LIVER TRANSPLANT PROGRAMME
What does your liver do?
Produces blood proteins that help your immune system function well, carry oxygen and enable clotting
Stores and releases nutrients to your bloodstream
Produces bile – the enzyme that helps help digest food
Breaks down saturated fat and produces cholesterol out of it
Stores glucose in the form of glycogen
Keeps your body free from toxins.
What is liver failure?
When the liver is irreversibly damaged and loses its ability to carry out its normal functions, it is called liver failure.
Acute Liver failure, wherein the liver fails to work all of a sudden, is usually caused as an after-effect of certain medication or infection.
Chronic liver failure or complete damage of the liver is a life threatening condition that sets in gradually, over many years. The causes can be cirrhosis or cancer of the liver.
What causes chronic liver failure?
Liver cirrhosis is a slowly progressing disease in which scar tissue replaces healthy liver tissue, causing permanent and irreparable damage to the liver.
The reasons for liver cirrhosis can be:
Hepatitis B or C infection
Alcoholic liver diseases
Non-alcoholic fatty liver disease (fat build-up in the liver cells)
Genetic and auto immune disorders
Congenital birth defects
According to the National Institute of Health, liver cirrhosis is the 12th leading cause of death by disease in India .
What are alcoholic liver diseases?
Alcohol is a toxin that can cause irreversible damage to your liver. Every time you drink, your liver does its best to break down the alcohol and expel the toxins from your body. However, if the alcohol content is beyond what the liver can handle, it will gradually start losing its ability to function, which in turn leads to several complications.
What are the different types of alcohol-related liver diseases?
The three major liver diseases induced by alcohol are alcoholic fatty liver disease, alcoholic hepatitis and alcoholic cirrhosis.
Alcoholic Fatty Liver
Excess alcohol consumption leads to accumulation of extra fat in your liver. The first stage of alcohol-related liver disease, this condition usually goes unnoticed as there might be no symptoms at all. However, some patients do present symptoms like unexplained fatigue and weakness. The fat accumulation in the liver will mostly go away by itself if you stop drinking alcohol at this stage. Those who are overweight and have diabetes will need to be extremely careful, for the risk of permanent liver damage is way higher in them.
This is a condition that causes the liver to swell, in turn damaging it. The symptoms of alcoholic hepatitis include loss of appetite, vomiting, abdominal pain, fever and jaundice. It is estimated that one out of every three heavy drinkers develops alcoholic hepatitis.Alcoholic hepatitis can either be mild or severe. Mild liver damage can be reversed; all you need is to quit drinking. However, if one continues to consume alcohol despite having mild alcoholic hepatitis, the liver will slowly start becoming dysfunctional. According to reports, more than 50% of patients with severe alcoholic hepatitis do not survive.
Alcoholic cirrhosis is permanent scarring of liver caused due to excess alcohol consumption. A life-threatening condition and the most serious alcohol-related disease, the liver fails to function normally as healthy liver tissue gets replaced with scar tissue. The damage caused to the liver is usually irreversible.
Though stopping alcohol consumption may help prevent further damage, related complications are not curable.
In addition to the symptoms of alcoholic hepatitis the patient may develop severe bouts of jaundice, vomit blood, suffer from fluid accumulation in the abdomen and feet, get mentally disoriented or worse, slip into coma.
Estimates say that almost 20% of heavy drinkersdevelop liver cirrhosis.
How do alcohol-related liver diseases progress?
Heavy drinkers usually progress from fatty liver to alcoholic hepatitis to alcoholic cirrhosis over time. However, one may develop alcoholic cirrhosis without getting alcoholic hepatitis first. Besides, obesity, diabetes and chronic Hepatitis C infection increase the chance of liver diseases substantially.
What are the complications that arise from alcohol-related liver diseases?
The complications of liver diseases start showing very slowly, over many years. Symptoms usually aggravate with time and become life threating. The patient may suffer from
Build-up of fluid in the abdomen (ascites) and legs (edema)
Vomiting blood due to rupture of veins in the food pipe or stomach
Deliriousness or confusion (Hepatic Encephalopathy)
How is alcohol-related liver disease diagnosed?
Your doctor can diagnose whether you have any alcohol-related disease based on your medical history, physical examination, blood tests and radiological investigations such as Ultrasound or CT scan.
If required, you may need to undergo a liver biopsy. This will help your doctor to understand the extent of damage caused to your liver. During the biopsy, a small portion of the liver tissue will be removed with the help of a needle and tested in the laboratory.
Remember, it is possible that a patient can suffer from multiple liver problems like Hepatitis B and Hepatitis C infection at the same time.
When does one need a liver transplant?
If the liver gets irreparably damaged and cannot be managed medically anymore, your doctor might recommend a liver transplant, depending on your health condition.
