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Transplant Surgery Transplant Surgery / Kidney transplant/Liver transplant/Pancreas transplant Cadaver Liver Transplant Facts about Liver Transplants Liver transplant involves surgical removal of your diseased liver and implanting a new liver. The liver can come from a cadaver (cadaveric liver transplant) or a living person can donate part of his liver (Living donor liver Transplant). Cadaver Liver Transplant Organs for liver transplant are obtained from deceased donors, after they or their families have given consent to be an organ donor. A liver transplant is a big step to take, but it can save your life. You will be able to take better care of your new transplant if you understand your illness and your treatment. You will need to reach certain goals in your recovery. It is very important that you understand what you must do to make your transplant work. You must take your medicines as told, keep your appointments, and stay in close touch with your doctors. Some facts about the liver The liver does several things: It helps digest your food. It clears wastes from your blood. It makes proteins that help your blood to clot. It stores the sugars (glycogen) that are used for energy. It makes proteins that the body must have. It helps use and store vitamins. It makes chemicals that protect the body. It breaks down many toxins. The liver also controls the way your body uses food and the way it works with your immune system. When the liver is badly damaged, it cannot grow enough new liver tissue to heal itself. Severe liver damage with scarring is called cirrhosis (sir o sis). Cirrhosis can lead to two problems: 1. Liver failure This happens when the liver cannot do what it is supposed to do. 2. Portal hypertension This happens when scarring in the liver stops blood from flowing through it. This causes pressure to build up in the vein that feeds the liver (portal vein). The liver can take a lot of damage, but when most of it is damaged, it will start to fail. Once a person has signs of liver failure, it means there is not much of the liver left for the body to use during sickness and times of need. Signs of liver failure may include: Yellow skin and eyes (jaundice) Forgetfulness, confusion, or coma (encephalopathy) Feeling very tired Muscle loss (muscle wasting) Itching Blood does not clot Other signs of liver disease are too much fluid in the stomach (ascites), infections, and bleeding in the stomach. There is no treatment that can help the liver do everything it needs to do. So when a person reaches a certain stage of liver disease, a liver transplant may be the only way to prolong their life. What will happen before my transplant? First, your doctor will refer you to a transplant specialist. Your General practitioner or a gastroenterologist will refer you for liver transplantation when and if your liver disease begins to get worse, and you show signs of liver failure or portal hypertension. This is a specialized operation, so you will need to go to a hospital where liver transplant is done. Your transplant surgeon will evaluate your health status. We call this evaluation the pretransplant evaluation. It is how we decide if a liver transplant is right for you. During this time, you and your family will learn what you need to know about having a liver transplant. You will have many tests done. This process can take a few days or a few weeks. It depends on how many tests you need to have. Some things that will happen during this evaluation: You will meet with the liver specialist, the transplant surgeon, and other doctors. The transplant coordinator will schedule you for lab tests (blood work) and x-rays. Most patients do not need a liver biopsy. You will receive the usual vaccines. Other tests to expect: X-rays and other imaging tests You will have regular x-rays taken, such as a chest x-ray. You will also have more specialized imaging tests, like a CT or MRI scan. These tests will give your doctors a detailed view of your liver, its blood supply, and other organs. The tests are also used to look for tumors in the liver. All these images will show the surgeon what he needs to know in order to do your operation. Endoscopy and colonoscopy You may have an endoscopy test done. During this test, the doctor will run a flexible tube with a tiny television camera on the end of it down your throat and into your stomach. With a colonoscopy, the doctor will run a tube through your rectum and into your large intestine. Both of these tests look for enlarged veins called varices. They are a sign of liver disease or problems with the lower intestine. If you have large varices, the doctor may tie them off with rubber bands. This prevents them from bleeding. You will be given medicine to make you sleepy during your colonoscopy and endoscopy. Heart and stress tests Since a liver transplant is major surgery, it is important to know that your heart and lungs are healthy. We will do a detailed evaluation of your heart. They may do an electrocardiogram (ECG), echocardiogram, and a stress test. If you have been a smoker, your may undergo lung function tests and a blood gas test. If you smoke, you need to quit before you have the transplant. Your emotional health will also be evaluated. Your emotional health is as important to your transplant team as your physical health. For this reason, you will also be seen by a team of health professionals like a social worker, psychologist, addiction specialist. We will schedule a family meeting so everyone can meet the transplant team. At this meeting, will explain what