Principal Consultant & Unit Head, Liver Transplant, Fortis Hospital, Shalimar Bagh, New Delhi, India
Series overview · 12 articles
Liver Transplant
August 11, 2024
Liver transplantation is the gold standard treatment for advanced liver disease, and the decision of when to transplant is often more consequential than the surgery itself: too early exposes a patient to unnecessary surgical and lifelong medication risk, too late costs lives that a transplant could have saved. Dr. Ashish George, Principal Consultant & Unit Head, Liver Transplant at Fortis Hospital, Shalimar Bagh, New Delhi, used his Jivo Masterclass to walk through the full pathway, from indications and contraindications through donor evaluation, survival outcomes and the long-term realities of living with a transplant, before fielding an extended, detailed question and answer session with doctors from across Africa.
A session built around a genuinely long Q&A
More than half of this session was live discussion, with doctors asking about survival rates, donor safety, hepatitis and transplant, COVID-19 risk, nutrition, re-transplantation, and the limits of organ preservation. This guide introduces a series built around both the core lecture and that extended discussion.
What this series covers
This series works through the indications for liver transplant, from acute liver failure to chronic liver disease to liver cancer; who should not receive a transplant and how the MELD-sodium score guides timing; real survival data; how living donors are evaluated for safety and compatibility; who is medically eligible to donate; hepatitis B and C in transplant candidates; re-transplantation; nutrition before and after surgery; the long-term risks of immunosuppression including COVID-19, cardiovascular disease and infection; and practical questions about organ preservation time and alcohol limits after transplant.
This article is based on a Jivo Masterclass session conducted by Dr. Ashish George, Principal Consultant & Unit Head, Liver Transplant, Fortis Hospital, Shalimar Bagh, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
Looking for a liver transplant consultation or a second opinion? Get in touch with the Jivo team
This guide is based on a live Jivo Masterclass: Dr. Ashish George taught doctors across Africa on August 11, 2024.
FROM THE LIVE Q&A
Jivo Doctor Partner (name unclear from transcript)
What is the survival rate of liver transplantation?
Dr. Ashish George
More than 90% of patients are alive at 1 year, 80-85% at 3 years, more than 75% at 5 years, and 65-70% at 10 years. Liver transplant does not have an expiry date because the liver can regenerate.
Book a Consultation with Dr. Ashish George
Book on WhatsAppOr message us on WhatsApp: +91 98182 98669
Frequently Asked Questions
Is liver transplantation a replacement, a like-for-like graft, or a therapeutic treatment, essentially a cure versus a therapy?▼
It is a cure in that the patient's symptoms completely resolve. However, because the patient needs lifelong immunosuppressant medication, they remain in medical follow-up indefinitely even though the disease itself is gone.
Is it advisable for patients with chronic hepatitis to undergo liver transplantation, given the risk of the new liver becoming infected too?▼
Yes. Patients who develop decompensated chronic liver failure from hepatitis B or C should undergo transplant. Hepatitis B patients are kept on lifelong antivirals post-transplant to suppress the virus; hepatitis C is now completely treatable with directly acting antivirals given before or after transplant. Chronic viral hepatitis does not pose a major barrier to offering transplant.
How do factors like donor liver quality and recipient health condition impact the success and recovery process after a liver transplant?▼
Both donor and recipient undergo extensive two-pronged evaluation: confirming the surgery poses no major risk to the donor, and confirming the liver quality is good enough to function well in the recipient. Primary non-function occurs in under 1-2% of living donor transplants; early allograft dysfunction in about 5-10%. Donors are generally 18-55, and a younger, non-fatty liver has better quality than an older or fattier one.
Who is eligible to donate a liver?▼
Legally, the donor must be a relative of the patient. Medically, the ideal donor is blood-group compatible (A or O for an A recipient, B or O for a B recipient, any group for an AB recipient, only O for an O recipient; Rh status doesn't matter), aged 18 to 55, and free of diabetes or advanced uncontrolled pulmonary disease. An incompatible donor can still be evaluated if no compatible one exists, with longer preparation, higher cost and slightly increased risk.
Is there research correlating liver transplant and COVID-19 survival, and what are the nutritional considerations before, during and after liver transplantation?▼
Post-transplant patients who contract COVID-19 usually develop mild disease since the immunosuppressed body can't mount a severe response, though those who do develop severe COVID-19 can have poorer survival due to vulnerability to secondary infections. On nutrition: patients awaiting transplant should follow a high-protein, high-calorie diet to fight muscle loss (sarcopenia); after transplant, only freshly cooked meals, clean water, and peeled fruits/vegetables eaten immediately are advised, plus reduced red meat, due to immunosuppression and cardiovascular risk.
What does this masterclass series cover?▼
Indications and contraindications for liver transplant, MELD-sodium scoring, survival outcomes, living donor evaluation, hepatitis B/C in transplant candidates, re-transplantation, nutrition, immunosuppression risks, and organ preservation time.
Who is Dr. Ashish George?▼
Principal Consultant & Unit Head, Liver Transplant at Fortis Hospital, Shalimar Bagh, New Delhi.
In This Series: Liver Transplant
- 1.Liver Transplant
- 2.Indications for Liver Transplant: Acute and Chronic Liver Disease
- 3.Liver Transplant for Liver Cancer: HCC, the UCSF Criteria and Downstaging
- 4.Contraindications and the MELD-Sodium Score for Timing Transplant
- 5.Survival Rates After Liver Transplant, and Why It's a Cure, Not Just a Therapy
- 6.Living Donor Evaluation: Compatibility, Safety and Liver Regeneration
- 7.Who Can Donate a Liver: Eligibility, Compatibility and the Ten-Year Myth
- 8.Hepatitis B and C in Liver Transplant Candidates
- 9.Re-Transplantation: When and How Often It's Possible
- 10.Nutrition Before and After Liver Transplant
- 11.Immunosuppression After Transplant: COVID-19, Cardiovascular and Renal Risk
- 12.Cold Ischemia Time and Post-Transplant Alcohol Limits