Overview of Liver Transplant
A transplant is commonly considered when the liver can no longer function properly. Liver failure can be caused by a chronic medical condition called ‘cirrhosis’ or sudden failure can occur following an infection, a complication from medication or several other reasons.
A liver transplant is required for chronic liver disease as well as acute liver failure. Liver transplant is indicated when a patient’s diseased liver no longer sustains required functions and develops complications.
At Alexis Multispeciality Hospital, our experts carry out both deceased and live donor liver transplants, backed by world-class infrastructure for a quick recovery. We also help patients with comprehensive management of acute liver failure and chronic liver diseases.
Signs and symptoms of Liver Disease
- Loss of Appetite
- Weight Loss
- Enlarged and Tender Liver
- Ascites or Peripheral Edema
- High Fever
- Blood Vomit
- Dark Tarry Stools
- Altered Sensorium
Conditions that we treat
- Liver Cirrhosis
- Acute Liver Failure
- Chronic Viral Hepatitis B and C
- Alcoholic Liver Disease
- Liver Tumours
- Fatty Liver
What is end stage liver disease?
End-Stage Liver Disease (ESLD) is used to describe advanced liver disease, liver failure, and decompensated cirrhosis (an advanced stage of cirrhosis).
ESLD develops after an inflammation of the liver, which then leads to fibrosis (scarring), and loss of regular liver function. While the only cure for ESLD is liver transplantation, many patients do not receive one due to waiting times or other health issues that make them too sick to survive the surgery.
ESLD refers to the irreversible decomposition of liver function due to chronic liver disease or acute liver failure. ESLD has several etiologies. Hepatitis B, other viral infections, and excessive alcohol intake are also linked to liver cirrhosis and, eventually, ESLD. Non-alcoholic steatohepatitis is becoming a more common etiology for ESLD because of the expanding population of pre-diabetics and patients with metabolic syndrome.
Types of liver transplant
- Cadaveric / Deceased Donor Liver Transplantation: –
In this type of liver transplant surgery, the entire healthy liver from a deceased or brain-dead (Cadaver) donor is surgically removed and transplanted into the patient after the diseased liver is removed.
As it is highly unpredictable as to when the liver will become available to the recipient, in most cases of deceased donor liver transplant, the surgery is done in an emergency as soon as the donor becomes available.
Several tests are done and the recipient’s blood group and liver size are matched to the donor’s before the surgery is done.
In the case of the deceased donor, the whole liver is taken out and transplanted. However, in some cases, it may be divided into two portions and used to conduct liver transplants of two patients, usually a child and an adult.
- Living donor liver transplant –
In this type of liver transplant surgery, a patient’s diseased liver is removed and replaced with a portion of the liver from a healthy donor that has to be a suitable first or second-degree family member of the patient. Since the liver can regrow itself to 90-100% of its original size, the parts of the liver in both, the patient and the donor, grow into normal size and shape after the surgery, usually within 2-4 months of surgery.
Overview of Kidney Transplant
For patients with compromised kidney function and advanced chronic kidney diseases three treatment options are available- haemodialysis, peritoneal dialysis or a kidney transplant. Depending on the age and the stage of kidney disease, a nephrologist decides the course of treatment. A successful kidney transplant when indicated provides a better quality of life as it prevents long-term issues related to dialysis.
A kidney transplant allows a person whose own kidneys have failed to receive a new kidney from another person. A successful kidney transplant can improve many of the complications of kidney failure. A kidney may come from a living donor or from an individual who has died (deceased donor). A living donor may be someone in your immediate or extended family, or it may be your spouse or a close friend. A deceased donor is someone who has consented to donating his or her organs upon death. In situations where the wishes of the deceased donor are not known, family members may consent to organ donation.
Symptoms of Kidney Failure
Most people notice that they feel weak, lethargic, and become easily fatigued. Their appetite decreases and tongue has an unusual taste. However, there are other common signs of renal failure which include:
- A reduction of urine or the need to urinate during the night
- Nausea, vomiting, pigmentation and easy bruising
- Reduced sexual function
- Abnormal build-up of fluid in the ankles and legs
- Chest pain
- Cramps and twisting
When is a kidney transplant needed?
The kidneys are two bean-shaped organs located on each side of the spine, below the rib-cage. The main functions of the kidneys are to filter and remove waste, minerals and fluid from the blood, producing urine. When the kidneys lose their filtering ability, harmful levels of fluid and waster accumulate in the body, raising the blood pressure, resulting in kidney failure. When the kidneys lose about 90% of their ability to function normally, it is called end-stage renal disease (ESRD).
When your kidneys are no longer working properly, there are treatments such as haemodialysis and peritoneal dialysis which can filter the waste products from your body. However, dialysis does not perform many of the other vital functions such as stimulating the production of red blood cells. In this case, only a kidney transplant can work.
