Facilities and expertise available
* Living related Liver transplant and Cadaveric transplant
Liver, Pancreas and Biliary Surgery
This department has vast experience in a wide variety of surgical conditions that affect the liver, pancreas, gall bladder and the biliary tree including tumors involving these organs, jaundice caused by benign blockage of the bile duct including stones. Surgery of the liver is a complex and highly specialized procedure that is best undertaken by trained experts in this field. Complex liver surgeries are routinely undertaken by the liver transplant team.
Liver Transplant Services
The major advancement in management of liver failure has been the development of liver transplantation.
What is liver failure?
Liver failure can be acute or chronic. Acute liver failure refers to a person who has been completely well, develops jaundice and goes into coma .On the other hand chronic liver disease or cirrhosis can be caused in conditions such as Hepatitis B or Hepatitis C infection, excess alcohol consumption, and diseases such as Primary Biliary Cirrhosis, Primary Sclerosing Cholangitis and a variety of inherited metabolic conditions.
Can it be treated?
With modern medicine, it is now possible to treat many such cases successfully. While a proportion of patients with acute liver failure can recover by receiving treatment in specialized liver ICUs such as the one available, some patients will require liver transplantation. Medicines and other measures such as draining ascites and stopping the blood vomiting by endoscopy are useful adjuncts to treatment of liver disease. Acute liver failure unresponsive to medical treatment requires a liver transplantation.
India leads in transplant for cirrhosis
Liver transplantation is an accepted treatment for end stage liver disease and liver failure in the west. Now in India, liver transplantation is done routinely. However, the major difference is that we do living related liver transplant also.
We have the state-of-the-art facilities for managing adult patients and children suffering from liver failure. Liver transplants are being performed here with equivalent results as compared to any other centre of repute in the world.
Who can be a donor?
Liver transplant requires a suitable donor. There are two types of donors:
a) Patients who have been declared as brain dead, whose family members have given consent for retrieval of organs for transplantation. Unfortunately this donation is rare in India with average 5-6 donations /year through our center.
b) The main group is from living related donor of the patient and has matched blood group.
Our liver specialists / transplant surgeons and physicians have been trained and have the distinction of working for several years at various renowned centers of the world, in country like Korea, U.K., Hong Kong and Japan. They have the expertise and are well-versed with the transplant techniques in adult and children using either organs from brain dead donors or portion of liver from a living related donor.
The department boasts of a dedicated transplant ICU manned by trained doctors and nursing staff and fully equipped with state-of-the-art ventilators and monitors. The department have high-tech operating rooms with anesthesia staff trained with liver transplant and round-the-clock investigation facilities including an advanced Transplant Immunology laboratory support and drug level assays. Specialists who are well trained in management of complex diseases especially requiring multispeciality tertiary level care are available under a single roof at this center.
How safe is liver transplant?
We strive for donor safety .However it is a complex operation and risk to donor death is 0.5% Liver transplant has 85 % 10 year survival.
Pediatric Gastroenterology, Hepatology and Nutrition Service
1. Facilities for investigations and nutritional rehabilitation and management of patients with acute and chronic liver disease.
2. Liver transplantation for end stage liver disease due to diverse etiologies such as extra hepatic biliary atresia, progressive familial intrahepatic cholestasis, fulminant hepatic failure and metabolic diseases like tyrosinemia and Wilson
3. Facilities for post operative care and followup of liver transplant patients.
In addition the department offers a comprehensive gastroenterology and nutrition service including diagnostic and therapeutic endoscopy.
There is a comprehensive dietetics department offering up to date guidance on infant and child nutrition.
Adult Hepatology and Gastroenterology
Our hospital boasts of the state of art Hepatology and Gastroenterology services. Endoscopic procedures for the care of liver patients are performed by well qualified and trained gastroenterologists. Complex endoscopic procedures like band ligation for bleeding varices in a cirrhotic, ERCP for a variety of biliary problems, sclerotherapy for control of ulcer bleeding etc are done. We also have capsule endoscope and liver dialysis system (MARS) under the ambit of Hepatoentrology.
