Auxiliary Liver Transplantation in Delhi, India

Auxiliary liver transplantation is a surgical procedure in which the recipient's liver is not entirely removed. The purpose of an auxiliary liver transplant is to retain the native's liver in the hope it will recover or if there is any scope of gene therapy in the future when it is a case of hereditary or metabolic disease.

Since the human liver has phenomenal regenerative abilities, an auxiliary liver transplant may help withdraw immunosuppression once the native liver has successfully regenerated. This liver transplant type is now established as the optimal treatment for young patients with severe acute liver failure.

Alternate Name of Auxiliary Liver Transplantation

Heterotopic Auxiliary Liver Transplant (HALT)

Body Location

The upper right part of the abdomen.

Auxiliary Liver Transplantation Procedure Type

Surgical or laparoscopic

Preparation for Auxiliary Liver Transplantation Procedure

Several preparatory steps need to be taken before the procedure can be performed, and these include:

• Evaluating the donor and recipients: Both the donor and the recipients will need to undergo a thorough medical evaluation to determine if they are suitable candidates for the procedure. This will include a physical exam, blood tests, and other diagnostic tests to assess the donor and recipients' overall health and identify potential complications.

• Counselling the donor and recipients: The donor and the recipient are counselled about the procedure, including the risks and benefits and the potential impact on their lives. This will help ensure that they fully understand the procedure and can make an informed decision about proceeding further.

• Coordinating the procedure: The surgical team will coordinate the procedure with the hospital and other medical staff to ensure everything is in place. This includes arranging an operating room, scheduling the procedure, and post-operative care.

• Prepping the donor and recipients: The donor and recipients will need to follow specific instructions in the days leading up to the procedure to ensure they are ready for surgery. This may include making changes to their diet and medication regimen, stopping certain medications, and avoiding certain activities.

Auxiliary Liver Transplantation Procedure

An auxiliary liver transplant is of two types– orthotopic and heterotopic. In this procedure, the remnant of the recipient's liver prevents small-for-size syndrome until the graft has fully regenerated to take on normal liver function. To be viable, an auxiliary liver transplant procedure is applied to candidates who fulfil two criteria:

• Their liver is functioning to take on an auxiliary role

• The ALT procedure is more beneficial to the individual than waiting for a sufficient-size graft.

Here is an overview of how auxiliary liver transplantation is typically performed:

• A part of the donor's liver (graft) is surgically removed using laparoscopic surgery.

• The affected or non-functional portion of the recipient's liver is surgically removed, ensuring the remaining organ is functional.

• The grafted liver is then positioned, and the recipient's blood vessels are connected to the donated part. This ensures that the donated graft and the owner's remnant receive an adequate blood supply.

• The recipient's bile ducts are connected to the donated liver to allow the organ to drain bile properly.

• Once the transplant is complete, the surgical team will close the incisions using sutures or staples.

Follow up After Auxiliary Liver Transplantation

Here are some follow-up care steps that may be involved after auxiliary liver transplantation.

• Monitoring the liver: The transplant team will monitor the liver and its two parts to ensure they function properly. This may involve regular blood, imaging, and other diagnostic tests.

• Managing medications: The recipient will likely need to take medications to help prevent their bodies from rejecting the transplanted liver graft. These medications, known as immunosuppressants, work by suppressing the immune system to prevent it from attacking the transplanted organs. Medications will also be given to the living donor to ensure healing and prevent complications.

• Managing side effects: Some people may experience side effects from the medications or the transplant procedure. The transplant team will work with the donor and recipient to manage any side effects and ensure they are as comfortable as possible.

• Managing diet and lifestyle: The donor and recipient will need to follow a specific diet and lifestyle to help ensure the success of the transplant. This may include avoiding certain foods and activities and getting regular exercise and rest.

• Regular follow-up appointments: The donor and recipients will typically need to attend regular follow-up appointments with the transplant team to monitor their progress and address any concerns.

Risks After Auxiliary Liver Transplantation

Some of the risks associated with auxiliary liver transplantation include the following:

• Surgical complications: Auxiliary liver transplantation carries the risk of complications like bleeding, infection, and damage to surrounding organs.

• Rejection of the transplanted liver: The recipient's immune system may attack and reject the transplanted liver. This can be managed with medications, but it can also lead to serious complications if not adequately treated.

• Medication side effects: The medications used to prevent rejection of the transplanted liver can have side effects, such as an increased risk of infections, high blood pressure, and kidney damage.

• Long-term complications: There is also a risk of long-term complications after an auxiliary liver transplant, including the development of liver cancer and the need for additional transplants.

While auxiliary liver transplantation carries risks, it can also be a lifesaving treatment for patients with liver failure or other serious liver conditions.

Recovery After Auxiliary Liver Transplantation

Recovery after auxiliary liver transplantation varies depending on the individual and the specifics of the procedure. Here are some tips for recovery after an auxiliary liver transplant:

• Follow the care plan given by your transplant team.

• Take it easy and avoid strenuous activities for some time after the transplant. The transplant team will provide specific recommendations on when it is safe to return to normal activities.

• Pain is common after surgery, and the transplant team will provide pain management medications to help control it. It is essential to follow the prescribed pain management plan and to report any persistent or severe pain to the transplant team.

• Follow a healthy diet and lifestyle after the transplant to help support the health of the transplanted liver. This may include avoiding certain foods and activities and getting regular exercise and rest.

• Attend all follow-up appointments with the transplant team to monitor the health of the transplanted liver and address any concerns.

Your recovery is gradual, and it may take time to return to normal activities.