- About Liver Transplant in India
- Cost of Liver Transplant in India
- When Is a Liver Transplant Needed?
- Causes of Chronic Liver Injury
- How are candidates for Liver Transplant selected?
- Which Tests are required before getting a Liver Transplant?
- Where does a Liver for a Transplant Come From?
- Types of Liver Transplant Procedure:
- What complications are associated with Liver Transplant?
- Best hospitals for Liver Transplant in India?
- Cost of Liver Transplant in India at different locations?
- What is the cost of Liver Transplant in India?
- Cost Comparison India vs Other Countries
- Medical Tourism in India
- How to get medical visa to India
Liver Transplant Surgery
A liver transplant is a medical procedure in which a patient's diseased liver is replaced with a whole or partial healthy liver taken from another person. This article explains the current indications for liver transplantation, types of liver donors, the operation itself, and the immunosuppression that is required after liver transplantation.
Liver transplant is usually kept as an option for people who are having significant complications due to end-stage chronic liver disease. In rare cases, sudden failure of a previously normal liver may occur.
The number of people waiting for a liver transplant greatly exceeds the number of available deceased-donor livers.
The human liver rebounds and returns to its normal size shortly after surgical removal of part of the organ. This makes living donor liver transplant an alternative to waiting for a deceased donor liver to become available.
A liver transplant is not a simple step to take, but it can save your life. Survival rates after liver transplants have improved remarkably well over the past several years. Currently, over 80 to 90% of people survive liver transplantation and enjoy good quality life subsequently.
Liver Transplant patients are diagnosed by an integrated multidisciplinary team consisting of GI and Liver Transplant Surgeons, Hepatologists, Surgical Critical Care Specialists, Interventional Radiologists and other Supporting services such as radiology, transfusion services, infectious diseases, microbiology, histopathology, nephrology and dedicated ICU staff.
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When Is a Liver Transplant Needed?
A liver transplant is considered when the liver no longer functions adequately (liver failure). Liver failure can happen anytime (acute liver failure) as a result of viral hepatitis, drug-induced injury or infection. Liver failure can also be the end result of a long-term problem. The following conditions may result in chronic liver failure:
- Chronic hepatitis with cirrhosis.
- Primary biliary cholangitis (it is a rare condition where the immune system inappropriately attacks and destroys the bile ducts)
- Sclerosing cholangitis (scarring and narrowing of the bile ducts inside and outside of the liver, causing the backup of bile in the liver)
- Biliary atresia (a rare disease of the liver that affects newborns)
- Wilson's disease (a rare inherited disease with abnormal levels of copper throughout the body, including the liver)
- Hemochromatosis (a common inherited disease where the body has too much iron)
- Alpha-1 antitrypsin deficiency (an abnormal buildup of alpha-1 antitrypsin protein in the liver, resulting in cirrhosis)
The liver has many jobs to do such as it helps in digesting your food, clearing some wastes from your blood, making proteins that help your blood to clot, storing glycogen for energy, breaking down many poisons and medicines and many more tasks. When the liver is seriously damaged, there is no treatment that can help the liver do all of its jobs. Therefore, when a person reaches at a specific stage of liver disease, liver transplant may be the only way to prolong his or her life.
The most common reason for liver transplantation in adults is cirrhosis, a disease in which healthy liver cells are killed and replaced with scar tissue. The common causes of cirrhosis are alcohol abuse and hepatitis due to B and C viruses. The most common reason for liver transplantation in children is biliary atresia, a disease in which the ducts that carry bile out of the liver are damaged.
Liver transplantation replaces a failing or diseased liver with one that is normal and healthy. At this time, liver transplantation is the only cure for liver insufficiency or liver failure because no device or machine reliably performs all of the functions of the liver.
Causes of Chronic Liver Injury
Hepatitis B infection accounts for 5% of all liver transplants performed in the United States but accounts for a larger proportion of liver transplants in other parts of the world, especially Asia and Australia / New Zealand.
Hepatitis C is the most common indication for liver transplantation in the United States, affecting nearly 50% of all liver transplant recipients.
Alcoholic Liver Disease
Liver failure due to alcohol abuse is the second most common indication for liver transplantation. Most centers require at least a six-month period of abstinence, often within a recognized substance abuse program such as Alcoholics Anonymous, as a condition of listing for liver transplantation.
Metabolic Liver Disease
Non-alcoholic steatohepatitis (NASH): Deposition of fat within liver cells may result in inflammation that injures and scars the liver. Risk factors for the development of fatty liver and NASH include obesity and metabolic conditions such as diabetes and hyperlipidemia (increased cholesterol). The percentage of patients being transplanted for this condition has increased 35 fold from 2000 to 2005.
