Liver Transplant in India

Liver Treatment – Symptoms and Diagnosis

The human liver is situated on the right side of the abdomen. It is one of the most significant and essential organs in the body under the rib cage. It is one of the vital and crucial organs for survival. The liver performs many functions in the body. By some estimates, it does more than 800 functions in the body.

It produces the necessary biochemicals responsible for digesting food and driving toxic substances out of the body. However, several diseases can occur to a liver if it’s not taken care of properly. A few of these are genetic, but other than inherited liver problems, the rest are caused by various factors.

Viruses, infections, alcoholism, and obesity can all cause damage to the liver, as well as scarring and cirrhosis. Cirrhosis and long-term damage to the liver can result in liver failure, which is a life-threatening condition. It can be avoided by seeking early treatment from a liver specialist in Mumbai, which aids in the healing of the liver.

Vital Functions of the Liver

1. Helps in food digestion

2. Maintain blood sugar level

3. Produces blood clotting factors

4. Breaks down many drugs and poisons

5. Help body resist infections by making proteins and immune factors

What can damage the Liver?

Liver damage can occur suddenly (acute) or can happen over a prolonged period (chronic). Most of the patients have a chronic form of liver disease.

1. Acute Liver Failure

  • Severe Viral Infections (Hepatitis A or B)
  • Rat Poisoning (Yellow Phosphorus)
  • Excessive ingestion of Paracetamol, some herbal drugs, or Chinese medication

2. Chronic Liver Failure

  • Excessive alcohol intake
  • Viral infections like Hepatitis B and C
  • NASH (fatty liver due to obesity, long term diabetes, high cholesterol, hypertension)
  • Various autoimmune disease

3. Pediatric Population

Symptoms of liver disease

In Early Stage

  • Jaundice (yellow discoloration of eyes and skin)
  • Dark-colored urine
  • Black colored stools
  • Itching
  • Weight loss, loss of appetite, weakness
  • Easy bruising and bleeding tendency

In Advanced Stage

  • Swelling of limbs (edema)
  • Water accumulation in the abdomen (ascites)
  • Blood in vomitus
  • Mental confusion and forgetfulness (Encephalopathy)
  • Change in sleeping habits
  • Frequent infections
  • Kidney and other organ failures

Diagnosis of Liver disease

  • Liver Function Test
  • Viral serology (Hepatitis B, C, HIV)
  • Liver Elastography
  • Liver Imaging (Ultrasound Doppler, Triple phase CT scan, MRI liver)

Treatment for Liver Disease

Liver treatment is particular to the diagnosis and condition. While some liver problems are treated with medications, some liver problems are treated with lifestyle changes. These changes may include zero alcohol consumption, weight loss, or a change in the diet. During this period, the liver specialist may closely monitor the patient’s liver function. Liver problems such as liver failure may require surgery or a liver transplant.

Lifestyle changes help to improve liver health. Once diagnosed, the liver specialist may ask the patient to quit alcohol or avoid particular red meat, trans fats, processed carbohydrates, and high-fructose fat. Lifestyle changes also include a moderate-intensity exercise of 30 to 60 minutes around twice or thrice a week. Obese patients may require to shed 500 to 1,000 calories daily.

The liver specialist may ask the patient to avoid some dietary or herbal supplements to reduce scarring. It is essential to discuss the potential risks before making any lifestyle or nutritional changes with the liver specialist.

If you’re looking for the best liver treatment in Mumbai. Please book an appointment with an experienced liver specialist, Dr. Gaurav  Gupta

Liver Transplant in India

What Is Cirrhosis?

Our liver has the ability to repair and regenerate itself. However, as it gradually builds scar tissue, it is less able to function correctly. As the number of scarring increases, the liver’s circulatory flow decreases. Further, the essential functions of the liver are compromised. In some cases, this may lead to liver failure and even death. Globally, over one million people die every year from Cirrhosis.

Dr. Gaurav Gupta, Head of Liver Transplant and HPB Surgery at Fortis Hospitals, Mumbai has over decades of experience in handling complex liver surgeries and treatment of Liver Cirrhosis too. Due to his vast expertise and experience, he is known to provide the best liver transplant in Mumbai.

