized Nurses and Quality Control Staff who have exhaustive experience in the management of Gastrointestinal, Hepato-biliary and Pancreatic diseases. The mission of the team is to provide state of the art services using evidence based guidelines at an affordable cost. It also endeavors to pioneer training and research in the field of Digestive & Hepato Pancreato Biliary Sciences.The hospital has all state-of-the-art facilities capable of working 24x7. The Transplant team has the distinction of being one the most experienced in the region. The department deals with the entire spectrum of diseases of the liver, biliary tract and pancreas requiring surgical treatment and is one of the few centers in the country where living donor liver transplantation is being carried out regularly. Technically complex and challenging surgeries for diseases such as cancer gallbladder, hepatocellular carcinoma and pancreatic cancer are routinely performed. The team members have been trained at the best centers in the world and have vast experience in managing patients with liver disease and performing liver transplant in India. A competent nursing and technical support team ensures optimum and uncompromising patient care. The department has advanced critical care unit with 16 dedicated ICU beds. A typical Liver Transplant ICU unit has separate cubicles with laminar flow. The post-transplant patients being on immunosuppressive medications are immensely helped in their recovery following surgery by this unique design. The team is also backed up by an enthusiastic and hardworking team of Physiotherapists and Dieticians.The team has been involved in over 700 liver transplant procedures and has established a successful transplant program which caters to both adult and pediatric patients with End Stage Liver Disease with results at par with the very best centres in the world. We have also been successful in establishing a Deceased Donor Transplant Program and have performed the maximum number of deceased donor organ recoveries and transplants last year in Northern India. Who Requires a Liver Transplant? Liver Transplant may be necessary for patients who suffer from: Liver damage due to Alcoholism Long-term (chronic) active infection (Hepatitis B or C) Primary Biliary Cirrhosis Chronic Liver disease due to HCC Birth defects of the Liver or Bile Ducts (Biliary Atresia) Metabolic disorders associated with Liver failure (e.g. Wilson's disease, Haemochromatosis) Acute Liver Failure Liver failure causes many problems, including malnutrition, problems with Ascites, Blood Clotting, Bleeding from the Gastrointestinal Tract and Jaundice. In most cases, patients who undergo Liver Transplant are very sick. They are hospitalised prior to surgery. A healthy Liver is obtained either from a living donor or from a donor who has recently died (brain dead), but has not suffered Liver injury. The diseased Liver is removed through an incision made in the upper abdomen and the new Liver is put in place and attached to the patient's blood vessels and bile ducts. This procedure can take upto 12 hours to complete and may require large volumes of blood transfusions. Patients are required to stay in the hospital for 3 to 4 weeks after the Liver Transplant, depending on the degree of illness. After the transplant, patients must take immunosuppressive medicines for the rest of their lives to prevent rejection of the transplanted organ by the body. What are the Different Types of Liver Transplants? A Liver is obtained from either a deceased or a living donor. Deceased Donor A Liver can be obtained from patients who are brain dead (declared dead clinically, legally, ethically and spiritually). Once a brain dead patient is identified and deemed as a potential donor, the blood supply to his body is maintained artificially. This is the principle of deceased organ donation. Young patients who die due to accidents, brain haemorrhage or other causes of sudden death are considered suitable donor candidates Living Donor The Liver has an amazing ability to regenerate itself if a part of it is removed. It takes the Liver 4 to 8 weeks to regenerate after the surgery. That’s why a healthy person can donate a part of his Liver. In a Live Donor Liver Transplant, a portion of the Liver is surgically removed from the live donor and transplanted into a recipient, immediately after the recipient’s Liver has been entirely removed. Who can Donate for Liver Transplant? Doctors, transplant coordinators and other healthcare professionals who form the Liver Transplant surgeons team, with their experience, skill and technical expertise select the best donor for a living Donor Liver Transplant. Potential live Liver donors are carefully evaluated and only those in good health are considered. The donor will be evaluated or cleared for donation by the Authorisation Committee. The health and safety of the donor is the most important parameter during the evaluation. The potential donor should: Be a close or first degree relative or spouse Have a compatible blood type Be in overall good health and physical condition Be older than 18 years of age and younger than 55 years of age Have a near normal body mass index (not obese) The donor must be free from: History of Hepatitis B or C HIV infection Alcoholism or frequent heavy alcohol consumption Any drug addiction Psychiatric illness currently under treatment A recent history of cancer The donor should also have the same or compatible blood group. Blood Group Compatibility Chart for Liver Transplant Patient Blood Group Donor Blood Group A A or O B B or O AB A, B, AB or O O O Note: The RH factor (+/-) of the blood type is not important in compatibility. What are the positive aspects of Living Donation? Gifting an organ can save the life of a transplant candidate Donors have reportedly experienced positive emotions, including feeling good about giving life to a dying person Transplants can greatly improve recipient’s health and quality of life, allowing them to return to a normal life