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.
Email : drabhideep@yahoo.com , care@drabhideep.com
3. 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
http://hypertextbook.com/facts/2004/MaryPennisi.shtml *
4. 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
7. 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.
ftp://ftp.cdc.gov/pub/infectious_diseases/hepatitis/slides/technote.t
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
10. 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
11. Long-term survival of liver transplant recipients has
become the rule rather than the exception
12. 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
13. 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)
16. Success rate
Disease progression
Donor availability
Cost
Disease recurrence
Compliance with post operative restrictions
Why No ?
17. Determine the need for transplant
Confirm all effective treatments have been
exhausted
Assess whether patient is an appropriate candidate
When to Consider Transplantation?
18. 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%.
19. 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
20. When medical therapy is effective in stopping
the progression of liver disease,
transplantation may be avoided or delayed
21. Expensive surgery (18-20 lac rupees)
Cost cutting measures
Avoid technical complications
Decrease transfusion requirements
Use medications of proven efficiency
Cost
22. 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
23. 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
25. 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
26. 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
28. 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
30. 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
31.
32. Liver transplantation
is possible due to the
amazing regenerative
capacity of human
liver
Both donor and
recipient eventually
lead normal lives post
procedure
33. 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
34. 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
35. 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