Causes of end-stage renal disease (ESRD) include:
- Diabetes or high-blood pressure
- Glomerulonephritis (inflammation of kidney’s filtering units, glomeruli)
- Polycystic kidney disease
- Other congenital defects of the kidneys
A kidney transplant is mostly the preferred treatment for kidney failure, compared to a lifetime on dialysis and is associated with:
- Better quality of life
- Fewer dietary restrictions
- Lower risk of death
- Lower treatments costs
However, for certain people with kidney failure, a transplant may be riskier than dialysis. Conditions that may prevent someone from being eligible for kidney transplant include:
- Advanced age
- Alcohol or drug abuse
- Active/recently treated cancer
- Dementia or other poorly controlled mental ailment
- Severe heart disease
- Any other factors that could affect the ability to undergo the transplant procedure
What types of kidney transplant are available?
- Deceased donor kidney transplant - when a kidney from someone who has recently died is removed with consent of the family or from a donor card and placed in the recipient whose kidneys have failed.
- Living donor kidney transplant - when a kidney from a living donor is removed and placed in the recipient whose kidneys functions are impaired. Since one donated kidney can replace two failed kidneys, living-donor kidney transplant offers an alternative to deceased-donor kidney transplant.
- Pre-emptive kidney transplant - when a kidney transplant is conducted before the kidney function deteriorates to the point of needing dialysis. Currently, most kidney transplants are performed on people who undergo dialysis, since their kidneys are unable to adequately clean impurities from the blood.
Family members are usually the most compatible living kidney donors. In case a compatible living donor is not available, the patient will be placed on a waiting list for a deceased donor kidney. The number of people waiting for a transplant is more than the available deceased donor kidneys hence the waiting time maybe long.
Overview of Bone Marrow Transplant
Bone marrow in our bones is responsible for formation of blood cells. In fact, all the blood cells are formed by a subset of bone marrow cells known as “hematopoietic stem cells” or simple “stem cells”. These stem cells have special characteristics i.e. they can renew themselves, and have the capability to develop into any type of blood cells. Nowadays, hematopoietic stem cells can also be obtained from peripheral blood after treatment with certain growth factors or from umbilical cord. Thus, “Hematopoietic stem cell transplantation” is now also referred to as “Bone Marrow Transplantation”, wherein the stem cells from bone marrow that produce red blood cells, white blood cells, and platelets are injected into a recipient after a short course of chemotherapy called conditioning. Today, this is a viable option for several disorders and with continued research, success has improved markedly.
Some conditions which require Bone Marrow Transplant (BMT)
The conditions which necessitate a BMT can be broadly classified into 2 groups:
- Cancerous Conditions
- Acute Myeloid and Lymphoblastic Leukaemia
- Chronic Myeloid and Lymphoblastic Leukaemia
- Hodgkin’s and Non-hodgkin’s Lymphoma
- Myelodysplastic Syndrome
- Myeloproliferative Neoplasms, Primary Myelofibrosis, etc
- Multiple Myeloma
- Non-Cancerous Conditions
- Aplastic Anaemia
- Haemoglobinopathies such as Thalassemia and Sickle Cell Anaemia
- Immunodeficiency disorders
- Congenital errors of metabolism
- Congenital storage disorders
Different types of Bone Marrow Transplant (BMT)
There are two basic types of transplants: Allogeneic and Autologous, depending on who donates the bone marrow or stem cells.
Allogeneic BMT: Donor and Recipient are two separate individuals and transplant is done using the stem cells of donor. It may be
- Matched Related, where donor is HLA matched relative usually a sibling.
- Matched Unrelated, where donor is not a relative of patient and usually found from one of the various national or international registries.
- Partially Matched Related, where donor is from a patient’s family but partially matched (haploidentocal)
- Cord blood from a cord blood registry
Autologous BMT: Donor and Recipient are same individuals, where transplant is done using patient’s own stem cells. The procedure involves giving high dose chemotherapy to patient in order to remove primary disease. Thereafter, an autologous transplant is conducted to rescue damaged bone marrow. This type of transplant has minimal complication and is preferred for diseases like multiple myeloma/lymphoma.
What Are The Stages during a Bone Marrow Transplant (BMT)?
Undergoing a Bone Marrow Transplant is a five-stage process.
- Physical examination – to assess recipient’s health status
- Harvesting – the process of obtaining stem cells to be used in the transplant
- Conditioning – preparing the body for transplant
- Transplanting the stem cells
- Recovery period
- Liver Transplant (Live & Deceased)
- Kidney Transplant (Live & Deceased)
- Combined Liver & Kidney Transplant (Deceased Donor)
- Bone Marrow Transplant