Transplant candidates generally have better results when they receive organs from living donors as compared to organs from deceased donors Better genetic matches between living donor and recipients may decrease risk of organ rejection A living donor makes it possible to schedule the transplant at a time that is convenient for both the donor and the transplant candidate. How soon does a Donor Recover After Liver donation? The surgery and recovery process vary in different cases. If you are thinking of becoming a donor then you should consult the hospital transplant team to understand what to expect. You can also consider talking with other donors. As a Liver donor, you may stay in the hospital for upto 10 days or longer in some cases. The Liver typically regenerates in two months. Most Liver donors return to work and resume normal activities in about three months, although some may need more time. Are there any Risks in Liver Transplant? The biggest risks associated with Liver Transplants are rejection and infection. Rejection occurs when the body’s immune system attacks the new Liver as an unwanted intruder, just as it would attack a virus. To prevent rejection, transplant patients must take drugs to suppress the immune system. However, because the immune system is weakened, it is harder for transplant patients to fight other infections. Fortunately, most infections can be treated with medicines. What Medicines do I Have to Take? Anti rejection drugs (Immunosuppressant Drugs) For the first three months after the transplant you need to take the following medicines: Antibiotics - to reduce the risk of infections Antifungal liquid - to reduce the risk of fungal infections Antacid - to reduce the risk of stomach ulcers and heartburns Any other medicines that you have to take will be prescribed depending on your symptoms. Why are Anti Rejection Drugs (Immunosuppressant Drugs) Needed? Our body isn't designed to readily accept another person's organs. It's the body’s natural instinct to attack and destroy a transplanted organ as a defence mechanism. Anti-rejection drugs make the defence mechanism weak against the transplanted organ and allow the Liver graft to sustain and work normally. What precautions should I take after my Liver Transplant? It is essential that everyone involved in the transplant procedure coordinate seamlessly to monitor the health of the patient, even after the operation. For the patient it is important to follow instructions given by their physicians and consultants, as these will help prevent or reduce the chances of any complications. A patient's most important job is to ensure that the family physician, local pharmacist and their family members are aware of the transplant. The medications must be taken as prescribed and precautions must be observed. Every family member must have the telephone number of the patient’s Liver Transplant Consultant. How long will my Transplanted Liver last? Advances in surgery have made Liver Transplants extremely successful. Recipients have been known to live 30 years of normal life after the operation. The five-year survival rate for Liver Transplant patients is approx. 85-90%. Some facts about Liver Transplant A Liver Transplant is needed when the Liver fails, usually because of a long-term disease About 1,00,000 people in India die of Liver failure every year The first successful Liver Transplant was done in 1967 The number of Liver Transplants has been steadily increasing for more than 15 years Donated Livers can come from either deceased donors or living donors The five-year survival rate of Liver Transplant patients is over 85-90% India is the Centre of Excellence for Living Donor Liver Transplantation Frequently Asked Questions 1. What is a Liver Transplant? The liver is the largest internal organ of the human body and performs several critical functions. There are many chronic diseases that can hinder the functioning of the liver and in chronic conditions can result in liver failure. The removal of a non-functioning liver through a surgical process and replace it with a healthy liver from a living or deceased donor is known as a liver transplant. Deceased Donor (Cadaver): A donor is usually an unfortunate person who has suffered has suffered irreversible brain injury/ brain death or a living Living Donor: Liver comes with a capability of regeneration. Hence, a living donor can donate a part of its liver to another person in need. 2. What are the various conditions for Liver Transplant? A person suffering from liver failure due to end-stage liver disease (ESLD) must undergo a liver transplant. These diseases include: Acute Liver Failure-Also known as fulminant hepatic failure, occurs when a healthy liver suffers from massive injury that results in clinical signs and symptoms of liver insufficiency. Acute or Chronic liver failure-It is caused due to the repeated injury and repair to the liver for many years. This condition leads to the point where the liver can no longer repair itself and is considered as the end stage of scarring known as liver cirrhosis. The common causes that lead to such condition of liver failure include: Chronic alcohol abuse Chronic viral hepatitis (hepatitis B, C and D) Accumulation of fat in the liver, Nonalcoholic steatohepatitis (NASH) Iron buildup in the body (hemochromatosis) Inherited disorders of sugar metabolism Galactosemia Glycogen storage disease Alpha-1 antitrypsin deficiency Metabolic syndrome Severe Obesity Cystic fibrosis Copper accumulated in the liver (Wilson's disease) Poorly formed bile ducts (biliary atresia) Genetic digestive disorder (Alagille syndrome) Infection, such as Syphilis Brucellosis Destruction of the bile ducts (primary biliary cirrhosis) Liver disease caused by your body's immune system (autoimmune hepatitis) Scarring and hardening of the bile ducts (primary sclerosing cholangitis) Medications Methotrexate Isoniazid 3. What are The Criteria for Liver Transplant Recipients? A doctor might evaluate the patient’s current medical condition