How is a patient chosen and enlisted for liver transplant?
The first thing we do is to assess the patient as a team to determine whether transplant is the best way forward.
Secondly his or her medical fitness for the transplant is assessed. Our team comprises hepato pancreato biliary/ multi organ transplant surgeons, hepatologists, transplant anaesthesiologists, liver anaesthesiologists, Intensivits, critical care experts, diagnostic radiologists, interventional radiologists, infectious diseases/ infection control physicians, psychiatrists and clinical psychologists supported by transplant coordinators, substance dependency experts to help those with a history of alcohol/drug use and social workers.
All medical records are reviewed carefully, and a comprehensive pre-transplant diagnostic and pathological investigations are done to understand the extent of liver damage, ascertain blood, heart and lung health and check for any other major infections or diseases.
If everything is acceptable, then we register the patient for liver transplant, according to blood type, body size, medical condition and a priority score based on three simple blood tests known as MELD (model of end-stage liver disease) in adults and PELD (paediatric end-stage liver disease) in children.
Patients with the highest scores are transplanted first.
What is liver transplant?
Liver transplant, put simply, is the process of replacing the diseased liver with a donated, healthy liver An extremely advanced procedure, it banks heavily on the expertise and experience of the transplant team and of course, high-end medical technology.
transplant team and of course, high-end medical technology. There are two types of liver transplant: living donor transplant and cadaveric donor (deceased donor) transplant.
When a healthy person donates part of his or her liver for transplantation, it is called living donor transplant. Living donor liver transplant has its advantages. If someone, preferably a family member is willing to donate part of their liver and the blood type matches, there is no need to wait.
The liver regenerates itself and will grow to its normal size in both the donor and the recipient in 6-8 weeks.
In case there is no live donor available, then one has to wait for cadaveric organ transplant (the liver of a donor who is brain-dead)..In some cases, one donor liver can be transplanted in two people. This is called Split Liver Transplantation.
Worldwide, the success rate of liver transplant- both live and cadaveric - is quite high.
Patients undergoing liver transplantation can expect a success rate of over 90%. We also perform pancreas transplant , which in most cases, is carried out simultaneously with a kidney transplant.
What are the possible post-surgery complications?
Like every advanced surgery, liver transplant too can have possible complications in some cases.
Your body’s immune system is programmed to destroy foreign substances that invade your body. This means your immune system may attempt to attack your new liver. This is called rejection and is see in more 30% liver-transplant patients within the first year of transplant.
The doctors will give you anti-rejection medications to counter the immune attack.
How is it going to be after the surgery?
Post-surgery, you will need to stay in the hospital for 2 to 3 weeks, so that we ensure you recover well. However, it is different for different people, as some might need more time to recover from post-surgery complications.
Our doctors will always take time out to listen to you and to take good care of you, supported by our award winning team of CLS/BLS/ATLS/PALS certified nurses.
In order to ensure your smooth recovery even after you get back home, our nurses and transplant coordinator will prepare well in advance prior to discharge.
What you should do and what not will be explained to you in detail, along with your new medications that will help you overcome possible post-surgery complications. You will need to take these medications all your life.
Our medical team will also tell you how to keep a watch on signs of rejection and infection and when you should seek immediate medical help.
It is very important to follow-up as advised after the surgery. You should do every single health check-up as prescribed without fail. You will become a participant in your own healthcare, and we will do everything possible to ensure you remain safe and healthy.
HESPERIS Fellowship by the European Society for Organ Transplantation | Fellow of Royal College of Surgeons of England (FRCS) | Member of Royal College of Surgeons of England (MRCS)|Certificate of Completion of Training (C.C.T) (General Medical Council, U.K) |MBBS (Armed Forces Medical College, Pune)
Medical adviser to the Zonal Coordination Committee of Karnataka (ZCCK-The Organization empowered to coordinate the cadaveric transplantation activities and also educate the public on organ donation)
Senior Consultant, Hepato Pancreato Biliary & Abdominal Multi Organ Transplant Surgery, Global Hospitals Bangalore
Research in liver transplantation, Department of Health and the UK National Health Blood and Transplant Services
Post CCT Royal College Transplant Fellow, St James Hospital,Leeds, UK
Research Fellow, Clinical Effectiveness Unit, Royal College of Surgeons, UK
Research Fellow, Ireland liver Transplant Audit
Trained in Yorkshire school of surgery & Freeman Hospital, Newcastle upon Tyne
Research interest: transplant epidemiology and prognostic modelling in liver transplantation
Published articles in peer reviewed journals
Proficient in English, Malayalam Hindi, Kannada
He attained extensive training in HPB & transplant surgery from some of the finest institutes in the UK, Europe, USA and Taiwan. His areas of special interest include management of hepatocellular carcinoma, complex gallbladder and biliary cancers, benign and malignant pancreatic disease and robotic HPB surgery.