a liver transplant involves and answer any questions. This team can also help you with financial concerns, connect you to hospital services, and give you information on support groups. Finally, your nutritional needs will be evaluated. A dietician will talk to you about your nutritional needs and design an eating plan for you to follow. They will also support you in eating well to you help your body heal after your transplant. Cadaver Transplant If you are for cadaver transplant then you will be listed on a waiting list. You will be informed when your turn comes and there is a suitable liver for you. The Waiting List Be sure to notify your transplant center of any change in your medical condition. When a liver is found for you, the transplant team must be able to contact you quickly. Your coordinators will need a current list of names and phone numbers of people who will know where to reach you. Dr.Rakesh Rai has clinic in following hospitals - Fortis Hospital Mulund, Fortis Vashi, Reliance Hospital New Mumbai, PD Hinduja hospital Mahim, Hinduja Hospital Khar. Saifee hospital, Mumbai (Monday 2 to 4 pm) WHAT'S APP CHAT Living Donor Liver Transplant Due to shortage of cadaver liver there is a long waiting list to get a cadaver liver. Many patients are too unwell or have tumour in their liver and they may not be able to wait long for cadaver liver. Many patients die waiting for a cadaver liver. In living donor liver transplant a portion of liver is surgically removed from a live donor and transplanted into a recipient, immediately after the recipient's liver has been entirely removed. Live donor liver transplantation is possible because the liver, unlike any other organ in the body, has the ability to regenerate, or grow. Both sections of the liver regenerate within a period of 4 to 8 weeks after surgery. FREQUENTLY ASKED QUESTIONS Who can be a live donor? The donor preferably is a first degree realtive. If a first degree relative is not suitable for donation then a close relative or friend can be considered. The blood type of the donor must be compatible with the recipient’s. The donor should be in good physical and mental health. The donor should be between 19-60 years old. The decision to be a donor should be made after careful understanding of the procedures, and consideration of the risks and complications involved. What would immediately disqualify me as a donor? • History of Hepatitis B or C • HIV infection • IV drug use • Psychiatric illness currently under treatment • A recent history of cancer • A significant medical condition If I am related to the recipient, will he or she have less rejection? The risk of rejection in a live donor liver transplant is low. The same risk of rejection exists when the donor is related or non-related. What are the advantages to live donor liver transplant? The main advantage is the shortened waiting time for the recipient. Depending on their condition, diagnosis, status, blood type and size, patients can be on the waiting list for months or even years. Some patients may develop complications and even die while waiting for a deceased donor organ. Will the recipient be removed from the active transplant waiting list if I’m evaluated? NO. The recipient will remain on the active list until he/she is actually transplanted. Should a deceased liver become available for the recipient, no further testing of the living donor will take place, and scheduled surgery would be cancelled. What is the evaluation process all about? The evaluation process is to determine if the donor’s liver is the right size for the recipient and is healthy. The evaluation also ensures that a potential donor is free from any transmittable diseases or psychiatric illness. What are the possible complications of the donor’s operation? As with any surgery involving general anesthesia, there are possible complications of the anesthesia itself, including heart complications, stroke and blood clot formation in the legs or lungs. There is also a risk that the remaining portion of your liver will fail and you will need an urgent liver transplant yourself. While these complications are very rare, the risks exist, and we will discuss them with you in more detail during the evaluation. The most common complications of this surgery are small bile leaks from the remaining portion of your liver, wound infections, and hernias. Gastrointestinal upsets such as constipation, indigestion, nausea or diarrhea are common; however, usually resolve after a couple of weeks. Should I stop smoking before my surgery? Even a light smoker should stop smoking before surgery. A heavy smoker may not be considered a suitable donor due to increased health risks. Should I stop drinking alcohol? If you are going to be a liver donor, it is best that you stop drinking alcohol. If you have a history of alcohol use, it is very important that you tell our team. Will I require a blood transfusion during my surgery? Blood transfusions during this surgery may be necessary, as with any kind of operation, but are not usual with living liver surgery. Will I have pain after the surgery? It is normal to experience some pain or discomfort after surgery. We use a variety of methods to minimize post-operative pain including intravenous and oral medication. When can I start to drink and eat after my surgery? Usually you will start having sips of water in the recovery room. You will gradually be advanced and you will be eating a normal diet in 4 or 5 days. Will I need to take any medication after I donate a part of my liver? Normally, you would only require pain medication for a short