to know whether he/she fits for Liver Transplant or not. You are a candidate for a Liver Transplant if you experience: Blood in Vomit Blood in Stools (Black colour stool) Abdominal swelling due to Ascites Altered Sensorium Kidney injury due to liver diseases Hepto- Cellular Cancer A patient with end-stage liver disease is not a candidate for a liver transplant if he/she suffers from: Severe, irreversible medical illness with a short-term life expectancy Systemic or uncontrollable Infection Psychiatric disease Pulmonary hypertension Last stage Cancer (spread outside of the liver) The unacceptable risk or Active substance abuse (drugs and/or alcohol) Inability to adhere to a strict medical regimen 4. What are the various Diagnosis required prior to Liver Transplant in India? Before recommending a Liver Transplant, a doctor might prescribe a patient to undergo a few examinations. The results help the doctor to evaluate the patient’s medical condition and help them create an individualised treatment plan. The list of diagnostic tests for liver transplant includes: Imaging tests: Magnetic resonance imaging (MRI) of the abdomen/pelvis Computed tomography (CT) scan of abdomen/pelvis Ultrasound of abdomen/pelvis Electrocardiogram/chest X-ray Colonoscopy Dobutamine stress echocardiogram (DSE) Mammogram or Pap smear for women Other Blood tests 5. What is the procedure for Liver Transplant in India? Liver Transplant Preoperative DetailsBefore proceeding with the surgery the doctors have to make sure that the patient is fit for the procedure. This is done by performing a series of tests and screening process. The patient might be prescribed certain medications, a week, or two before the surgery, to avoid any sort of infection during or after the surgery. A patient will receive general anaesthesia before moving to the operation theatre and will sleep through the Liver transplant procedure. Liver Transplant in India Operative Details The liver transplantation is the procedure that actually consists of three operations. First Operation: Harvesting the Liver from the donor-For a liver transplant procedure, a patient requires a donor’s liver that is replaced with the patient’s defective liver. There are two types of liver donors: Deceased Donor (Cadaver): A donor is usually an unfortunate person who has suffered has suffered irreversible brain injury/ brain death or a living Living Donor: Liver comes with a capability of regeneration. Hence, a living donor can donate a part of its liver to another person in need. The team of doctors keeps the donor’s organ working with the help of medications and other "life support" devices. The team removes the donated organs and keep them alive using ice and special solutions until they can be implanted. For the liver, the transplant must take place within six hours of its removal. Second Operation: Removing the recipient's damaged Liver- Depending on the medical condition of the patient, the process of the removal of the damaged liver can be very easy or very complicated (especially when a patient has had previous liver surgery). The doctor makes a curved incision in the upper part of the patient’s abdomen and removes the patient’s liver. Third operation: The implantation of the donor’s Liver- The operation involves the final step of replacing the patient’s liver with the donor’s liver. The doctor after transplantation connects the suture (stitch) the new liver to the patient’s blood vessels and bile ducts. Liver Transplant post-operative details A patient has to spend 6 to 10 days in the intensive care unit for monitoring purpose. The recovery time for regeneration of liver following surgery takes around 5 to 7 weeks. After surgery, most people remain symptom-free and feel better. However, they have to take certain precautions and medication for a lifetime to improve their quality of life. 6. What are the precautions one must take after the Liver Transplant? The patient must follow the following precautions after the Liver Transplant: Do not drink alcohol if you have undergone Liver Transplant Eat a healthy diet for liver and reduce the number of fried foods and spices you eat. Maintain a healthy weight/BMI Take your medicines on time Go for a regular checkups Exercise to stay fit like brisk walking and stretching Stay hydrated 7. What are the complications involved in Liver Transplant? The surgery might come with mild complications, such as: Bile duct complications Bile duct leaks Shrinking of the bile ducts Bleeding Blood clots Infection at the site of incision Complications with donated liver Rejection Failure Seizures Recurrence of liver disease 8. What are the side effects of Liver Transplant Anti-rejection Medications? After a liver transplant in India, Liver Specialists might prescribe you to take anti-rejection medications for the rest of your life which can cause side effects such as: Headaches Diarrhoea Diabetes Bone thinning High blood pressure High cholesterol These anti-rejection drugs work by suppressing the immune system, thus they come with increased risk for infection. Doctors even prescribe medication to fight the infections caused by these anti-rejection drugs. 9. What is the Liver Transplant Cost in India? A liver transplant is the best treatment for patients suffering from end-stage liver diseases. Liver transplant surgery cost in Delhi, Chennai, Mumbai, Bengaluru, and other metropolitan cities is generally cost-effective due to the better management, expert surgeons, and global standard healthcare facilities available at the hospitals. Patients should be aware of the costs of this procedure before undergoing it to be prepared financially. They should know about the various factors that influence the liver transplant surgery cost in India. Liver transplant cost in India depends on organ recovery, organ transport charges, the surgeon's expertise, hospital stay, category of room chosen, hospital infrastructure, patient’s health condition, post-transplant medications, recovery, and rehabilitation.

