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Liver transplant In India by Dr. Abhideep Chaudhary, Sir Ganga Ram Hospital


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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.
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Published in: Health & Medicine
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Liver transplant In India by Dr. Abhideep Chaudhary, Sir Ganga Ram Hospital

  1. 1. Dr Abhideep Chaudhary Consultant Surgeon Surgical Gastroenterology and Liver Transplantation Sir Ganga Ram Hospital New Delhi
  2. 2. 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 *
  3. 3. 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
  4. 4. © 2007 Thomson - Wadsworth What Happens When Liver Fails
  5. 5.  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. 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
  6. 6.  1967 : 1st successful Liver Transplant  1989 : 1st successful LDLT ( Adult to child )  1998 : 1st successful LDLT ( Adult to Adult )
  7. 7.  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
  8. 8. Long-term survival of liver transplant recipients has become the rule rather than the exception
  9. 9.  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
  10. 10. 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)
  11. 11. No.oflivertransplants
  12. 12. Should all liver disease patients have a LT ? NO
  13. 13.  Success rate  Disease progression  Donor availability  Cost  Disease recurrence  Compliance with post operative restrictions Why No ?
  14. 14.  Determine the need for transplant  Confirm all effective treatments have been exhausted  Assess whether patient is an appropriate candidate When to Consider Transplantation?
  15. 15.  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%.
  16. 16.  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
  17. 17.  When medical therapy is effective in stopping the progression of liver disease, transplantation may be avoided or delayed
  18. 18.  Expensive surgery (18-20 lac rupees)  Cost cutting measures Avoid technical complications Decrease transfusion requirements Use medications of proven efficiency Cost
  19. 19. 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
  20. 20.  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
  21. 21.  Hepatocellular carcinoma, which are confined to the liver can be treated by liver transplantation
  22. 22.  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
  23. 23.  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
  24. 24.  Donation after brain death  Living related donor
  25. 25.  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
  26. 26. Till then … Living related liver transplant
  27. 27.  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
  28. 28.  Liver transplantation is possible due to the amazing regenerative capacity of human liver  Both donor and recipient eventually lead normal lives post procedure
  29. 29.  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
  30. 30.  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
  31. 31. 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
  32. 32. “The Great One”
  33. 33. Pledge your organs Save a life Don’t Take me to heaven, no one needs me there!