What is the liver transplant success rate? What can you not do after liver transplant surgery?


It was only in 1998 that the first successful deceased donor liver transplant (DDLT) and a living donor LT (LDLT) were performed in India. Currently, more than 1800 liver transplants (LT) are performed annually. And with tech-aided improvements, the process has become faster, holding out hope for a lot of patients.

What is a liver transplant?

Liver transplant is a procedure where a diseased liver is completely removed from the patient and is replaced by a new liver. A liver transplant is needed when someone is suffering from liver failure, either advanced chronic liver disease or acute liver failure, and liver cancer, also known as hepatocellular carcinoma (HCC).

What kinds of liver transplants are possible?

A liver could be transplanted from either a dead person or a living person. If it is a dead person’s liver, the procedure is known as deceased donor liver transplant or cadaveric liver transplant. A (recipient) patient must be on a waiting list for cadaveric liver transplant. The second method of receiving a liver transplant is to receive half or a portion of one’s own liver. This applies to both adults and children.

Who is eligible for a liver transplant?

Adults who have liver failure or liver cancer require a liver transplant. A liver failure can occur in adults with chronic liver disease, which means it has been present for a long time. Liver failure can occur because of alcoholic liver disease, non-alcoholic fatty liver disease, uncontrolled diabetes, obesity, high cholesterol levels, a poor lifestyle or a combination of these factors. It can also be caused by hepatitis C or hepatitis B, as well as other rare metabolic causes such as biliary diseases. When such diseases reach advanced stages, they cause complications and lead to liver dysfunction, a condition known as decompensation. A liver transplant is required when someone has decompensated chronic liver disease.

Biliary atresia, a rare disease of the liver and bile ducts that occurs in infants, is one of the most common diseases in children that require a liver transplant.

In this case, a blockage occurs in the tubes (ducts) that transport bile from the liver to the gall bladder in children, causing jaundice and further liver damage. Sixty per cent of all liver transplants performed on children are done because the child has biliary atresia.

Who can donate a liver?

A person between 18 and 55 years but with the same blood group as the recipient or a universal donor, who is not overweight and is a member of the donor’s family qualifies.

Can one lead a normal life after getting a liver transplant and/or donating their liver?

The quality of life after partial liver donation, as well as the quality of life among patients who have received a liver transplant, is excellent.

A successful liver transplant recipient can resume normal life in two months. Adults and children alike can return to work and follow their prescribed diets. Children can return to school, participate in daily activities and live a normal life within two months of transplant. The younger the patient, the faster they can get back to normal life. Young people may be able to return to their normal lives in six to eight weeks, while older people may require a month or more.

The patient’s post-transplant recovery is also affected by how sick they were prior to the transplant. If they were extremely ill, had lost a lot of weight and were nutritionally deficient, it may take them four weeks longer to recover after transplant, but they can eventually have an excellent quality of life. However, recipients after transplant require life-long monitoring to stay on track.

Can you explain the process of recovery post a transplant — for the recipient and donor?

The donors are discharged five to seven days after transplant, and they may return to a normal life in a month. They must follow a normal diet, healthy lifestyle, stay physically fit and can participate in sports. However, it may take up to four months for them to play hockey or start doing weights. The life expectancy of the donor is not hampered due to the transplant and does not require any medication or follow-up after two months.

The recipients are discharged within 10-15 days and their recovery time is like that of donors. The younger ones generally return to normal life a little sooner in comparison to the older ones. The recipients are put on multiple medications after four months of transplant and then confined to a few life-long medicines. However, these do not come in the way of their quality of life. We see patients with new liver playing cricket, resuming their career and having a normal life expectancy.

What are some of the challenges of a liver transplant?

Liver transplantation is a difficult specialty. For example, we frequently encounter children who are critically ill and weigh only 3 kg. In such cases, we need specialised training and approaches. At Medanta, we have performed the most transplants on babies in the country. We have performed approximately 400 paediatric liver transplants, 250 of which were performed on babies weighing less than 10 kg. However, post-transplant, these babies recover very well and lead a healthy life.

Furthermore, there are numerous challenges to liver conditions because these patients have multiple problems such as jaundice, bleeding tendency, inflamed body and abdominal swelling due to water retention in their belly. Some may reach a pre-coma state. Liver failure causes multi-system damage, affecting multiple organs such as the brain, heart and kidneys, making transplant and post-operative care extremely difficult. However, with experienced surgeons and a state-of-the-art facility, we have success rates of 95 per cent for adults and 97 per cent for children, and we provide complete safety for liver donors.

How many liver transplants can a person get during their lifetime?

Liver transplants are not required to be repeated. A liver is a strong organ that, once transplanted, will last a lifetime. It is a myth that repeated liver transplantation is required for improved liver function. Re-transplantation of the liver is a very uncommon situation. I’ve performed approximately 3,700 liver transplants, with only 22 being liver re-transplants.

The following are the major advances in liver transplantation in the last 20 years:

Swap or exchange liver transplantation, which involves exchanging organs between two families when the blood group of the donor in one family does not match the patient’s blood group. We have been doing the same thing for the past 12 years.

There’s ABO-Incompatible Liver Transplantation, which is an advanced and critical treatment that crosses the blood-typing barrier to save lives from liver diseases by immune-modulating recipients’ bodies.

Robotic liver donor surgery assists and allows surgeons to perform advanced procedures with the potential for improved precision, as well as providing the surgeon with a three-dimensional view of the surgical site. This tool has made recovery much faster, and it has revolutionised liver transplantation in many ways. The majority of young donors prefer robotic surgery because it is painless, leaves no scars, and allows for a faster recovery.

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