Now, let’s know about Cirrhosis, its diagnosis, and treatment.

 

Prolonged liver damage leads to a condition known as Cirrhosis of the liver. In this condition, the liver becomes hard and nodular. Liver tissue is replaced by fibrosis. Once cirrhosis sets in, liver damage becomes irreversible. The cirrhotic liver becomes incapable of regenerating.

Classification of Cirrhosis

1. Compensated Cirrhosis

It is merely a damaged liver that is still relatively functional.

2. Decompensated Cirrhosis

It represents the advanced stage of cirrhosis where signs and symptoms of liver dysfunction start.

Why can Cirrhosis be Dangerous?

Cirrhosis leads to various complication like

  • Ascites (fluid in the abdomen)
  • Edema (fluid in limbs)
  • Variceal bleeding (bloody vomiting)
  • Confusion (encephalopathy)
  • Kidney dysfunction (hepatorenal Syndrome)
  • Lung complication (Hepatic hydrothorax, Hepatopulmonary syndrome)
  • Liver cancer

The risk of death with intractable ascites and variceal bleed can be quite high. Patients with ascites that are not controlled with medications (intractable ascites) have a mortality risk of almost 70% within one year.

A single episode of infection in patients with ascites (SBP) carries a 50% one-year mortality risk.

If complications are not controlled when the liver ceases to function, your Liver Transplant Surgeon in Mumbai may recommend liver transplantation.

Approximately 5% of people with cirrhosis develop hepatocellular carcinoma (HCC). It’s the most common form of liver cancer.

Symptoms of Cirrhosis 

Progression of liver damage from early-stage fibrosis to cirrhosis usually takes years to manifest symptomatically. There are often few, if any, symptoms in the early years.

When symptoms occur, they are sometimes misdiagnosed, ignored, or attributed to other possible causes. However, as the ailment progresses, the symptoms may get more apparent. These symptoms include:

  • Fatigue
  • Confusion
  • Weakness
  • Itching
  • Loss of appetite
  • Weight loss
  • Nausea
  • Easy bruising
  • Jaundice
  • Swelling of ankles, feet, and legs
  • Abdominal bloating from the ascites

Causes of Cirrhosis

The most common causes of cirrhosis are:

  1.  Alcohol-related liver disease: It is typically associated with heavy alcohol intake over several years.
  2.  Hepatitis B: It is a prevalent cause of cirrhosis.
  3. Hepatitis C: It is one of the frequent causes of cirrhosis and the leading indicator for liver transplants.
  4. Non-alcoholic fatty liver disease: People with diabetes, high blood pressure, obesity, and high cholesterol are more prone to cirrhosis. This is becoming one of the most common causes of Liver cirrhosis with the increasing incidence of lifestyle diseases in our population.

 

Some of the rare causes of cirrhosis include:

  • Primary Sclerosing Cholangitis
  • Hereditary diseases like Wilson’s disease
  • Autoimmune hepatitis
  • Hemochromatosis
  • Celiac disease
  • Medication

 

Diagnosis of Cirrhosis

1. Liver biopsy:

It is the most accurate method for the diagnosis of cirrhosis and its stage. With advancements in Radiological tools, Liver Biopsy is rarely done these days to diagnose cirrhosis.

2. An ultrasound or Magnetic Resonance Elastography:

These are non-invasive ways to detect cirrhosis.

3. Blood tests and imaging tools (CT scan and MRI):

These can be used to monitor disease progression.

Treatment of Liver Cirrhosis

  • Many cases of cirrhosis have been manageable before they progress and require a liver transplant in Mumbai.
  • The management of cirrhosis depends primarily on the cause and severity of the disease.
  • But the treatment should begin immediately after its diagnosis.
  • Cirrhosis is generally not curable except through liver transplantation.