period of time. How long will I need to stay in the hospital? If there are no complications, the usual hospital stay is 7-10 days. How long will I be off work? The minimum amount of time you need to recover is 4-6 weeks. However, even if there are no complications, some donors require a few months before they feel ready to return to work. Will I have a normal life after surgery? We expect that you will return to a totally normal life within 3 months after your surgery, provided you do not experience any complications. When can I lift weights, jog, swim, etc? You will need to avoid any heavy lifting (no weight greater than 15-20lbs, or about 2 grocery bags) for the first 6 weeks, until your abdomen has completely healed. After 6 weeks, if you are feeling well and have not experienced any complications, you may begin to return to your normal activities. Begin slowly and build up gradually. Be cautious with activities that strain abdominal muscles. How long after the surgery will it take before my liver functions normally again? Unless there are unforeseen complications, your liver will function immediately after the surgery. After 6 weeks, your liver will have grown back to almost its normal size. Dr.Rakesh Rai has clinic in following hospitals - Fortis Hospital Mulund, Fortis Vashi, Reliance Hospital New Mumbai, PD Hinduja hospital Mahim, Hinduja Hospital Khar. Saifee hospital, Mumbai (Monday 2 to 4 pm) WHAT'S APP CHAT Pancreatic Transplant A pancreas transplant is surgery to implant a healthy pancreas from a donor into a patient with diabetes. Pancreas transplants give the patient a chance to stop taking insulin injections. Description The healthy pancreas is taken from a donor who is brain dead, but is still on life support. The donor pancreas must be carefully matched to the patient who is receiving it. A portion of the first part of the small intestine, called the duodenum, is transplanted with the donor pancreas. The healthy pancreas is transported in a cooled solution that preserves the organ for up to 20 hours. The patient's diseased pancreas is not removed during the operation. The donor pancreas is usually placed in the right lower part of the patient's abdomen. Blood vessels from the new pancreas are attached to the patient's blood vessels. The donor duodenum is attached to the patient's intestine or bladder. The surgery for a pancreas transplant takes about 3 hours. However, the operation is usually done at the same time as a kidney transplant in diabetic patients with kidney disease. The combined operation takes about 6 hours. Why the Procedure is Performed The pancreas makes a substance called insulin. Insulin moves glucose, which is sugar, from the blood into the muscles, fat, and liver cells, where it can be used as fuel. In people with type 1 diabetes, the pancreas doens't make enough, or sometimes any, insulin. This causes glucose to build up in the blood, leading to high blood-sugar levels. High blood sugar levels can cause many complications, including: Amputations Blindness Heart disease Kidney damage Nerve damage Stroke A pancreas transplant can cure diabetes and eliminate the need for insulin shots. Because of the risks involved with surgery, however, most people with type 1 diabetes do not have a pancreas transplant soon after they are diagnosed. A pancreas transplant is major surgery, and people with diabetes have a high-than-normal risk of heart disease and other complications. People who have had a pancreas transplant will need to take several medicines for the rest of their lives. These medicines have serious side effects. Because of these risks, pancreas transplant is rarely done alone. It is almost always done when someone with type 1 diabetes also needs a kidney transplant. Pancreas transplant surgery may NOT be done in patients who also have: A history of cancer HIV Infections such as hepatitis, which are considered to be active Lung disease Obesity Other blood vessel diseases of the neck and leg Severe heart disease (such as heart failure, poorly controlled angina, or severe coronary artery disease) Smoking, alcohol or other lifestyle habits that can damage the new organ The doctor may also recommend against a pancreas transplant if the patient is not able to keep up with the many follow-up visits, tests, and medications needed to keep the transplanted organ healthy. Risks The risks for any surgery are: Bleeding Breathing problems Heart attack or stroke Infection or abscess Reactions to medications Scar formation The risks for pancreas transplant include: Blood clots (deep venous thrombosis) Clotting (thrombosis) of the arteries or veins of the new pancreas Development of certain cancers after a few years Inflammation of the pancreas (pancreatitis) Leakage of fluid from the new pancreas where it attaches to the intestine or bladder Rejection Outlook (Prognosis) If the transplant is successful, you will no longer need to take insulin shots, test your blood-sugar daily, or follow a diabetes diet. There is evidence that the complications of diabetes, such as diabetic retinopathy, may not get worse -- and may even improve -- after a pancreas-kidney transplant. More than 95% of people survive the first year after a pancreas transplant. The risks for organ rejection are about 1?ch year. The quality of life after a pancreas transplant has improved. Almost all patients find that managing daily life is a lot easier and more satisfying. Kidney Transplant The kidneys The kidneys are two bean-shaped organs located on each side of the body, just beneath the ribcage. Their main role is to filter waste products from