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The Medical at BLK-Max Super Speciality Hospital brings together a unique group of specialists and state-of-the-art medical services to provide a coordinated, comprehensive diagnosis and treatment of a broad range of digestive and liver conditions. Our team of experienced doctors includes specialists in gastroenterology and hepatology, who work in collaboration with experts in oncology, nephrology, infectious diseases, surgery, and radiology.We offer high-end patient care using a multidisciplinary approach and state-of-the-art technology, equipment, facilities, and treatment services that are at par with international standards. The key highlights of the medical offer: Comprehensive round-the-clock coverage Internationally Acclaimed team of Gastroenterologists Palliative Care for GI cancers of gallbladder, bile duct, pancreas, stomach, colon EUS guided diagnostic with therapeutic procedures Regular academic activities, training programme for physicians, Gastroenterologists, nurses & technicians, both national and international Recognised for advanced training in Gastroenterology (DNB- Gastroenterology) by National Board of Examination, New Delhi OUR AREAS OF FOCUS INCLUDE: 

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The Gastrointestinal Surgery offers quaternary level surgical care to patients with Gastroenterological diseases including cutting edge contemporary care for cancers of oesophagus, stomach, colon, pancreas, gallbladder and liver. The team delivers comprehensive treatment for many complex abdominal operations using the advanced skill-sets and multidisciplinary approach.  Our highly talented and motivated GI surgeons to deliver Advanced Minimally Invasive Laparoscopic, Robotic and conventional operations for treating GI cancers, weight loss and other complex diseases of the abdomen. The Minimally Invasive Laparoscopic and Robotic surgery approach means safer operations with less pain, fewer wound infections, shorter hospital stay and early return to work and productive life. In order to retain its identity as a leading unit of excellence for providing cutting edge GI surgical care to patients, the Gastro-Intestinal Surgery Team invests heavily in academics and research. Members of the Gastro-Intestinal Surgery Team have published research in many indexed journals and have been invited to deliver lectures and talks at National and International forums. Surgical Gastroenterology is a major thrust area of the Institute for Digestive & Liver Diseases. It is recognised by the National Board of Medical Examinations for conducting two postgraduate courses- a two-year fellowship in advanced Minimal Access Surgery and a three year super specialization degree course in Surgical Gastroenterology.  