You should take the below steps to decrease the progression of liver scarring, including:

  • Avoid taking alcohol and medicines that can cause injury to the liver.
  • Avoid over-the-counter herbal agents and supplements, as some have been associated with liver injury.
  • Cirrhosis elevates the risk of prescription-drug liver injury. So, all prescriptions should be carefully reviewed for effects on the liver.
  • Avoid raw shellfish that may contain bacteria. It could potentially cause severe infection in people with advanced liver disease.
  • Screening and vaccination for hepatitis A and  hepatitis B
  • Antiviral therapy for hepatitis B and hepatitis C.
  • Screening and treatment of secondary causes of cirrhosis such as ursodiol for bile duct blockages.
  • Nutrition plays an important role in managing Cirrhosis patients.

The management of cirrhosis should begin as soon as you’re diagnosed with the condition. After the diagnosis, you should always consult a qualified and experienced Liver Specialist in Mumbai to seek the best treatment.

Liver Transplant in India

Information Of Liver Transplant Treatment

Liver damage due to various injuries can be reversed with timely management- reversibility also depends upon the stage of the disease. Treatment and management of liver disease depend on the type of injury and causative factors. Complete abstinence from alcohol – can reverse, stop or delay the progression of liver damage. Timely treatment for Hepatitis B and C again can slow down the progression of liver disease. Fatty liver can be reversed by diet control, exercise, lifestyle modification. When Liver damage becomes irreversible, a liver transplant becomes the only option for treatment.

Liver Transplant

  • Every year close to 2.5 lakh death happens in India due to liver failure
  • There are estimated to be more than 30,000-40,000 patients who could be saved by a liver transplant
  • In India, only 1500 liver transplants are done in a year
  • There is a huge unmet need for liver transplantation in India.

Who needs Liver transplantation?

  • Acute Liver Failure, Severe Viral Infections (Hepatitis A or B)

–   Rat Poisoning ( yellow Phosphorus)

–   Excessive ingestion of Paracetamol, some herbal drugs, or Chinese medications

  • Chronic Liver disease (cirrhosis). The cause of cirrhosis can be excessive alcohol, viral infection like hepatitis B or C, autoimmune disease like autoimmune hepatitis, Sclerosing cholangitis, Primary biliary cirrhosis
  • Cirrhosis per se is not an indication of a transplant. Decompensated cirrhosis( cirrhosis with complications) should be seen by Transplant doctors. There are various objective markers used by the transplant team to assess the risk and benefits of recommending any patient for a liver transplant. The Childs- Turcotte- Pugh (CTP) score of more than 7-8 and MELD ( Model for End-Stage Liver Disease) of more than 15 should be seen by the transplant team
  • Hereditary disease leading to chronic liver damage like Wilson’s disease, Hemochromatosis, Alpha -1 antitrypsin deficiency.
  • Liver cancer – Not all liver cancer patients are candidates for a liver transplant. There are specific criteria known as UCSF or Milan criteria that determine eligibility for liver transplant
  • Pediatric patients have a different indication for a liver transplant. Biliary atresia is the most common cause of liver failure requiring a Pediatric Liver Transplant.

Source of Liver for Liver Transplant

The Liver for transplant can be obtained broadly from two sources:

  • Braindead ( cadaver ) –  If unfortunately, someone suffers severe brain injury leading to brain death. If that person has already pledged his or her organs or family decide to opt for Organ Donation as a gift of life. Liver from such cadavers can be used for transplantation. Patients should be listed on the waiting list and organs are allocated as per Maharashtra Govt rules by ZTCC( Zonal Transplant Co-ordination Centre)which is not a profit Government organization
  • Living Donor – A part of the liver is taken from a healthy, relatively young person ( generally first kin blood relative) who is willing to donate to save the life of his or her dear one. Liver is the only solid organ that has the capacity to grow and regenerate after it is cut and divided. In 3 months Liver grows back to almost 90% of its original volume. Before accepting anyone as a donor a thorough medical check-up with laboratory test along with heart, lungs check-up is done. CT scan is done to make sure the liver has enough volume for both donor and recipient. Only after a thorough check-up which also includes Psychologist and psychiatrist counseling, a person is accepted as a donor candidate

Team Approach

All the liver disease patients are seen by Liver transplant Surgeons, Physicians, Nutritionists, Physiotherapists. A good outcome can be ensured only by optimizing the condition of the patient. Here the role of Nutritionist and physiotherapist becomes crucial. All our patients have individual and group sessions with dieticians and physiotherapists. They get individualized diet plans according to personal taste and preferences.

