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Category Archives: Liver

What Is The Liver Transplant Procedure And When Is It Done ?

Dr. Subhash Gupta

Liver transplantation has now become a well-accepted modality for the management of end stage liver disease. Liver transplantation involves removing the diseased liver from the patient and replacing it with healthy liver either from a brain dead person or more commonly with partial liver from a healthy donor. Retrieval of organs from brain dead people involves removal of organs from individuals whose brain has stopped functioning (typically resulting after head injuries and brain hemorrhage), but their heart and breathing functions are being supported with artificial support. These organs would be of great service to humanity, however owing to the social structure of our society these organ donations are far below what is needed.  It is said that “Don’t take your organs to heaven for only God knows that that there is a great need for them on earth”.  Owing to the scarcity of brain dead or “cadaveric” organs, the available resource is that for a healthy individual to donate a part of his liver for the patient. Owing to the huge functional reserve of a healthy that we initially talked about, the part of the liver remaining with the donor is sufficient to maintain normal functioning and the remaining liver grows back to it’s normal size soon after donation.

When does one require a liver transplant?

Liver disease severe enough to require a liver transplant can come from many causes. In adults, the most common reason for liver transplantation is cirrhosis. Cirrhosis is a condition in which the liver slowly deteriorates and malfunctions due to chronic injury. Scar tissue replaces healthy liver tissue, partially blocking the flow of blood through the liver. Cirrhosis can be caused by viruses such as hepatitis B and C, alcohol, autoimmune liver diseases, buildup of fat in the liver, and hereditary liver diseases. Many people who develop cirrhosis of the liver due to excessive use of alcohol also need a liver transplant. Abstinence from alcohol and treatment of complications for 6 months will usually allow some of them to improve significantly and these patients may survive for prolonged periods without a transplant. For patients with advanced liver disease, where prolonged abstinence and medical treatment fails to restore health, liver transplantation is the treatment.

In children, the most common reason for liver transplantation is biliary atresia. Biliary atresia is a rare condition in newborn infants in which the common bile duct between the liver and the small intestine is blocked or absent. Bile ducts, which are tubes that carry bile out of the liver, are missing or damaged in this disease, and obstructed bile causes cirrhosis. Bile helps digest food. If unrecognised, the condition leads to liver failure. The cause of the condition is unknown. The only effective treatments are certain surgeries, or liver transplantation.

Other reasons for transplantation are liver cancer, benign liver tumors, and hereditary diseases. Primary liver cancers develop at a significantly higher rate in cirrhotic livers as compared to normal livers, particularly in patients having liver disease secondary to Hepatitis B. Liver Transplantation at an early stage of liver cancer may result in long-term survival for select patients. However, cancers of the liver that begin somewhere else in the body and spread to the liver are not curable with a liver transplant.

Is Chairman of Max Centre for Liver & Biliary Sciences, Max Super Speciality Hospital, Saket, New Delhi

Fatty Liver – An Epidemic Brewing

Dr.Nivedita Pandey

What is fatty liver?

It is the excessive accumulation of fat in the liver. With time this fat begins to cause damage leading to a condition called Non Alcoholic Steato Hepatitis (NASH) which ultimately leads to cirrhosis.  In the early stages it is reversible but once NASH develops it more often leads to progressive liver disease.

How is fatty liver caused?

The single most important risk factor for fatty liver is obesity. Obesity is a rapidly growing global epidemic. India, with 41 million obese people, ranks third after the US and China in having the highest number of overweight people in the world. India’s women are more likely to be obese as compared to male counterparts. There were 20 million obese women in India in 2014 as compared with 9.8 million men.

Diabetes and high cholesterol are other risk factors.

Metabolic syndrome is a cluster of conditions — increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels — that occur together, increasing your risk of fatty liver.

Why is it serious?

Lack of awareness about the seriousness of this condition is a major concern. Fatty liver, if undiagnosed and untreated can not only lead to progressive liver damage but can also cause Liver cancer.

What are the symptoms of fatty liver?