Autoimmune Liver Disease
- Autoimmune hepatitis (destruction of the liver by the patient's own immune system)
- Cholestatic Liver Diseases
- Primary Biliary Cirrhosis (PBC) (destruction of small bile ducts within the liver)
- Primary Sclerosing Cholangitis (PSC) (destruction of bile ducts inside and outside the liver). 70% of patients with PSC also suffer from ulcerative colitis, an autoimmune disorder of the colon.
- Neonatal sclerosing cholangitis (infection and scarring of the bile ducts in the liver of an infant)
- Biliary atresia (absence of bile ducts outside the liver)
- Caroli's disease (abnormality of the bile ducts within the liver)
- TPN-induced cholestasis. Patients who receive intravenous nutrition, termed total parenteral nutrition (TPN) sometimes develop bile stasis (slowing or stopping of normal bile flow) that can, over time, lead to liver injury and failure.
Genetic Liver Disease
- Hemochromatosis: excess iron deposition in the liver
- Wilson's disease: abnormal copper metabolism
- Alpha-1 anti-trypsin deficiency: lack of a gene product that limits the activity of trypsin, an enzyme that digests protein. Over time this leads to progressive destruction of the liver and lung.
- Glycogen storage disease (type I, III, IV): an inherited metabolic disorder
- Tyrosinemia: a disorder of tyrosine metabolism
Vascular Liver Disease
Budd-Chiari syndrome is thrombosis (clotting) of the hepatic veins which leads to poor blood flow through the liver.
Hepatocellular carcinoma (HCC) is a primary cancer of the liver, meaning that it originates from abnormal liver cells. Hepatocellular carcinoma (HCC) occurs only rarely in a normal, non-cirrhotic liver. Its incidence is, however, strikingly increased in the background of cirrhosis and, in particular, by certain types of liver disease that lead to cirrhosis (hepatitis B and C, hemachromatosis, and tyrosinemia). Although cancer first starts within the liver, as it grows it can spread to other organs, a process called metastasis. Hepatocellular carcinoma (HCC) most frequently spreads to the lungs or to bones.
Liver transplantation definitively cures a patient of Hepatocellular carcinoma (HCC), provided that the tumor has not spread beyond the liver. Because there are far more people in need of liver transplants than there are available organs, specific guidelines, called the Milan Criteria, have been established to define which patients with Hepatocellular carcinoma (HCC) are eligible for liver transplantation. These criteria define limits of tumor number and size that ensure a very low likelihood of cancer spread outside of the liver.
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How are candidates for Liver Transplant selected?
Specialists from various fields are needed to determine if a liver transplant is appropriate. Many healthcare facilities assemble a team of such specialists to evaluate and choose candidates for a liver transplant. The team may include the following professionals:
- Liver specialist (hepatologist)
- Transplant surgeons
- Transplant coordinator or usually a registered nurse who specializes in the care of liver transplant patients
- Social worker to discuss your support network of family and friends, employment history, and financial needs
- Psychiatrist to help you deal with issues, such as anxiety and depression, which may accompany a liver transplant
- Anesthesiologist to discuss potential anesthesia risks
- Chemical dependency specialist to aid those with history of alcohol or drug abuse
Which Tests are required before getting a Liver Transplant?
You will need to bring all previous doctor records, X-rays, liver biopsy slides, and a record of medications to your pre-evaluation for a liver transplant. Some or all of the following studies are generally performed during an evaluation.
- Computed tomography, or CT, which uses X-rays and a computer to create pictures of the liver, showing its size and shape to rule out hepatocellular carcinoma. CT scan and chest x-rays will also be taken to evaluate your heart and lungs.
- Doppler ultrasound to determine if the blood vessels to and from the liver are open.
- Echocardiogram to help check the heart function.
- Pulmonary function studies to determine the lungs' ability to exchange oxygen and carbon dioxide
- Blood tests to determine blood type, clotting ability, and biochemical status of blood, and to gauge liver function. HIV, other viral testing and hepatitis screening are also included.
If specific problems are identified, additional tests may be ordered.
Where does a Liver for a Transplant Come From?
There are two types of liver transplant options: living donor transplant and deceased donor transplant.
Living donor liver transplants are an alternative for some patients with the end-stage liver disease. This involves removing a segment of liver from a healthy living donor and implanting it into a recipient. Both the donor and recipient liver segments will grow to normal size in few weeks.