 

Liver Transplant workup

  • Whether someone opts for a Living donor Liver Transplant( LDLT) or a deceased donor (DDLT), the workup of the recipient is mostly similar. A detailed and comprehensive workup is done which includes testing for the cause of liver disease, complications of chronic liver disease. A detailed cardiopulmonary workup is done to ensure the patient can withstand the stress of surgery. Any immunization which has not been done in past is given to patients while waiting for transplants.

The Operation

  • In LDLT, the operation can be planned according to the severity of the disease. In DDLT, patients get called for transplant as an organ becomes available.
  • Operation generally lasts 8- 10 hours. It involves two teams of surgeons, anesthetists, Nurses, Technicians. A liver transplant involves the coordination of a large number of departments including pathology, blood bank, microbiology, ICU, Radiology, OT staff
  • After transplant Patients stay in an Isolation room in ICU for the next 4- 5 days depending upon condition.
  • Patient will be under the strict supervision of doctors, nurses for bleeding, infection, and other complications. To prevent rejection, patients are started on anti-rejection medication (immunosuppressant). These medications need to be continued lifelong. 90% of our patients get discharged within 2 weeks after transplant.

Results of Liver transplant

  • Results of liver transplants are measured as 1,5 years of survival. The 1-year survival of liver transplants is close to 90%. 5-year survival is close to 70 %. Survivals are a little higher for LDLT as compared to DDLT( as LDLT can be done in a planned manner and patients does not have to wait to get an organ offer)
  • Main complications occur in the first year( more in the first 3 months) after liver transplant which includes bleeding, infections, blockage of one of the blood vessels going to liver, rejections, Bile duct narrowing

Quality of life after Liver transplant

  • By the end of three months, most of the patients are on just 2 pills twice a day.
  • Change in the quality of life of a patient after transplant is truly amazing. Patients have done Mansrover Yatra after one year of liver transplant treatment. People have gone back to work, participated in sports, trekking, and various other activities. Recipients can expect a life that is normal in all respects including longevity, reproductive function, and physical activity. Most women have a normal pregnancy after a liver transplant. In the case of the children, those with growth failure secondary to liver disease will resume growing, and that there appears to be a general improvement in lifestyle.

Liver Transplant in India

Liver- Everything you need to know!

‘Is the life worth living? It depends on the liver.’ This saying is so apt when talking about the liver. It is a vital organ in humans.

It is so vital that people would perish if it stopped working even for a single day. Regrettably, it is also one of the organs that receive the least attention.

That’s why, when liver damage becomes irreversible due to acute or chronic liver disease, a liver transplant becomes the only option for treatment. Luckily, most patients can get the best treatment for a liver transplant in India due to improved infrastructure and advance technology.

Let’s take some time to learn more about the liver and give it the attention it deserves, considering its significance. 

Interesting facts about the Liver

  • The liver is the largest glandular organ in the human body and the second largest organ in the body after the skin.
  • The liver is multifunctional, performing over 800 essential functions for the body at the same time. Providing glucose to the brain, fighting infections, and storing nutrients are only a few of these vital functions.
  • Around 5-10% of the liver is made up of fats. Higher fat content in the Liver leads to a condition called “fatty liver.” This condition is more prone in people with obesity, type 2 diabetes, hypertension, High Cholesterol, and heavy alcohol drinking.
  • The human liver produces and stores iron and essential vitamins and nutrients from the diet and keeps them in storage until the body needs them.
  • It also acts as a detoxifier. The toxic substances consumed by people, such as alcohol and drugs, are detoxified by the liver. The body cannot process these substances without the liver.
  • The liver produces important proteins of blood clotting, which circulates in the body. That’s the reason patients with liver failure are more prone to bleeding.
  • The liver has the incredible capacity to regenerate, which makes Living donor liver transplantation possible. When people donate half of their liver, the liver regenerates the portion that the doctor removed. Within three months, the liver grows back to 90% of its original size.

So, the liver is an essential organ that performs a variety of functions. It works in coordination with other organs of the body to keep us fit and healthy. This is the reason with Liver failure other organs also start to get affected like kidney, heart, lungs, and many more.