Unfortunately most patients do not have any symptoms of fatty liver only. Symptoms begin to get noticed once liver disease progresses, these can include: loss of appetite, fatigue, jaundice, confusion or encephalopathy, bleeding with minor trauma.

How is it diagnosed?

It is usually diagnose on routine ultrasound. Liver functions test also need to be done to evaluate for any liver damage.

What are the grades of fatty liver?

Grade 1 fatty liver is an early stage that is usually reversible provided risk factors mentioned above are modified. As the stage of fatty liver progresses, liver damage is seen.

What is the treatment?

The corner stone of therapy is lifestyle change like dietary modification dn erxercis leading to weight loss.

Control of diabetes and high cholesterol is very important as well.

There are many drugs in the pipeline but none have been sufficiently studied to make a recommendation. Vitamin E has been shown to have some benefit.

If advanced liver disease is present transplant is a curative option.

When to see your doctor?

You must bring it to the medical attention of your doctor if you are diagnosed with fatty liver. If this is accompanied by liver test abnormalities you must see a liver specialist.

Can fatty liver be prevented?

Yes, Fatty liver is a disease of lifestyle. A holistic approach is required for prevention. Dietary change alone is not beneficial; it must be accompanied by exercise. Research shows that losing even 3-5% of the current weight can improve liver damage.

Max Super Speciality Hospital, Saket

Organ Donation…Rising Need

Dr. Jitendra Kumar

Organ donation is a common term in today’s date but very few people are well aware of this medical procedure to step forward and donate organs to save a life. The process of removing an organ from the body of a living or deceased person is called harvesting. The recovered organ from the body of the donor is transplanted to recipient’s body through proper medical procedure.

Why India is lagging in Organ donation

As per global survey, India is lagging far behind in organ donation (0.00005% as compared to 0.003% in western world) and the main reason behind it is lack of awareness and a lot of misconceptions.

In India, nearly 5 lakh people die due to non availability of organ per year as the country is suffering from an acute shortage of organ donor. It is scientifically proven that a person can save 8 lives by donating his/her organs. But a lot of myths prevail in Indian society regarding organ donation and through mass spread of awareness campaigns only, these myths can be replaced by facts to save thousands of lives. Here are a few facts on Organ Donation:

Organ Donor

Almost everyone can be an organ donor irrespective of age, caste, religion and medical history. The process of organ donation is executed with the consent of the donor. In case of living donor, there are some legal procedures to donate organs (especially kidney donation) but in case of deceased donor, after declaration of brain death, the consent of the family members is important.

Organs that can be donated and transplanted


  • Kidney– Among the list of donated organs, kidney takes the top position as it is most commonly donated. Kidney failures are quite common as diseases affecting kidneys affect both the kidneys almost simultaneously and hence a donor with one kidney is not subjected to any additional risk. A patient with kidney failure can add years to his life through kidney transplant. On an average, the lifespan of a transplanted kidney is 10 years.
  • Liver– One liver can save two lives. A liver has two lobes and each can be transplanted to each individual. Even a portion of the liver can be donated as this is the only organ in human body that can grow cells and regenerate itself to its previous form. A living donor can donate liver.
  • Lungs– Both single and double lobe of the lungs can be transplanted. Single lobe lungs are donated by living donor whereas double lobe lungs can be donated by deceased donor in case of brain death and that needs to get transplanted on the recipient’s body within 4 to 6 hours of retrieval from donor’s body.
  • Intestine– A living donor can donate a portion of the intestine. But generally pancreas can be donated in case of brain death.
  • Heart– Heart can be donated in case of brain death only. Once retrieved from a donor’s body, a heart needs to be transplanted within 4 hours as a heart can survive for only 4 hours after removal from donor’s body.
  • Pancreas– A part of the pancreas can be donated and the functionality of pancreas can be retained with that part only.

Besides organ donation, tissues can also be donated and these can be harvested within 24 hours of death. Besides veins, skin, bones, valves and tendons, cornea donation is the most crucial one as survey reports reveal that nearly 2 lakh cornea donations are needed in India per year whereas only 50,000 corneas are donated. Cornea donation can give vision to many.