The donor, who may be a blood relative, spouse, friend or even unrelated "Good Samaritan," will have extensive medical and psychological evaluations to ensure the lowest possible risk. Blood type and body size are critical factors in determining who is an appropriate donor. ABO blood type compatibility is preferable as well as donors less than 60 years of age.
Recipients for the living donor transplant must be active on the transplant waiting list. Their health must also be stable enough to undergo transplantation with excellent chances of success.
In deceased donor liver transplants, the donor may be a victim of an accident or head injury. The donor's heart is still beating, but the brain has stopped functioning. Such a person is considered legally dead, because his or her brain has permanently and irreversibly stopped working. At this point, the donor is usually in an intensive-care unit and life support is withdrawn in the operating room during the transplant.
The identity of a deceased donor and circumstances surrounding the person's death are kept confidential.
The Liver Transplant Operation
A liver transplant involves the removal of and preparation of the donor liver, removal of the diseased liver, and implantation of the new organ. The liver has several key connections that must be re-established for the new organ to receive blood flow and to drain bile from the liver. The structures that must be reconnected are the inferior vena cava, the portal vein, the hepatic artery, and the bile duct. The exact method of connecting these structures varies depending on specific donor and anatomy or recipient anatomic issues and, in some cases, the recipient disease.
For someone undergoing liver transplantation, the sequence of events in the operating room is as follows:
- Evaluation of the abdomen for abnormalities that would preclude liver transplantation (for example: undiagnosed infection or malignancy)
- Mobilization of the native liver (dissection of the liver attachments to the abdominal cavity)
- Isolation of important structures (the inferior vena cava above, behind, and below the liver the portal vein the common bile duct the hepatic artery)
- Transection of the above-mentioned structures and removal of the native, diseased liver.
- Sewing in the new liver: First, venous blood flow is re-established by connecting the donor's and the recipient's inferior vena cava and portal veins. Next, arterial flow is re-established by sewing the donor's and recipients hepatic arteries. Finally, biliary drainage is achieved by sewing the donor's and recipient's common bile ducts.
- Ensuring adequate control of bleeding
- Closure of the incision
Types of Liver Transplant Procedure:
1. Orthotopic Liver Transplantation
In Orthotopic Liver Transplantation, the recipient's diseased liver is completely replaced with the healthy liver.
2. Heterotopic Liver Transplantation
In Heterotopic Liver Transplantation, the diseased liver is kept remain intact at its place and donor's liver is placed at the nearest site to the diseased liver. Heterotopic Liver Transplantation is performed when the doctor is of the opinion that the diseased liver might recover, if the liver recovers, the other organ shrivels away, if not, then the original one shrivels and the donor's liver performs the body functions.
3. Reduced size Liver Transplantation
Reduced Size Liver Transplantation is done on children and involves the transplanting a part of the healthy donor liver into a patient. Reduced Size Liver Transplantation is performed when 15-20% of the original liver is intact. This way, one donor liver can be used for two successful transplants.
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What complications are associated with Liver Transplant?
Some common problems related to liver transplant are the following:
Your immune system works to destroy foreign substances that invade the body. But the immune system can't distinguish between the transplanted liver and unwanted invaders, such as viruses and bacteria. So, your immune system may attempt to attack and destroy your new liver. This is called a rejection episode. About 64% of all liver transplant patients have some degree of organ rejection, most within the first 90 days of liver transplant.
Because anti-rejection drugs that overcome your immune system are needed to prevent the liver from being rejected, you are at higher risk for infections. This problem lessens as time passes. Not all the patients have problems with infections, and most infections can be treated successfully as they happen.
Some of the procedures that led to the failure of the patient's own liver can damage the new liver and eventually destroy it. Perhaps the best example is hepatitis B infection. In the early 1990's, patients who received the liver transplant for hepatitis B infection had less than 50% five-year survival. The vast majority of these patients suffered from very aggressive re-infection of the new liver by hepatitis B virus. During the 1990's, however, several drugs and strategies to prevent re-infection and damage of the new liver were developed and instituted widely by transplant centers. These approaches have been highly successful such that recurrent disease is no longer a problem. Hepatitis B, once considered a contradiction to transplantation, is now associated with excellent outcomes, superior to many of the other indications for liver transplantation.
Currently, the primary problem with recurrent disease is focused on hepatitis C. Any patient that enters transplantation with hepatitis C virus circulating in their blood will have ongoing hepatitis C after transplantation. However, those who have completely cleared their virus and do not have measurable hepatitis C in the blood will not have hepatitis C after transplantation.