What are the causes of Liver Disease?

The following factors can cause Liver disease:

  • Viruses and parasites
  • Autoimmune disorders
  • Cancer 
  • Abnormal gene
  • Alcohol abuse for a long time
  • The fat build-up in the liver

Which are the most common Liver diseases? 

  1. Hepatitis is caused by viruses, obesity, allergic reactions, drugs, or heavy drinking.
  2. Cirrhosis scars the liver as a result of long-term damage.
  3. The most common form of liver cancer develops after the presence of cirrhosis.

What are the signs and symptoms of Liver diseases?

One or more of the following symptoms can occur, with more severe symptoms often associated with more advanced disease:

  • Skin and eyes turn yellowish (jaundice)
  • Easy bruising or bleeding
  • Tiredness
  • Swelling in legs and knees
  • Itchy skin
  • Urine with a dark hue
  • Stools that are pale, bloody, or tar-colored
  • Vomiting or nausea
  • Diarrhea
  • Appetite loss
  • Swelling in the abdomen
  • Mental confusion

What is the treatment for liver disease?

Treatment options depend on the nature and severity of the damage as well as the underlying cause. Some liver treatment includes losing weight or avoiding alcohol while the doctor monitors the patient’s liver functions.

In certain cases, the doctor may opt for medicine or surgery. The patient may need a liver transplant in the most severe cases.

For critical procedures like these, patients are recommended to undergo Liver Treatment in Mumbai as the city is equipped with expert surgeons and world-class infrastructure.

Hepatitis Treatment – Types, Causes and Treatment

Hepatitis is an inflammation of the liver. Our liver, located in the abdomen’s right upper area, performs many critical functions that affect our metabolism.

You should consult an expert like Dr. Gaurav Gupta for issues related to the liver. Dr. Gupta is among the top-rated Liver Specialist in Mumbai. He is renowned for his expertise in Liver Transplant in Mumbai. He has more than 15 years of surgical experience, out of which 10+ years in the field of Liver Transplantation.

Moreover, Dr. Gaurav Gupta is among the best liver transplant surgeons in Mumbai and has conducted more than 500 liver transplants. Presently, he is associated with Fortis Hospitals as a Consultant and HOD of the Liver Transplant & HPB Surgery.

Overview of Hepatitis, its types, symptoms, diagnosis, and hepatitis treatment.

What is Hepatitis?

It is an inflammatory disease of the liver usually caused by a viral infection. However, other possible causative factors of hepatitis include autoimmune hepatitis. Hepatitis also occurs as a secondary result of drugs, toxins, and alcohol which are also major causes of other diseases like Liver Cirrhosis.

Symptoms of Hepatitis

You may not have signs at first if you have chronic infectious forms of hepatitis, such as hepatitis B and C. Symptoms may not occur until the damage has a detrimental effect on liver function.

Acute hepatitis symptoms and signs appear rapidly. They are as follows:

  • fatigue
  • abdominal pain
  • flu-like symptoms
  • loss of appetite
  • dark urine
  • pale stool
  • yellow skin and eyes
  • unexplained weight loss

Types of Hepatitis

Hepatitis is of different types, viz. infectious and non-infectious. However, the most common type is viral hepatitis.

Viral hepatitis can be broadly divided into two types:

1. Acute Viral Hepatitis

a. Hepatitis A

An infection causes it with the hepatitis A virus. It usually transmits by consuming food or water contaminated by faeces from a patient infected with hepatitis A.

b. Hepatitis E

It is a waterborne disease caused by the hepatitis E virus. It is mainly found in areas with poor sanitation. It typically results from ingesting fecal matter that contaminates the water supply.

 

2. Chronic Viral Hepatitis:

a. Hepatitis B

It spreads through contact with infectious body fluids, such as blood, genital secretions, containing the hepatitis B virus. Using shared injections or razors of an infected person or having sex with an infected partner increases the risk of acquiring hepatitis B.

b. Hepatitis C

It results from the hepatitis C virus. It is one of the bloodborne viral infections. It circulates through direct contact with infected body fluids, usually through injections and sexual contact.

c. Hepatitis D

It is a severe liver disease caused by the hepatitis D virus. It is also known as delta hepatitis and its spreads through close contact with infected blood. It is a rare form of hepatitis and only occurs in conjunction with hepatitis B.

