The Department of Surgical Gastroenterology, PGIMER has recently successfully conducted its second Simultaneous Liver Kidney Transplant on a 47-year-old male patient from Jammu on 29/01/23; who was suffering from simultaneous kidney and liver failure.
He was able to sustain his life with support dialysis and for liver wasgettings upportivecare. He was admitted on 28th January 2023 and operated next day. Patient had anuneventfulre covery and dischargedon15/02/23. His total stay in the hospital was 16 days. He hadnopostoperative complication of any kind related to procedure. He was discharged with normal liver and kidney functions. He has been Prescribed adequate immunos up pressant and is on follow up.
His last follow up was 1 week back and he is ready to join back his job as Professor of English literaturein University of Jammu under the union territory of Jammu and Kashmir.
Previously we conducted First Simultaneous Liver and Kidney Transplantinour department June 14th 2022, in a 24-year-old male from Himachal Pradesh.He was also suffering from simultaneous liverandkidney failure due to congenitalhepatic fibrosisandend stage renal disease. His was sustaining his life on regular renal dialysis and supportive for liver. He is on regular follow up and maintaining his kidney as well as liver function onimmunos up pressant.
Both these patients are free of dialysis and no need for any other support for liver as of now. Before transplant,both of these patients had very poor quality of life were dependent of other stoper form daily activities and earn livelihood.
When is liver transplant required ?
Liver transplant is the only chance of survival/ cure for patient suffering from chronic liver diseases, acute liver failure and acute on chronic liver failure. Patients who are diagnosed
with liver cancer in setting of chronic liver disease may also benefit from liver transplantation in carefully selected cases.
What is over all survival after liver transplant?
One year survival is close to 90% in adults and it is 96-98% in paediatric population.
Do they need lifelong treatment after liver transplant ?
Patients who are successfully transplanted need lifelong medicine to maintain graft functions. These medicines are to be taken daily and its doses are reduced with time. In the beginning usually three tablets have to be taken after three months usually one or two tablets with minimum doses are required as maintenance therapy.
Can a person lead productive life after liver transplant?
A person can lead normal productive life after liver transplant. He can join back his professional work. There are some restrictions which are explained by the operating team at the time of discharge.
What are the ways to get liver?
There are two different way to get liver : Liver can be donated by brain dead and heart beating patients who are already admitted in the hospital in ICU and relatives of the these type of patients take a decision to donate organ. Then these patients are assessed by transplant team and suitability of the patient who is ready to donate is decided and if all is okay then only organ is taken for transplant. The usual criteria is ; donor should be less than 65 years of age , should not have any on-going infection, there should not be cancer in the body anywhere and organ should be suitable for transplant. This type of liver transplant is called as DDLT(Deceased donor liver transplant ) Second type of liver transplant us called LDLT(live donor liver transplant); Here one of the close relative can donate a portion of liver to his close relative to save his live. A normal liver has two lobes and one of the lobes can be donated to the diseased person. A minimum of 40 to 45% of liver is left in the donor and about 55 to 60% of the normal liver is donated to diseased person.
Is Live Donor Liver Transplant safe ?
Liver is an unique organ and it has got immense capacity to regenerate. A 20% of normal liver is required to sustain life therefore a healthy individual can safely donate about 55 to 60% of his liver. There is 0.5% (05 in 1000) life threatening risk of life to the donor. Other minor complications could also be there which is close to 6 to 7% and which is manageable. Donor has to be close relative and blood group has to be same.
Can organ be donated after death of patient;
There is wrong perception amongst people about organ donation. Organ can’t be used after death except cornea. For organ donation person has to be admitted in hospital and he or
she should be on ventilator. His brain is irreversibly damaged but heart should be beating and other organs must be viable. So it must be clear in the mind that a heart berating and brain dead patient can only donate his/her organ after consent from relative.
Who decides about brain death?
in hospital which is recognised for organ donation there is a committee constituted by the hospital to certify brain death. It consists of a team 5 to 6 specialist doctors who examine the patient and declare brain dead. This committee meets twice after an interval of 6 hours and again thorough examination and certain tests are done and all are convinced that the damaged brain due to any injury is not going to recover at any cost then only person is declared dead.
Can organ donation be done in any hospital?
To get certification to organ retrieval hospital has to apply and an expert team of doctors visit the hospital and based on the infrastructure they permit that particular hospital to start organ retrieval. So every hospital can’t have facility to donate organ in the same hospital. What should be done if there is a donor in a hospital and there is no permission/ Facility for organ transplant? so if there is a potential donor in any ICU and relatives are willing to donate then the hospital authority can find out the nearest institute where organ transplant is being done and they can inform the authorities and patient could eb shifted to the hospital on ventilator and then team can take organ and use for transplant.