Post-Transplant Lymphoprolipherative Disorder (PTLD)
Post-Transplant Lymphoprolipherative Disorder (PTLD) is type of cancer that arises exclusively in transplant recipients, as suggested by its name. Post-Transplant Lymphoprolipherative Disorder (PTLD) is almost always associated with Epstein - Barr virus (EBV), the same virus that causes infectious mononucleosis or "the kissing disease."
The majority of adults have been exposed to Epstein - Barr virus (EBV), most commonly in their childhood or teenage years. For these patients, Epstein - Barr virus (EBV) associated PTLD can develop after transplantation because immunosuppression allows the virus to reactivate. In contrast, many children come to liver transplantation without ever having been exposed to Epstein - Barr virus (EBV). If patients are exposed to Epstein - Barr virus (EBV) after the liver transplantation then under the influence of immunosuppression they may be unable to control the infection.
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Which are the best hospitals for Liver Transplant in India?
Some of the best hospitals for liver transplant in India are:
- Medanta- The Medicity, Gurgaon
- Fortis Escorts, New Delhi
- Apollo Hospital, Bangalore
- Kokilaben Dhirubhai Ambani Hospital, Mumbai
- Jaypee Hospital, Noida
- BLK Hospital, Delhi
- Artemis Health and Research Institute, Gurgaon
- Breach Candy Hospital, Mumbai
- Lilavati Hospital, Mumbai
- Sir Ganga Ram Hospital, Delhi
- Sri Ramachandra Medical Center, Chennai
- Apollo Chennai, Chennai
- Yashoda Hospitals, Malakpet, Hyderabad
- Jaslok Hospital, Mumbai
- KIMS Hyderabad
- Institute for Liver and Biliary Sciences, Delhi
- MIOT International Hospital, Chennai
- Christian Medial College and Hospital, Vellore
- Wockhardt Hospital, Mumbai
What is the cost of Liver Transplant in India at different locations?
The best Hospital available for Liver Transplant in Delhi is BLK Super Specialty Hospital. It provides Liver Transplant at very affordable price and cost. The estimated cost of Liver Transplant in Delhi at BLK Hospital will be an approximate to Rs.15 to 25 Lakhs. The treatments provide here are very cost friendly and the hospital provides all the facilities at a cheaper price. BLK Super Specialty Hospital is a 650 bedded hospital with dedicated 125 critical care beds with over 150 specialists across various super specialties making it one of the best hospitals in Delhi and India.
The best Hospital available for Liver Transplant in Noida (Uttar Pradesh) is Jaypee Hospital. It provides Liver Transplant at very affordable price and cost. The estimated cost of Liver Transplant in Noida at Jaypee Hospital will be an approximate to Rs. 15 to 25 Lakhs. The treatments provide here are very cost friendly and the hospital provides all the facilities at a cheaper price. Jaypee hospital is a very famous hospital which consists of 150 critical beds and it is one of the premier hospitals in Delhi/NCR and gaining popularity in India.
The best Hospital available for Liver Transplant in Faridabad (Haryana) is Sarvodaya Hospital. It provides Liver Transplant at very affordable price and cost. The estimated cost of Liver Transplant in Faridabad at Sarvodaya Hospital will be an approximate to Rs. 15 to 25 Lakhs. The treatments provide here are very cost friendly and the hospital provides all the facilities at a cheaper price. Sarvodaya Hospital is a 300 Bedded Hospital. It is located in Faridabad (Haryana) is one of the finest medical institutions.
The best Hospital available for Liver Transplant in Gurgaon (Haryana) is Medanta Hospital. It provides Liver Transplant at very affordable price and cost. The estimated cost of Liver Transplant in Gurgaon at Medanta Hospital will be an approximate to Rs. 15 to 25 Lakhs. The treatments provide here are very cost friendly and the hospital provides all the facilities at a cheaper price. Medanta Hospital which is located in Gurgaon is a 1000 bedded multi specialty hospital. It follows medical practices and procedures which are research oriented and benchmarked against the best in India.
The best hospital available for Liver Transplant in Jaipur (Rajasthan) is SMS Hospital. It provides Liver Transplant at very affordable price and cost. The estimated cost of Liver Transplant in Jaipur (Rajasthan) at SMS Hospital will be an approximate to Rs. 15 to 25 Lakhs. The treatments provide here are very cost friendly and the hospital provides all the facilities at a cheaper price. SMS Hospital is a very famous hospital in Jaipur (Rajasthan).
