At South Asian Liver Institute, our distinguished team of transplant specialists and surgeons is dedicated to offering unparalleled expertise in liver transplantation, providing life-changing solutions for individuals facing end-stage liver diseases. From meticulous donor matching to state-of-the-art surgical procedures, we prioritize safety and success. We understand the profound impact a liver transplant can have on one’s life, and we are committed to delivering compassionate care and unwavering support throughout this transformative journey.
The Only Private Liver Institute in India
We are the only private institute in India dedicated to patients with liver disease.
Experience with Complex Surgeries
Our highly experienced team of surgeons, physicians, and nurses ensure an unmatched success rate.
Comprehensive Post-Treatment Care
We ensure that all our patients have regular follow-ups with our physicians, nutritionists, and physiotherapists.
Outreach Centres Across India
We have outreach centres across the country, making it easy for families to attend follow-up clinics.
Things to do before the liver transplant
It is very important that you bring all your documents at the time of evaluation. Once in South Asian, we will examine all your medical records which will include X-rays, CT reports, liver biopsy slides, operative reports, and a list of medications. To complement and update previous tests, some or all of the following studies are performed during your evaluation and it takes 2-3 days of admission to complete your this “work up”.
Specialised computed tomography (CAT or CT scan), which uses X-rays and a computer to create pictures showing liver size and shape, blood supply, and any liver lesions. In some cases a CT scan of the chest may also be required.
Doppler ultrasound to determine if the blood vessels to and from your liver are open. Our radiologists are experts at this and estimate issues accurately so that we do not find surprises during surgery.
Echo cardiogram and stress testing to evaluate your heart function.
Pulmonary function studies to determine your lungs’ ability to exchange oxygen and carbon dioxide. This is important since it decides how quickly patients can leave the ICU after the operation.
Blood tests to determine blood type, clotting ability, and biochemical status of blood, and to measure liver and kidney function. Serology screening (a blood test that looks for antibodies) is also included.
When is a liver transplant necessary?
Just onset of cirrhosis is NOT an indication for transplant. The usual and main indication for a liver transplant is “end stage liver disease”, an advanced stage of cirrhosis i.e. wherein the liver has lost its ability to even do enough to sustain life. This happens slowly over months with increasing bilirubin or ascites or encephalopathy. However what leads to such a situation of ESLD? Well a number of things can impair or destroy liver function to the point that a liver transplant is necessary.
- Viruses like hepatitis B, C, and D viruses, which causes inflammation and chronic damage to the liver
- Alcohol
- Certain Drugs
- Autoimmune hepatitis, in which the body’s immune system malfunctions and destroys liver tissue
- Obesity & poor sugar control. This leads to ‘non alcoholic fatty liver disease (NAFLD)’ in which fat deposits accumulate in the liver
- Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC), progressive diseases that cause liver failure
- Liver tumors
- Metabolic and genetic disorders, which are inherited and include diseases such as alpha 1 antitrypsin deficiency, monochromatic, Wilson’s disease, and poly-cystic liver disease
- In children, Biliary atresia is the commonest cause for ESLD
What happens if you don’t do a liver transplant?
In order to answer this question, we must understand a bit of liver disease natural history. The early stage of cirrhosis of the liver in is called compensated cirrhosis. As the damage worsens it progresses to a state called decompensated cirrhosis. Compensated cirrhosis is simply a damaged liver that is still relatively functional. At this stage we aim to halt or reduce the rate of progression of the disease with life style changes, medications and few minor procedures such as variceal band ligation. Decompensated cirrhosis is a stage when the liver is almost completely non-functional and at this stage patients have a wide variety of symptoms. And obviously these symptoms are what occurs if we don’t do a transplant. These can range from fever with high temperatures and shivers, often caused by an infection of fluid in abdomen, shortness of breath, vomiting blood, very dark or black tarry stools to periods of mental confusion or drowsiness.
We can often treat these symptoms with medications but is usually temporary and the disease often progresses. These red flag symptoms indicates end stage liver disease. Once these complications cannot be controlled with medications then liver transplant is mandated. If we delay transplantation further then the chances of death due to complications such as uncontrollable bleeding, infection and liver coma are extremely high. It is important to put the patient early on the waiting list (if there are no living related donor options), bearing in mind the waiting time for a donor organ and also patient’s age and background medical status (which will only deteriorate over time and make the operation riskier).
When should we NOT do a liver transplant?
Foremost, as mentioned above just onset of cirrhosis is NOT an indication for transplant. There are other times when one must NOT do a transplant, even if they meet the criteria for transplant from a liver point of view. When the patient suffers from severe, irreversible non-liver related medical complications that is likely to increase the risk of death during a transplant, then a transplant is clearly not a good idea. Some examples include:
- Severe pulmonary hypertension
- Cancer that has spread outside of the liver
- Systemic or uncontrollable infection
- Active substance abuse (drugs and/or alcohol)
- History of non-compliance or inability to adhere to a strict medical regimen
- Severe, uncontrolled psychiatric disease
When is the right time to do a liver transplant?
Ah! Not sooo easy..!! There are several factors to be considered in the timing of liver transplantation. Development of signs of decompensated liver such as swelling of the abdomen due to accumulation of fluid, bleeding, jaundice or disturbance in the mental state (due to high ammonia) etc are signs of end stage disease and suggest need for transplantation. But do we need to wait till patients develop all of these symptoms? – NO! As sometimes patients can deteriorate very quickly and end up with a high risk of death before they can receive a transplant. Statistical models such as Child-Pugh score and MELD score have been developed to guide the timing of transplant in these patients.
Unfortunately, not all patients who need liver transplantation CAN be transplanted. For example patients sometimes develop kidney & lung complications due to their liver disease- once these organs are damaged too much, then liver transplant becomes too dangerous. All candidates in good centers undergo rigorous assessment to ensure suitability- this must be after seeing and examination of a patient by the transplant surgeon himself. We do not believe in simply registering patients without seeing them, as we feel this will increase risk to patients.
Apart from patient factors, in case of a cadaveric transplant, the estimated waiting time of an organ also has to be considered by the physicians evaluating the transplant candidate.