Global Hospitals is the first one to launch a multi-organ transplant centre in India. Since its inception in 2002, Global Hospitals has became one of the leading institute to do Liver Transplantation in India, we have performed 60 liver transplants including 15 living related transplants. We have 85% success rate comparable to any transplant centre in the world. Our team is trained in USA, UK (Kings College Hospital) and Japan (by Prof Tanaka). We have excellent hepatogists who are also trained abroad, namely Dr. Dharmesh Kapoor (Adult) and Dr. K. Ramesh (Paediatric). The transplant program is supported by well trained liver anaesthesiologists Dr. PBN Gopal trained at King’s College, UK.

Who needs a transplant?
Any one who has end Stage liver disease or cirrhosis (scarring of liver). Also some one who has early stage cirrhosis but with a small cancer is cured by liver transplant. It is also indicated for patients with acute liver failure not responding to standard medical management.

What is cirrhosis?
It is a term used for scarred, shrunken, nodular liver, which can result from a number of reasons. Common causes are liver injury due to alcohol, hepatitis B and C viruses, autoimmune liver disease, diseases of bile ducts and some other uncommon cause like metabolic derangements.

Indications

Paediatric
Biliary atresia is a condition where children are born with absent or improperly formed bile channels. They will be need a minor surgery within six months and finally need a transplant. Children with some cancers like hepatoblastoma initially need surgery to remove the tumar. If that is not successful or feasible, then the patient may benefit from transpalnt. There are other metabolic causes like Wilson’s disease, type 1 tyrosenemia, and alfa 1 antitrypsin deficiency, haemochromotosis glycogen storage diseases which may require transplant.

Adult

Cirrhosis caused by hepatitis B, hepatitis C and alcohol (not presently consuming)

• Cirrhosis with small < 5cms cancers
  
• Cirrhosis caused by autoimmune hepatitis, primary biliary cirrhosis and Primary sclerosing cholangitis
  
• Budd Chiari syndrome
  
• Familial amyloid polyneuropathy
  
• Contraindications

Absolute contraindications:

• AIDS
  
• Extra hepatic cancer
  
• Advanced cardiopulmonary disease
  
• Cholangiocarcinoma

Relative contraindications:

• Age >70
  
• Sepsis
  
• Active alcohol abuse
  
• Severe psychiatry disorder
  
• Pulmonary hypertension

Patient evaluation for transplant
Initially a surgeon and a hepatologist see the patient. If the patient meets the criteria for transplant, He / She will be subjected to investigations to see whether the heart and lungs tolerate surgery. He will also assessed by a cardiologist. A CT scan would be done to look at the blood vessels of the liver. After all the workup, the patient will be presented to the committee and a decision to put the
patient on the list.

How is the transplant done?
Cadaveric liver transplant: when a donor is available, the recipient (who is going to receive the liver) is called into the hospital and routine blood tests will be done. He will seen by the anaestheseiologist. Meanwhile the donor team will be retrieving the liver and if the liver is transplantable, the hospital where the recipient team is waiting will be informed so that the blood bank and operating staff can be alerted.

When the liver arrives, it has to be cleaned which will take one two hours. Meanwhile, the recipient will be prepared for surgery. The surgery takes anywhere between 5 and 15 hours. If it a good quality liver, It starts working immediately in the form of producing good bile and good control bleeding.