Even in this 21st century, there is perception in most Indians that organ donation will lead them towards hell after death. But this is a completely wrong notion as organ donation is not a sin but an auspicious activity that will help you to earn blessings of Almighty as well as many people who will get another life through your donated organs, only because of you.

Director of Nephrology & Renal transplant at asian Institute of Medical Sciences, Faridabad

Hepatitis Diagnosis and Prevention

As per World Health Organization (WHO) statistics, India is amongst the top 11 countries which carry the global burden of chronic hepatitis. Since, it accounts for a huge burden of illness, outbreaks and epidemic spread, resulting in increased death cases, the disease is one of the greatest concerns all over the world.

“The five main types of hepatitis virus include A, B, C, D and E. Infection by any of these viruses can lead to inflammation of liver and some infections can lead to liver cirrhosis or cancer. Based on the symptoms, a physical examination is done to check the enlargement of liver, skin colour and presence of fluid in the abdomen followed by a suitable antibacterial treatment. Awareness and early diagnosis is key to patient treatment as the infection can be difficult to cure at later stage,”  Dr. Rakesh Kumar, Senior Consultant, Internal Medicine, Indraprastha Apollo Hospital, New Delhi.

“A person can have hepatitis B infection for many years before diagnosis, I see a lot of patients with liver cirrhosis and primary liver cancer (hepatocellular carcinoma, HCC) as their first presentation. The most important challenges remaining in the area of hepatitis B and HCC are development of improved means of early detection and treatment. Currently, HBV-related HCC is often detected late, at a time that surgical interventions and liver transplantation is no longer feasible,” said Dr. Govind Nandakumar, Chief of Gastrointestinal Surgery & GI Oncosurgery, Columbia Asia Hospitals, Bangalore.

“Better approaches of universal HBV vaccination and identification and treatment of chronic hepatitis B are needed especially in the smaller towns and villages to allow for application of the many advances that has been made in prevention and treatment of this important form of cancer,” added Dr. Sumana Kolar.

Some of the symptoms of hepatitis include Jaundice, fatigue, nausea, stomach bloating, itching, weight loss, loss of appetite and dark coloured urine.

Below mentioned are some ways to prevent the infection:

Hepatitis A 

  • Practice proper hygiene
  • Wash hands well after using the restroom and before eating meals
  • Avoid eating at unhygienic or contaminated places

Hepatitis B and C:

  • Do not share personal grooming instrument like razors
  • Check for used needles to prevent risk of infection
  • Be careful about equipment used while tattooing
  • Before getting piercing done, ensure the equipment is clean
  • Practice safe intercourse

“About 50% of people with liver complications suffer from alcohol induced liver diseases, about 25- 30 % suffer from NASH (Non-Alcoholic Steato-Hepatitis) and 10-15% suffer from viral hepatitis and other liver diseases. Liver diseases are not only common among high alcohol consumers but many non-alcohol consumers also suffer from liver complications due to high Body Mass Index (BMI). Diabetes and obesity are the major causes that lead to fatty liver disease, increasing the risk of hepatitis infection in a person,” said Dr. Rakesh Kumar.



The liver is an essential organ in the body that not only contributes to the digestive system but also produces protein essential for blood clotting.

It is the largest gland in the human body that activates enzymes, stores essential nutrients and excretes bilirubin, cholesterol and other hormones.

At any given time, if the liver fails to perform any of these essential functions, it may have to be replaced. This is when a liver transplant is performed.

Read more »


The liver is an essential organ in the body that not only contributes to the digestive system but also produces protein essential for blood clotting. It is the largest gland in the human body that activates enzymes, stores essential nutrients and excretes bilirubin, cholesterol and other hormones.

At any given time, if the liver fails to perform any of these essential functions, it may have to be replaced. This is when a liver transplant is performed.

When to opt for a Liver Transplant?

The key reason for a person to go for a Liver Transplant is when the liver fails or is almost on the verge of failing. Medicines are usually provided to prevent or cure the symptoms of liver failure, however, there isn’t a medication available to cure a liver failure.

Reasons for Liver Failure

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