the blood before converting them to urine. If the kidneys lose this ability then waste products can build up, which is potentially dangerous and can be life threatening. Loss of kidney function is known as end stage chronic kidney disease or kidney failure, which is the most common reason for a kidney transplant. When an individual's kidneys fail, three treatment options are available: hemodialysis, peritoneal dialysis and kidney transplantation. Many patients feel that a successful kidney transplant provides a better quality of life because it allows greater freedom and often is associated with increased energy levels and a less restricted diet. In making a decision about whether this is the best treatment for you, you may find it helpful to talk to people who already have had a kidney transplant. You also need to speak to your doctor, nurse and family members. What is a kidney transplant? A kidney transplant is the transfer of a healthy kidney from one person (the donor) into the body of a person who has little or no kidney activity (the recipient). Are there different kinds of kidney transplants? Yes. There are two types of kidney transplants: those that come from living donors and those that come from donors who have died (non-living donors). A living donor may be someone in your immediate or extended family or your spouse or a close friend. A person only needs one kidney to survive. Therefore, unlike other types of organ donation, such as heart, a living person can donate a kidney. Ideally, this will be a close relative. Receiving a donation from a close relative means there is less risk of the body rejecting the kidney. How do I start the process of getting a kidney transplant? Your doctor can discuss the transplant process with you or refer you to a transplant center for further evaluation. What is rejection? The most important complication that may occur after transplant is rejection of the kidney. The body's immune system guards against attack by all foreign matter, such as bacteria. This defense system may recognize tissue transplanted from someone else as "foreign" and act to combat this "foreign invader." You will need to take medications every day to prevent rejection of your new kidney. Most patients need to take three types. The major one is usually cyclosporine or tacrolimus or sirolimus. In addition, you will most likely be taking some type of steroid and a third medication, such as mycophenolate mofetil or azathioprine. Additional treatment may be needed if a rejection episode occurs. Regular checkups at your transplant center will ensure early detection and treatment of rejection. What are the side effects of the anti-rejection medications? Anti-rejection medications have a large number of possible side effects because the body's immune defenses are suppressed. Fortunately, these side effects usually are manageable for most patients. If side effects do occur, changing the dose or type of the medications will usually take care of them. Some of the most common side effects include high blood pressure, weight gain and a susceptibility to infections and tumors. You may also require additional medications to maintain blood pressure and prevent ulcers and infections. What are the chances that a transplanted kidney will continue to function normally? Results of transplantation are improving steadily with research advances. In the event that a transplanted kidney fails, a second transplant may be a good option for many patients. Will I need to follow a special diet? Kidney transplants, like other treatments for kidney failure, often require following special diet guidelines. If you were on dialysis before, you may find this new diet less restricted. The length of time you must follow the special diet varies. Your progress will be followed closely, and your doctor and dietitian will change your diet as needed. What else can I do? You should inform yourself fully by reading and talking to doctors, nurses and patients who already have kidney transplants. You can also see the National Kidney Foundation publications listed below. If you would like more information, please contact us. Risks A kidney transplant is a major surgical procedure with a wide range of potential risks. In the short term, rejection, infection and blood clots are a risk. Long term risks are usually related to the medication needed to reduce the chance of rejection (immunosuppressants). Because of this people who have had a kidney transplant require regular check-ups for the rest of their life. Living with a transplant Having a healthy lifestyle goes a long way to minimising these types of risks. It’s recommended that you: quit smoking if you smoke eat a healthy diet lose weight if you are overweight or obese; ideally you want to achieve a body mass index of less than 25. Outlook The outlook for a person who receives a donated kidney will depend on a number of factors. These include: whether the donation was a living donation or not (living donations usually have a slightly better outlook) whether the donation was from a close relative or someone with the same tissue type (this lowers the risk of the body rejecting the kidney) the age of the person receiving the donation (the younger the person, the better the outlook) the overall health of the person receiving the donation (the healthier a person is, the better the outlook) The kidney survival times for living donations are: 1 year - 90-95% 5 years - 80% 15 years - 60% Where kidneys are donated from someone who has recently died, the kidney survival times are: 1 year - 85-90% 5 years - 70% 15 years - 50%