Advancements made in the techniques of Liver transplantation, has continued to evolve drastically, such that the patient not only lives a longer life but also has better quality of survival post treatment.
“Developments in the imaging techniques such as MRI liver scans, has provided better access and identification of even the smallest tumor which otherwise cannot be easily picked up in a CT scan. The biggest development of all that is just around the corner is machine perfusion of organs that have been removed from dead donors. The retrieved organs have a very limited time in cold storage and liver must be transplanted in a suitable recipient usually within 12 hours of harvest. With machine perfusion, the organ can be kept at normal temperature and blood is perfused through it by a pump and the liver will actually be producing bile during this period. ” said Dr. Subhash Gupta, Chairman – Max Centre for Liver & Biliary Sciences, Max Super Speciality Hospital, Saket
A living – donor liver transplant process involves transplanting a portion of the liver from a living donor into a recipient whose liver no longer functions properly. The remaining liver in the donor’s body regenerates within couple of months and returns to its normal volume and capacity after surgery. Even the transplanted liver portion grows and restores its normal functioning in the recipient.
For effective treatment of liver cancer, patients detected at later stages are succumbed to liver transplant. With the knowledge that chronic liver disease including fatty liver have a 15% increased chances of developing liver cancer and hence timely intervention requires regular screening. Surgical techniques have evolved so much that living donor liver transplant can be done successfully even in very small babies who suffer from Biliary atresia (Congenital condition in which the bile duct does not develop in the baby) by using techniques of graft reduction or mono-segment grafts. In patients with very high bilirubin, plasma exchange can be used to decrease the biliary and increase the chance of success of transplantation.
Transplanting liver from a live donor is a very transparent activity in India. It is a well organized process with the recommendations and clearance required from the concerned specialists. Liver donation has become very safe, with a surgery performed to remove a part of liver from the donor used for transplant. Within a time span of 2-3 weeks the donor recovers completely well as the liver regenerates itself.
Similarly, disease recurrence post-transplant such as hepatitis C is no longer to be dreaded as this can be treated effectively post-transplant. The development of direct acting antiviral therapy for hepatitis C has been so remarkable that hepatitis C will not be a reason for liver transplant in the future. Similarly the costs liver transplants in Hepatitis B has become much less as it has now been realized that expensive immunoglobulin’s are no longer needed to prevent disease recurrence. In Liver transplant for Liver cancer, downstaging therapy can prevent recurrence post transplantation.
“Post-operative care has improved so much that over one third of patients can be woken up from anesthesia after the surgery is over. This is of great importance in children who are underweight and malnourished as they do not tolerate machine ventilation for long. The liver graft that is taken from the donor nowadays has a much better chance of functioning as methods of preservation has improved considerably.” added Dr. Gupta
Finally major research is underway in promoting what is termed tolerance following liver transplantation. In this method, anti-rejection medication is gradually withdrawn after a few years. This saves the patient money and also prevents side effects such as kidney damage and development of cancer. Other strategies that are currently under investigation involve using T regulatory cells to control rejection. In the future, it may be possible to transplant without anti-rejection medication.