European Society for Organ Transplantation Diploma | CCT (Joint Committee on Surgical Training, UK) | FEBS (HPB Surgery – European Board) | FRCS (The Royal College of Surgeons of Edinburgh, UK) | MRCS (The Royal College of Surgeons of Edinburgh, UK) | MS (JJM Medical College, Davangere, Karnataka) | MBBS (JJM Medical College, Davangere, Karnataka)
Fellowship in Living Donor Liver Transplantation (The Royal College of Surgeons of Edinburgh Ethicon Travelling Fellowship - Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan)
Fellowship in Minimally Invasive Robotic HPB Surgery (UIC, Chicago, USA)
Senior Fellowship in Liver Transplantation (Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK)
Higher Specialist Surgical Training - HPB & Transplantation (Northern Deanery, UK)
Research Registrar - Newcastle University, UK
Research interest: multi modal management of hepatocellular cancer
Published numerous articles in peer reviewed journals
Proficient in English, Hindi, Urdu, Kannada and Telugu
Fellowship in Liver Diseases and Transplantation (Mount Sinai Medical Center, New York, USA)
FMGE in Gastroenterology (Manipal Hospital, Bangalore)
MD in Internal Medicine (AIMS, Karnataka)
MBBS (AIMS, Karnataka)
Worked at Mount Sinai Hospital, USA
Consultant, Hepato Pancreato Biliary & Abdominal Multi Organ Transplant Surgery, Global Hospitals Bangalore Global Hospitals, Bangalore
Department of Gastroenterology and Hepatology at Manipal Hospitals, Bangalore
Actively involved in an on-going international research in the field of liver disease
Co-investigator on a multi-centre drug trial for non-alcoholic steatohepatitis - tobira trial
Published research articles, authored a text book chapter
Member of American Association for the Study of Liver Disease (AASLD)
Proficient in Hindi, Kashmiri, English, Kannada
Clinical Fellow in Hepatology (NUH Singapore) | Certificate in Gastroenterology (Royal College of Physicians, UK) | DM in Gastroenterology (Govt. Medical College, Thiruvananthapuram) | DNB in General Medicine | MD in General Medicine (Govt. Medical College, Thiruvananthapuram) | MBBS (Govt. Medical College, Kottayam)
Consultant Gastroenterologist & Hepatologist, Medical Trust, Kochi .
Set up the Cadaveric Liver Transplant Unit at Medical Trust Hospital along with Dr. Deepak Varma in 2012
Visitor observer in Liver Transplantation at Addenbrookes, Cambridge
Proficient in English & Malayalam
American College of Graduate Medical Education (ACGME) accredited Clinical Fellowship in Advanced Liver Diseases and Transplant Hepatology (The Mount Sinai Medical Center, New York, USA) | DM in Gastroenterology (Post Graduate Institute of Medical Education and Research, Chandigarh) | MD in Internal Medicine (Post Graduate Institute of Medical Education and Research, Chandigarh) | MBBS (Gandhi Medical College, Bhopal)
Chief Hepatologist, Aster Integrated Liver Care Team, Aster CMI Hospital, Bangalore
Chief Transplant Hepatologist, BGS Global Hospitals, Bangalore
Head of the Department and Consultant in Gastroenterology and Hepatology, NMC Specialty Hospital, Abu Dhabi
Clinical Fellow, Division of Liver diseases, Mount Sinai Medical Center, New York, USA
Specialist Gastroenterologist and Hepatologist, New Medical Centre, Abu Dhabi
Senior Resident in Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh
Published research articles & chapters in textbooks
Proficient in English & Hindi
DM in Hepatology (Post Graduate Institute of Medical Education and Research, Chandigarh, India) | MD in Internal Medicine (Post Graduate Institute of Medical Education and Research, Chandigarh, India) | MBBS (Mahadevappa Rampure Medical College, Gulbarga, Karnataka)
Consultant Hepatologist, Aster Integrated Liver Care, Aster CMI, Bangalore
Assistant Professor, Internal medicine, ASRAM Medical College, Andhra Pradesh
Senior resident in Gian Sagar Medical College, Chandigarh
Senior Resident in Internal Medicine (Haematology and Emergency Medicine), PGIMER, Chandigarh
Member, Life of Lamp, an organ donation awareness initiative of PGIMER, Chandigarh (promoting organ donation)
Published research articles, textbook chapters
Proficient in English, Hindi, Kannada
FFICM (UK) | FRCA (Royal College Of Anaesthetists, UK) | MBBS (Bangalore Medical College)
Consultant- Anaesthesia/Critical Care, Aster CMI Hospital, Bangalore
Consultant- Critical Care BGS Global Hospitals, Bangalore
Consultant-Anaesthesia and Critical Care, Lister Hospital, Stevenage