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The Centre for Obesity and Metabolic Surgery (COMS) at BLK-Max Super speciality Hospital is recognised as a Centre of Excellence by the International Excellence Federation for Bariatric & Metabolic Surgery. The Centre is especially sought for its excellent results, unique personalised experience, and guidance not only during the surgery but also throughout the entire weight loss journey and beyond.  A comprehensive team of obesity surgeons, endocrinologists, interventional endoscopists, bariatric and metabolic endoscopists, weight loss specialists, anaesthetists, intensivists, physiotherapists, dieticians and support staff including counsellors and physiologists strive to deliver quality care and provide constant support with empathy and passion. With a vast experience in Bariatric Surgery operations, the team has a very comprehensive program of data capturing, follow-up and research. Thereby, making significant contributions to the science of obesity and metabolic diseases. The Centre aims to provide a predictable, seamless, and safe experience throughout the weight loss and Bariatric Surgery procedure. Various Bariatric Surgery Procedures Offered At The Centre Include: Bariatric Surgery can be a minimally invasive or non-invasive surgery that is performed using advanced laparoscopic, endoscopic and robotic techniques. The major types of Obesity & Metabolic Surgery that we perform at the centre include: 

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Liver resection is recommended to treat various types of liver disease such as both benign and malignant. This surgery is used for the following common benign conditions: Hepatocellular adenoma Hepatic hemangioma Focal nodular hyperplasia The malignant conditions indicative of liver resection are as follows: Hepatocellular carcinoma Metastases due to colorectal cancer In multispecialty centers, hepatic resections are performed by expert hepatobiliary surgeons who are specially trained for such surgical management. Alternate Name of Liver Resection Surgery Hepatic Resection, Hepatectomy Body location Liver Liver Resection Procedure Type Surgery, noninvasive surgery Preparation for Liver Resection Surgery Considerations and corrections of the following factors are primarily required for patients undergoing hepatic resection: Correction of coagulopathy and thrombocytopenia. Assessment and correction of ascites. Evaluation of renal dysfunction and pulmonary disease. Improvement of nutritional status and vitamin B1 supplementation. Laboratory tests The following blood tests for liver function are performed: Serum bilirubin Serum aspartate aminotransferase activity/platelet count ratio Alanine aminotransferase Alkaline GGT Phosphatase. Imaging studies Elastography (for noninvasive fibrosis assessment) Hepatobiliary scintigraphy Magnetic resonance imaging (MRI) USG based test for portal hypertension In some special disease-specific cases, tests such as the indocyanine green retention test (ICG R15) is required to predict surgical outcome. Liver Resection Surgery Procedure Several techniques can be used to perform the surgery. Crush technique The technique involves crushing the portion of the liver that has to be removed by a surgeon’s finger or surgical clamp (“crush-clamp”). Ultrasound dissection Liver resection is performed using ultrasound that involves low blood loss and a low chance of bile leak. Radiofrequency-based technique This technique applies radiofrequency energy to thermocoagulate the liver parenchyma that later helps in resection by a scalpel. Water-jet dissection The method uses a high-pressure water jet to break apart the liver tissue and selectively remove the unwanted portions with minimal blood loss. Vascular stapler method This is an alternative to the crush-clamp technique. In this method, a vascular stapler is used to make the procedure faster with less blood loss and no requirement of transfusion. Minimally invasive technique In recent times, minimally invasive techniques such as total laparoscopic, hand-assisted laparoscopic, and robotic-assisted surgery have gained popularity due to their better outcome, shorter hospital stays, and fewer postoperative complications. Recovery After Liver Resection Surgery In present times, the evolution of modern surgical techniques, new ways of controlling bleeding, and better in-patient care has improved the perioperative outcome. Patients need to spend 5–10 days or a maximum of three weeks in the hospital after hepatectomy. If laparoscopy is performed, the recovery time is shorter and the patient can return to daily activities within a week. Drips and drains are removed before they leave the hospital. Following recovery tips can be followed at home: Take pain medications as prescribed. Recommended diet and no consumption of alcohol. Exercise and walking. Consuming plenty of fluids. No lifting heavy weights for 8 weeks post-surgery. Follow Up After Liver Resection Surgery An emergency follow-up is required for the following cases: Pain or an increased pain Swelling in the abdomen (ascites) or legs (edema) Vomiting Yellowing of the eyes and skin Confusion Normally, follow-up visits are scheduled every 3 to 6 months for 2 years, then every 6 to 12 months as the highest chance of recurrence is within 2 years. During the check-up, besides physical examinations, doctors may perform the following tests: A CT scan or an MRI of the liver and other parts of the abdomen to look for carcinoma that may remain after treatment or that has spread. Blood tests, including liver function tests, to check how well your liver is working. Blood tests to check tumor marker levels of alpha-fetoprotein to see if they lowered after treatment. Risks After Liver Resection Surgery Some rare postoperative complications involved with hepatectomy are Fever: Due to infection in the venous catheter, UTI, or incisional infection. Hemorrhage: GI bleeding, coagulopathy, or intraperitoneal hemorrhage Bile leakage: Can occur in 4.0% to 17% cases. Liver failure: Associated with several hepatic diseases and surgical factors. Pleural effusion: It may spontaneously resolve, and if the patient has no significant symptoms or signs, no special treatment will be needed. Related Blogs Understanding Liver and Liver Health Care After Successful Liver Transplant Surgery and Precautions Liver Failure - Symptoms, Causes Stages and Treatment Liver Cancer Symptoms - Understanding Common & Advanced Symptoms Foods Good for Liver - Role of Diet in Liver Health

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