This presentation is related to Liver Transplant, Liver Failure, It's causes and remedy. Here we also talk about liver transplant scenario in india and success rate of liver transplant both cadaver or living donor. We also give a brief about the cost of liver transplant. Dr. Abhideep Chaudhary, is liver transplant consultant/surgeon at Sir Ganga Ram Hospital, New Delhi, India. Email : drabhideep@yahoo.com , care@drabhideep.com

1. Dr Abhideep Chaudhary
Consultant Surgeon
Surgical Gastroenterology and Liver Transplantation
Sir Ganga Ram Hospital
New Delhi

3. Largest & Most massive internal organ
Position :
• Upper right part of abdomen behind ribs
Weighs : 1.2 to 1.5 kg
Performs > 500 different functions in
body
Natural regeneration capacity due to
hepatocyte function
• Long term repeated exposure however
causes liver damage & may finally cause
liver failure
http://hypertextbook.com/facts/2004/MaryPennisi.shtml *

4. I am a non-complainer
I can't and won't tell you I'm in trouble until
I'm almost at the end of my rope... and yours.
Your….. Liver

6. © 2007 Thomson - Wadsworth
What Happens
When Liver
Fails

7.  Acute Liver Failure
 Alcoholic cirrhosis
◦ Represents the most common cause of cirrhosis5
◦ Accounts for 40% of US deaths from cirrhosis5
 HCV
◦ HCV is the most frequent diagnosis in patients
undergoing liver transplantation1
◦ Viral recurrence is nearly universal, with up to 30%
of patients progressing to cirrhosis1,2
 HBV
 HCC
◦ Accounts for 90% of all liver cancers3
◦ Causes 50% to 70% of liver-related mortality
among patients with cirrhosis4
◦ Incidence and mortality is rising4
Viral
hepatitis (40%)
Alcoholic
hepatitis (32%)
Primary biliary
cirrhosis (10%)
Unknown (7%)
Viral + alcoholic
hepatitis (5%)
Autoimmune hepatitis (4%)
Other causes (2%)
Causes of cirrhosis
Source: CDC. Slide 45.
ftp://ftp.cdc.gov/pub/infectious_diseases/hepatitis/slides/technote.t
xt.
HCV = hepatitis C virus; HCC = hepatocellular carcinoma; HBV = hepatitis B virus
1. Berenguer M, et al. Hepatology. 2002;36:202–10; 2. Berenguer M, et al. J Hepatol. 2001;35:666–78; 3. Jelic S, Sotiropoulos GC. Ann
Oncol. 2010;21 (Suppl 5):v59–64; 4. Varela M, et al. Liver Transpl. 2006;12:1028–36; 5. Murray KF, Carithers RL. Hepatology.
2005;41:1407–32 7

9.  1967 : 1st successful Liver Transplant
 1989 : 1st successful LDLT ( Adult to child )
 1998 : 1st successful LDLT ( Adult to Adult )

10.  In last 40 years, Liver Transplantation has
evolved from an experimental procedure to a
definite treatment option for patients with
acute liver failure and end-stage liver disease

11. Long-term survival of liver transplant recipients has
become the rule rather than the exception

12.  Chronic Liver Disease - One of top ten cause of
death in India
 About 2,00,000 Indians die of liver failure
every year.
 25,000 liver transplants need to be done every
year in India.
 Only 1,100 transplants performed in India
every year

13. Region Rate of LTs
 Developed West 12-32 per million
 India - future 20/million (25000/yr)
realistic – 5000/yr
 India- current 0.06 per million (2010)
(320, 500, 750 transplants in 2008, 2009,
2010)

14. No.oflivertransplants

15. Should all liver disease patients have a LT ?
NO

16.  Success rate
 Disease progression
 Donor availability
 Cost
 Disease recurrence
 Compliance with post operative restrictions
Why No ?

17.  Determine the need for transplant
 Confirm all effective treatments have been
exhausted
 Assess whether patient is an appropriate candidate
When to Consider Transplantation?

18.  Timing of the transplant -- from the initial
referral to the actual surgery-- can have a
profound impact on outcome.
 When patients undergo a transplant before
multisystem complications of ESLD have a
chance to develop, their prognosis is excellent.
 However, in severely debilitated patients,
survival decreases by 20% to 30%.

19.  Patients with cirrhosis should be referred for a
transplant when they develop evidence of synthetic
dysfunction, experience their first major
complication or develop malnutrition
 Waiting to refer patients until they have
intractable ascites or hepatorenal syndrome
frequently results in death before a transplant can
even occur
 Patients with HCC and cirrhosis should be referred
as soon as the tumor is discovered
 Patients with FHF can deteriorate rapidly, so
should be referred as soon as the diagnosis is
suspected

20.  When medical therapy is effective in stopping
the progression of liver disease,
transplantation may be avoided or delayed

21.  Expensive surgery (18-20 lac rupees)
 Cost cutting measures
Avoid technical complications
Decrease transfusion requirements
Use medications of proven efficiency
Cost

22. Liver transplant surgery carries a risk of
significant complications, including:
 Bile duct complications, including bile duct leaks
or shrinking of the bile ducts
 Bleeding
 Blood clots
 Failure of donated liver
 Infection
 Memory and thinking problems
 Rejection of donated liver

23.  For those in whom prolonged abstinence and
medical treatment fails to restore health,
transplantation may be considered.
 Patients who continue to drink alcohol despite
medical advice are not considered for
transplantation

24.  Hepatocellular carcinoma, which are confined to
the liver can be treated by liver transplantation

25.  Patient needs medication to protect the new
liver from rejection
 These medications however reduce both in
dosage and number as time passes and the
immune system gets used to the new liver

26.  Most liver transplant recipients are able to
return to a normal and healthy lifestyle
 Most report that they feel re-energized, have
an improved quality of life and enjoy everyday
activities once more
 Liver transplant recipients are able to
participate in normal exercise after their
recuperation and women are able to conceive
and have normal post-transplant pregnancies
and deliveries

27.  Donation after brain death
 Living related donor

28.  1.3 billion population
 HOTA (Legal Act)
since 1994
 Liver used in only
40-50%
 Donation< 0.03 per
million (20-35 per
million – west)
No. of deceased donors per year

29. Till then …
Living related liver transplant

30.  Any person above the age of 18 years can
legally donate his part of liver however in India
as per Human Organ Act 1994, liver donation is
restricted to family members(brother, sister,
father, mother, son daughter) or close
relatives (Uncle, aunt, cousin, brother-in-law,
sister-in-law, grand parents)
 Medically the liver donor should have a
compatible blood group and should be me
medically fit and psychologically sound

32.  Liver transplantation
is possible due to the
amazing regenerative
capacity of human
liver
 Both donor and
recipient eventually
lead normal lives post
procedure

33.  Right hepatectomy complex surgery
 Bile leak well recognized complication
 Wound pain quite common
 Psychological trauma in case of recipient death
 Overall risk -0.1-0.2%
The risk to living liver donor

34.  Donor usually discharged within 7-10 days
 Donor can resume his normal activity within 3-4
weeks and resume his job within 6 weeks time
 No special precautions are needed for donor
after about 4-6 weeks and he lives a normal life
thereafter

35. Don’t drown me in
alcohol
Watch those drugs, can
harm me. No
medications without
consulting doctor
Don’t eat too much of
fatty food.Get Shots against
Hepatitis A and B
Don’t have unsafe sex,
don’t share
needles/syringes,
personal items like

36. “The Great One”

37. Pledge your organs
Save a life
Don’t Take me to
heaven, no one
needs me there!