Clinical Fellow- Cardiac Anaesthesia Harefield Hospital, London
Clinical Fellow- Liver transplant and Hepatobiliary, RFH
Specialist registrar- Hospitals attached to RF/UCHL Hospitals, London
Senior House Officer- The Ipswich Hospital, UK
Published research articles
Proficient in English, Kannada, Telugu, Hindi, Tamil
CCT in Hepato Pancreato Biliary & Organ Transplantation (UK) | FRCS ((The Royal College of Surgeons of Edinburgh, UK) | MD in Influence of genetic risk on development of sporadic pancreatic cancer (Newcastle University, UK) | MS in General Surgery (Bangalore Medical College) | MBBS (JSS Medical College, Mysore)
Senior Consultant, Department of Hepatobiliary Surgery and Multi-organ Transplantation, Aster CMI Hospital, Bangalore
Research MD programme: Influence of genetic risk on development of sporadic pancreatic cancer at Newcastle University UK
Senior Fellowship at the Institute of Transplantation (liver transplantation), Newcastle upon Tyne UK
Fellowship in Living Donor Liver Transplantation at the Queen Mary Hospital, Hong Kong
European Pancreatic club, IHPBA, EHPBA, ELITA, British Transplantation Society & International Liver Transplantation Society
Proficient Kannada, Tamil, Hindi, English
Msc (University of Alberta, Canada) | American Society of Transplant Surgeons (ASTS) accredited Fellowship in Multi-organ transplantation (Edmonton, Canada) | MRCS (The Royal College of Surgeons of Edinburgh, United Kingdom) | MS (JIPMER, Pondicherry) | MBBS (JIPMER, Pondicherry)
Senior Consultants, Department of Hepatobiliary Surgery and Multi-organ Transplantation, Aster CMI Hospital, Bangalore
Postgraduate Research Degree from the University of Alberta
American Society of Transplant Surgeons (ASTS) accredited fellowship in Multi-organ transplantation in Edmonton, Canada
Training in Hepatobiliary Surgery and Multi-organ transplantation Liver at the St James’s University Hospital in Leeds, UK
Selected for the European Health Leadership program at INSEAD, France
Subspecialty training in Surgical Oncology - All India Institute of Medical Sciences (AIIMS), New Delhi
British Transplant Society, The American Society of Transplantation, The Canadian Transplant Society, Alberta Heritage fellowship (AHFMR) & American Association of the Society of Liver disease (AASLD) HPB surgery and Liver Transplantation awards
Has published more than 40 research articles in international journals
Proficient in English, Hindi, Kannada & Tamil
Dr. Arun also has experience in management of chronic pain, especially interventional pain management of headaches, spinal, musculoskeletal and cancer pain. His areas of special interest include solid organ transplant, hepatobiliary surgery, onco surgery, chronic pain in failed back surgeries, chronic deadache and facial pain.
CCT (London, UK) | FFMRCA (Royal College of Anaesthetists, UK) | FRCA (Royal College of Anaesthetists, UK) | MD in Anaesthesiology (JIPMER, Pondicherry) | MBBS (JIPMER, Pondicherry)
Senior Consultant, Anaesthesia and Chronic Pain, Aster Integrated Liver Care, Aster CMI, Bangalore
Senior Consultant, Anaesthesia and Chronic Pain, BGS Global Hospitals
Worked as Consultant in Anaesthesia & chronic pain management in NHS, UK
Specialist training in Anaesthesia including transplantation from Addenbrooke’s Hospitals, Cambridge, UK
Setup pain clinics in Delhi and Bangalore
Proficient in English, Tamil, Hindi
FRCA & CCT (Royal College of Anaesthetists, London, UK) | MD in Anaesthesia (King George Medical University, Lucknow) | MBBS (Kilpauk Medical College, Chennai)
Expertise in Liver Transplant Anaesthesia, Critical Care, Regional Anaesthesia, Obstetric anaesthesia & Difficult Airway.
Special interests include clinical audit, patient safety and training of allied specialities.
Lead Consultant, Transplant Anaesthesia at BGS Global Hospitals, Bangalore
Senior Registrar, Anaesthesia, West Yorkshire
Proficient in English, Tamil, Kannada and Hindi
DM in Gastroenterology (Kilpauk Medical College) | DNB in Paediatrics | MD in Paediatrics (Madras Medical College) | MBBS (Coimbatore Medical College)
Expert in all diagnostic and therapeutic endoscopic procedures including Esophageal balloon dilatation, savory dilatation, EVL, control of bleeding, colonoscopy, polypectomy, colonoscopic stricture dilatation, ERCP (diagnostic and therapeutic), PEG placement.
Proficient in English, Malayalam, Tamil, Hindi
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