The Hinduja Hospital has all facilities required to carry out this major life saving procedure successfully. This includes a fully equipped theatre suite, advanced laboratory support and state of the art intensive care unit. Patients are being listed after a 3-stage assessment. Liver transplant is indicated for irreversible liver pathology, where the life span is expected to be less than 1-2 years. The commonest causes of end stage liver disease in India are cirrhosis due to Hepatitis B, C and excessive alcohol intake. Rarer causes include auto-immune cirrhosis, cryptogenic cirrhosis, primary sclerosing cholangiitis, and the Budd-Chiari syndrome.
In children, biliary atresia forms the commonest indication. Inherited metabolic diseases such as Wilsons disease, Criggler Najjar syndrome, alfa-1-antitrypsin deficiency, protein C deficiency, hyperoxalosis can be cured by transplant.
Liver transplant is the only hope for patients with fulminant hepatic failure fulfilling the Kings College criteria. Common causes include Hepatitis B & E, non A non B hepatitis, paracetamol overdose and Wilsons disease.
Primary hepatocellular cancer, metastasis from carcinoid tumours form rarer indications for transplantation.
The new liver is usually obtained from a brain dead heart-beating cadaver, often as part of a multi-organ retrieval procedure. Preservation with UW solution ensures that the liver can stay outside the body for upto 18 hours.
A successful operation is just the first step. The post-operative period is crucial, requiring good intensive care support. The chief complications encountered are sepsis owing to the immunosuppression required, primary graft non-function, hepatic artery thrombosis, biliary leaks, and rejection of the graft.
Immuosuppression is maintained with cyclosporine and steroids, with high dose steroids used to treat acute rejection. Following successful recovery, the patient can expect to lead a normal productive life. Life long immunosuppression similar to renal transplant patients is necessary.