The best Hospital available for Liver Transplant in Patna (Bihar) is Paras HMRI Hospital. It provides Liver Transplant at very affordable price and cost. The estimated cost of Liver Transplant in Patna (Bihar) at Paras HMRI Hospital will be an approximate to Rs. 15 to 25 Lakhs. The treatments provide here are very cost friendly and the hospital provides all the facilities at a cheaper price. Paras HMRI Hospital is the first corporate hospital in Patna (Bihar). The hospital has reasonable health-care facility and experts from many faculties.
The best Hospital available for Liver Transplant in Chandigarh is PGI Chandigarh. It provides Liver Transplant at very affordable price and cost. The estimated cost of Liver Transplant in Chandigarh at PGI Chandigarh will be an approximate to Rs. 15 to 25 Lakhs. The treatments provide here are very cost friendly and the hospital provides all the facilities at a cheaper price.
The best Hospital available for Liver Transplant in Mohali (Punjab) is Max Super Specialty Hospital. It provides Liver Transplant at very affordable price and cost. The estimated cost of Liver Transplant in Mohali (Punjab) at Max Super Specialty Hospital will be an approximate to Rs. 15 to 25 Lakhs. The treatments provide here are very cost friendly and the hospital provides all the facilities at a cheaper price. Max Super Specialty Hospital is a very famous hospital in Mohali (Punjab).
The best Hospital available for Liver Transplant in Mumbai (Maharashtra) is Kokilaben Hospital. It provides Liver Transplant at very affordable price and cost. The estimated cost of Liver Transplant in Mumbai (Maharashtra) at Kokilaben Hospital will be an approximate to Rs. 15 to 25 Lakhs. The treatments provide here are very cost friendly and the hospital provides all the facilities at a cheaper price. Kokilaben Hospital is a 750 bedded multi specialty hospital and known for its comprehensive treatments for all major specialties.
Medical Tourism in India
Medical Tourism is a form of associating patients to world class medical, dental and cosmetic surgery facilities overseas. India is a growing destination for medical tourism, and people from all over the world are looking to visit India for medical needs.
Medical Tourism involves traveling abroad to take world class medical treatment at very economical rates, as compared to countries like US, UK and Australia. As a result of which, we can see a rise in Indian medical tourism with each of the passing day.
Imagine a typical surgical procedure performed in a high class hospital by experienced doctors at a very low price than it generally takes. That's India. From the high quality of treatment, huge range of procedures, infrastructure and experienced doctors to perform any medical procedure with no waiting time, the list of benefits of traveling for medical treatment in India are many.
Lazoi is an online healthcare portal where the patients can come and book their appointments with any of the doctors irrespective of their location. We are having best Gastrointestinal surgeons in India who remains ready to work for the welfare of the patients.
Domestic patients can be treated across all over India they have the flexibility of choosing the location where they would like to have their treatment done. The patients who come from abroad or the international patients are provided with high class medical care in the metro cities like Delhi, Mumbai, Bangalore and many more.
Quality of care is what mainly attracts people to India. However, the quality services provided to the patients should not be excess than the patient's affordability. If quality comes at an affordable cost, it's an unbeatable advantage. This combination of getting best quality treatment with low cost advantage is very unique for India.
We are having various JCI-accredited hospitals and medical centers that are known for offering the best and the efficient healthcare services with us. International patients can get the benefit of having affordable medical treatments in India along with the use of state of the art technology, treatment at trusted hospitals and special personalized care.
If you are an international patient and you had your medical treatment done in India, you will get the facility of having second opinion with the doctor in the mode as you like which will be provided by us. You can ask an online query, get tele-consultation with the doctor or you can have an online video consultation. This helps in saving the travel time of the international patients.
We act as a bridge and provide various facilities to the patients as well as the doctors. This is because patients do not have the access of doctors. Lazoi is a formal and a high reputed organization which is trusted by many. Beware of misguiding agents which further can harm you and may also take huge amount of money.
What is the cost of Liver Transplant in India?
Cost of Liver Transplant in India is:
1. Government Hospitals
The cost of liver transplant in India lies between 5 Lakhs - 10 Lakhs INR (i.e. USD 7500 - USD 16000).
2. Private Hospitals
In these hospitals the cost of liver transplant in India lies between 18 Lakhs - 24 Lakhs INR (i.e. USD 28000 - USD 40000).
Is there cost comparison of Liver Transplant Surgery in India to other countries?
Cost of Liver Transplant Surgery in USA is approx to Rs. 2 crores ($300,000).
Cost of Liver Transplant Surgery in Singapore is approx to Rs. 1.2 crores ($200,000).
Cost of Liver Transplant Surgery in UK is approx to Rs. 1.2 crores ($200,000).
Cost of Liver Transplant in India is approx to Rs. 20 lakhs ($35,000).
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