 

How Is Hepatitis Diagnosed?

a. History and Physical exam

At first, your doctor will record your medical history to determine any risk factors you may have for infectious or non-infectious hepatitis. Your doctor may gently press your abdomen to see if there’s pain or tenderness and check whether your skin or eyes are yellow.

b. Liver Function Tests

It involves taking blood samples to check the efficacy of your liver. High levels of liver enzymes could mean that your liver is inflamed, or not working correctly.

c. Other Blood Tests

If your liver function tests come back abnormal, your doctor can order additional blood tests to determine what’s wrong. These tests will detect the hepatitis-causing viruses. It also detects the presence of antibodies that are common in conditions such as autoimmune hepatitis.

d. Ultrasound

It involves using ultrasound waves to create an image of the abdominal organs. It assists your doctor in checking any abnormalities in your liver and nearby organs.

e. Liver biopsy

It is an invasive process that involves taking a tissue sample from your liver. It can be done with a needle through the skin and does not require surgery. These days role of Liver biopsy is very limited in diagnosing liver ailments. Typically, an ultrasound guides your doctor when taking the biopsy sample.

How Is Hepatitis Treated?

Mainly acute viral hepatitis needs symptomatic treatments and good nutrition to support the liver. Almost 90-95% of patients get cured without hospitalization. However, rarely, 1-2% of cases result in acute liver failure. It is a critical condition in which the bilirubin level increases, the liver stops making protein, and the liver starts to fail. Patients can develop Encephalopathy. It is a severe condition that needs to be treated only at a dedicated liver care unit.

1. Hepatitis A

Hepatitis A often doesn’t need treatment as it’s a short-term illness. Follow your doctor’s hydration and diet guidelines if you have vomiting or diarrhea. Hepatitis A vaccine is available for both children and adults to prevent the infection.

2. Hepatitis B

Acute hepatitis B doesn’t require specific treatment. Antiviral medications are beneficial in treating chronic hepatitis B. Hepatitis B can be prevented with vaccination.

3. Hepatitis C

Very good antiviral treatment is available these days to cure Hepatitis C. Hepatitis C patients who develop cirrhosis or liver disease may need a liver transplant. Hepatitis C vaccine is currently unavailable.

4. Hepatitis D

To date, no antiviral medications exist for the treatment of hepatitis D. According to research, a drug called alpha interferon can be used to treat hepatitis D. Still, it only shows improvement in about 25 to 30 % of patients. Hepatitis B vaccination can help prevent it, as infection with hepatitis B is needed to develop hepatitis D.

5. Hepatitis E

Hepatitis E is currently treated with no particular medical therapies. Since the infection is often acute, it usually resolves on its own. The doctor frequently advises people with this condition to get adequate rest, drink plenty of fluids, get enough nutrients, and avoid alcohol.

6. Autoimmune hepatitis

Corticosteroids, like prednisone or budesonide, are beneficial in the early treatment of autoimmune hepatitis. They’re effective in about 80% of patients with this condition.

Prevention of Hepatitis

1. Hygiene

  • Practicing good hygiene and avoiding outside food is one fundamental way to avoid contracting hepatitis A and E.
  • Hepatitis B, C, and D are transmitted through contaminated blood. It can be prevented by not using shared drug needles, razors, toothbrushes, etc.
  • Sexual contact and intercourse can also lead to the transmission of hepatitis B and C. Practicing safe sex by using condoms can help decrease infection risk.

2. Vaccination

Vaccination is a vital factor in avoiding the spread of hepatitis. So, you should discuss with your doctor about hepatitis vaccination and get it done.

The complete diagnosis and Hepatitis treatment in Mumbai are available at Fortis Hospital, Mulund with the best infrastructure and state-of-art technology. Patients all over India are recommended Mumbai for their Hepatitis Treatment.

Make an appointment with Dr. Gaurav Gupta to avail the best Liver treatment in Mumbai.