Who needs a transplant | Pre-transplant evaluation | Transplant operation | Post operative care | Living with a transplant

Liver Transplant Operation

Cadaveric donor (deceased donor) liver transplant

The waiting time can be very variable from 1 to 12 months depending on your blood group and your waiting list number. While waiting, if you are not available at your usual numbers, you must inform the Transplant Team of your whereabouts at all times so that they can contact you as soon as an organ becomes available.

It is good idea to have a suitcase already packed with essential toiletry and underwear at home so that no time is wasted before you go to the hospital.

Live Donor Liver Transplant

Due to a lack of cadaveric donors in India, majority of the transplants Dr. Soin currently performs are live donor liver transplants whereby a portion of the patient's relative's liver is removed and is used to replace the diseased liver of the patient. Dr. Soin's team at SGRH conducts 5-6 live donor liver transplants every month with results which are at par with the best centres in the world i.e., a success rate of 90% for the patients and a 100% safety record for the donors. The details of suitability for and safety of liver donation are given in the section "Liver Donation".

CLICK TO VIEW SNAPSHOT OF OPERATION

(one of the Live Donor Liver Transplants conducted by the author and his team at his centre, Sir Ganga Ram Hospital)

Preparing for Surgery

When you arrive at the hospital, you will undergo a series of tests. These are a routine part of the preparation for surgery and are designed to discover any infections which may not be immediately obvious. You will have a general physical examination and be asked to give samples of urine and blood. A chest X-ray, and electrocardiogram of your heart will also be made. Finally you will be asked to wash yourself thoroughly with antiseptic soap and the nurse will shave the surgical area.

The transplant surgeon and anaesthetist will meet with you to explain the operation procedure and the risks that may be involved. You will be asked to sign a form consenting to the operation.

The Operation

The transplant involves a major operation to remove the diseased liver and replace it with a normal donor liver placed in its usual position in the right upper abdomen. While this may sound relatively easy, the surgery is very demanding and can take between six and eighteen hours to complete. At least three surgeons, two anaesthetists, and half a dozen nurses are needed during the operation. The diseased liver must be disconnected from four major blood vessels and the tube that carries bile from the liver to the intestines, known as the bile duct, has to be disconnected from the bowel. The new liver is then put in place, and the major blood vessels and bile duct reattached to complete the operation.

After the operation you will be taken to the intensive care unit and connected to a respirator (breathing machine). If all goes well, the respirator can gradually be phased out over 24-48 hours, although it is not unusual to require the respirator for longer periods of time.

After three to ten days in intensive care, you will probably spend another two to four weeks convalescing in the transplant unit before being allowed to go home. It is important that you try to get up and about as soon possible so that blood circulatory problems can be avoided.
Since the donor liver is foreign to the body, the body mounts an immune response to reject it. This is prevented by certain medicines referred to as immunosuppressive drugs.

After another one month at home, you will start feeling normal again and gradually be able to get back to normal activities. Once the donor liver takes in the body (if the person remains well for about 3 months after operation), the person has an excellent chance of leading a normal life and with longevity comparable to any other person of their age and fitness.

Check-up Visits

During the first 3 months after discharge from the hospital, it is important that you return to the Transplant Unit once or twice a week for follow-up visits. The purpose of follow-up visit is to monitor your progress and detect any potential complications. On each visit, your liver function will be carefully assessed and you will undergo an examination so that any infections can be identified. Once you are stable, the frequency of visits will decline.

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