If the particular hospital is accredited for organ retrieval only then it can again contact nearby recognised transplant center and team from that centre would come and retrieve and take organs to organ and transport to transplant centre for transplantation Can organ be transported from one place to other and how many hours can organ be kept before transplant
It is very important to understand that organ can be preserved in appropriate perfusion solution at 4 0 c (in ice box ) up to 10 to 12 hrs however for liver out will be good if could be transplanted before 8 hours. For Kidney duration may be more even one can stretch it to 12 to 14 hours.
Status of organ donation in India organ donation in our country is very poor. In North and east India it is worse. It is still better in south and west India. We should encourage organ donation. Here is lack of awareness and partly religious belief are main factor for poor donation rate. Best gift is gift of life to other if one is able to do that.
What is approximate cost of Liver transplant?
In government institute like ours it is close to 8 to 10 lacs however in corporate the cost is in the range of 25 to 30 lacs depending upon hospital
When is liver transplant required ?
Liver transplant is the only chance of survival/ cure for patient suffering from chronic liver diseases, acute liver failure and acute on chronic liver failure. Patients who are diagnosed with liver cancer in setting of chronic liver disease may also benefit from liver transplantation in carefully selected cases.
What is over all survival after liver transplant?
One year survival is close to 90% in adults and it is 96-98% in paediatric population.
Do they need lifelong treatment after liver transplant ?
Patients who are successfully transplanted need lifelong medicine to maintain graft functions. These medicines are to be taken daily and its doses are reduced with time. In the beginning usually three tablets have to be taken after three months usually one or two tablets with minimum doses are required as maintenance therapy.
Can a person lead productive life after liver transplant?
A person can lead normal productive life after liver transplant. He can join back his professional work. There are some restrictions which are explained by the operating team at the time of discharge.
What are the ways to get liver?
There are two different way to get liver : Liver can be donated by brain dead and heart beating patients who are already admitted in the hospital in ICU and relatives of the these type of patients take a decision to donate organ. Then these patients are assessed by transplant team and suitability of the patient who is ready to donate is decided and if all is okay then only organ is taken for transplant. The usual criteria is ; donor should be less than 65 years of age , should not have any on-going infection, there should not be cancer in the body anywhere and organ should be suitable for transplant. This type of liver transplant is called as DDLT(Deceased donor liver transplant )
Second type of liver transplant us called LDLT(live donor liver transplant); Here one of the close relative can donate a portion of liver to his close relative to save his live. A normal liver has two lobes and one of the lobes can be donated to the diseased person. A minimum of 40 to 45% of liver is left in the donor and about 55 to 60% of the normal liver is donated to diseased person.
Is Live Donor Liver Transplant safe ?
Liver is an unique organ and it has got immense capacity to regenerate. A 20% of normal liver is required to sustain life therefore a healthy individual can safely donate about 55 to 60% of his liver. There is 0.5% (05 in 1000) life threatening risk of life to the donor. Other minor complications could also be there which is close to 6 to 7% and which is manageable.
Donor has to be close relative and blood group has to be same. Can organ be donated after death of patient; There is wrong perception amongst people about organ donation. Organ can’t be used after death except cornea. For organ donation person has to be admitted in hospital and he or she should be on ventilator. His brain is irreversibly damaged but heart should be beating and other organs must be viable. So it must be clear in the mind that a heart berating and brain dead patient can only donate his/her organ after consent from relative.
Who decides about brain death?
in hospital which is recognised for organ donation there is a committee constituted by the hospital to certify brain death. It consists of a team 5 to 6 specialist doctors who examine the patient and declare brain dead. This committee meets twice after an interval of 6 hours and again thorough examination and certain tests are done and all are convinced that the damaged brain due to any injury is not going to recover at any cost then only person is declared dead.
Can organ donation be done in any hospital?
To get certification to organ retrieval hospital has to apply and an expert team of doctors visit the hospital and based on the infrastructure they permit that particular hospital to start organ retrieval. So every hospital can’t have facility to donate organ in the same hospital.
What should be done if there is a donor in a hospital and there is no permission/ Facility for organ transplant?
so if there is a potential donor in any ICU and relatives are willing to donate then the hospital authority can find out the nearest institute where organ transplant is being done and they can inform the authorities and patient could eb shifted to the hospital on ventilator and then team can take organ and use for transplant.
If the particular hospital is accredited for organ retrieval only then it can again contact nearby recognised transplant center and team from that centre would come and retrieve and take organs to organ and transport to transplant centre for transplantation
Can organ be transported from one place to other and how many hours can organ be kept before transplant
It is very important to understand that organ can be preserved in appropriate perfusion solution at 40c (in ice box ) up to 10 to 12 hrs however for liver out will be good if could be transplanted before 8 hours. For Kidney duration may be more even one can stretch it to 12 to 14 hours.
Status of organ donation in India
organ donation in our country is very poor. In North and east India it is worse. It is still better in south and west India. We should encourage organ donation. Here is lack of awareness and partly religious belief are main factor for poor donation rate. Best gift is gift of life to other if one is able to do that
What is approximate cost of Liver transplant?
In government institute like ours it is close to 8 to 10 lacs however in corporate the cost is in the range of 25 to 30 lacs depending upon hospital