Renal Transplant and Dialysis Access Service
Facilities and Expertise available
* Renal transplantation in adults and children
* Laparoscopic / Open live donor nephrectomy
* Vascular Access procedures for hemodialysis
* Continuous Ambulatory Peritoneal Dialysis
Our Renal Transplant Programme is one of the best equipped and most successful renal transplant and dialysis programme in the country. We take a multidisciplinary approach to the management of these patients. Our transplant surgeons and nephrologists are supported by a team of cardiologists, endocrinologists, anesthetists, diagnostic services, psychologist and dieticians who work closely with patients and ensure the highest level of care and service to them with information before, during and after Renal Transplant Surgery.
We have senior transplant surgeons and nephrologists who have worked in renowned centers. Our surgeons are well versed with the transplant techniques in adults as well as children. We provide facilities for laparoscopic as well as open donor nephrectomy. Currently we perform more than 100 renal transplants per year.
We has high tech operating rooms, a separate transplant ICU with trained and dedicated nurses fully equipped with state of the art monitors and other equipment, round the clock availability of laboratory facilities including an advanced transplant immunology laboratory and drug level assays.
Short waiting period
A renal failure patient can be transplanted within two to three weeks of walking into the hospital if the accompanied donor is approved by the government appointed authorization committee .
Pediatric Renal Transplant: We are well equipped with pediatric nephrology and advanced pediatric centre. We have very senior pediatric Nephrologist and transplant surgeon to offer transplantation to a very small baby.
Re-transplantation: We accept 2nd and 3rd transplant also if the donor is available .Our team is very well equipped and trained to do such operation.
Who can be a renal donor?
Kidneys for transplantation come from two sources i.e. Living and Deceased donors
Living Donors: Kidney can be donated by a family member, spouse or friend who is compatible and willing to donate. Our Team thoroughly evaluates and accepts a healthy donor to optimally match the recipient. As per Indian Transplant Law, a person below 18 years of age (minor) cannot be considered as a donor. Though no upper age limit has been defined by the law for living donors, but as per hospital policy, we usually accept donors up to the age of 65 yrs. But irrespective of age the medical suitability of the donor is the most important. Approval of the authorization committee, appointed by the government, is mandatory to undergo transplant surgery.
Deceased Donors – persons who have suffered brain death and family members have consented to donate their organs. We has the facilities and technical expertise for cadaveric multi-organ procurement and transplantation
How Donor kidney is removed?
There are two ways to remove kidney from a donor- Open donor nephrectomy and Laparoscopic donor nephrectomy.
Suitability for open / laparoscopic method is decided on several factors. We have excellent facilities for both types of donor nephrectomy.
Till now a high number of laparoscopic donor nephrectomy have been performed with minimal conversion rate. The advantage of laparoscopic donor nephrectomy is less pain, short hospital stay (3-4 days) and early return to work. The kidney retrieval incision (6 cm) is not visible as it is placed over the pubic hair.
Authorization Committee : It is a committee of several members appointed by the government for scrutinizing all the living donors and recipients to give the approval for surgery. No organ transplant can be performed without prior approval of the authorization committee. The objective of the committee is to ensure that living donor transplants are performed as per Transplantation of Human Organs Act and subsequent amendments made there under.
Causes of End Stage Renal Disease :
End stage renal disease (ESRD) is reached when renal function is reduced to about 10% of the normal level and the patient is showing signs and symptoms of uremia. A wide variety of conditions can result in ESRD. Chronic Glomerulonephritis, Diabetes, Hypertension, and Cystic renal disease are the most common causes of ESRD.
Treatment Options in Renal Failure :
* Renal transplantation
* Peritoneal dialysis.
When one has developed end stage renal failure, three options are available:Renal transplantation is the best modality of treatment as a successful renal transplant provides a better quality of life, is more cost effective and provides long term rehabilitation as compared to dialysis dependence. After a successful transplant one has greater freedom, less restricted diet and better energy levels.
Vascular Access and Peritoneal Dialysis Catheters :
Surgery to provide vascular access for dialysis is carried out either by the transplant team or by the vascular surgical team. AV Fistula, Perma catheter, interposition grafting, IJ catheters and Peritoneal Dialysis catheters are performed routinely.
Histopathology and Immunology Testing:
The hospital is equipped with all the latest technology to do immunological tests for transplantation. We have trained pathologists to provide support for the accurate diagnosis of rejection and renal pathology.
* Histopathology with specialized stains for Immuno Florescence and Immunochemistry
* HLA and cross matching
* C4d Antibodies staining
* Monitoring drug levels after transplant