Live Discussion with Dr. Sandeep Jha
Questions doctors asked during the Jivo Masterclass on Basics of Living Donor Liver Transplant, taught by Dr. Sandeep Jha, Consultant, Liver Transplantation, Shalby Sanar International Hospital, Gurugram, India, on . Written by Jivo Healthcare from the transcript of the session, drafted with AI assistance and edited by the Jivo team.
A patient underwent a successful liver transplant in India but later developed repeated serious infections; after returning home the infection could not be controlled and the patient died. Why are post-transplant infections so difficult to control, and is this related to the medication or to the new liver?
Asked by Dr. Eshetu, Ethiopia
Transplant recipients are immunosuppressed. We must suppress the patient's immunity so that it does not damage the new liver, but the consequence is exposure to very severe infections. This does not happen in every patient, but it can happen in a few, and in these patients even minor infections escalate very quickly. Our approach is to hit them early and hit them hard. If you suspect infection in a transplant recipient, immediately send all blood investigations, including cultures and procalcitonin, look for the source of infection as quickly as possible, and start very high-grade empirical antibiotics. The antibiotic protocol differs from that for normal patients: go one or even two steps ahead of what a normal patient would require, and give a complete course of at least 14 days. Cultures should be repeated regularly and any source of infection eliminated. In hindsight it is very difficult to comment on why an individual patient did not do well, but better collaboration between the doctors in the home country and in India would help.
Answered by Dr. Sandeep Jha
What is the cost-effectiveness of this surgery, and what are its side effects and post-operative complications?
Asked by Dr. Sunday Oge
It is extremely cost-effective: a few hundred can buy 40 to 50 years of life. If a patient is dying of cirrhosis, a liver transplant gives a new life; what value would you put on that? Most complications and side effects occur in the first few months after transplant, mostly in the first month. At the end of one year, around 80 to 85% of patients are doing well, and these are patients who would not have survived without a transplant. Without transplant, 57% of patients with bleeding and ascites die within one year; with transplant, more than 80% survive the first year, which is itself a very big benefit. Not all these patients have only bleeding or ascites: some have cancer, encephalopathy or extreme sarcopenia, and their survival is even poorer. Getting them to live 15 to 20 years is the miracle of liver transplant.
Answered by Dr. Sandeep Jha
What is the fate of the donor after donating their liver, and what are the possible complications?
Asked by Dr. Sunday, Nigeria
After a complete evaluation, the donor is absolutely fine. The risk to life is 0.5%, and even that is old data: donors today are very safe, and whenever we sense a problem we do not take the donor for surgery. Donors are up and about two to three days after surgery, walking and eating, and are discharged by day six or seven. Some can travel home by day 10; most travel back about two to three weeks after surgery. They can do office work, computer work and light household work, though not heavy exertion. The only restriction is no heavy lifting for three months; after that they can lift any weight and do anything. Donors live a very fulfilling life after donation.
Answered by Dr. Sandeep Jha
In the cases I have seen, liver transplant patients often survive only three to five years, and many are bedridden with poor mobility. How effective would a second transplant be if the first graft fails, what management can help them resume normal activity, and which foods should be recommended or avoided to support recovery?
Asked by Dr. Nasoro, Kenya
No diet can prevent cirrhosis. Cirrhosis results from hepatitis B, hepatitis C, alcohol, diabetes and obesity, so prevention means addressing those causes: stopping alcohol, treating hepatitis B and C, and controlling diabetes and obesity. There is no drug that prevents it. Once a patient has cirrhosis, there are definite dietary recommendations to prevent complications: a high-protein, low-salt diet, with more frequent meals and protein snacks every three to four hours. On outcomes, I do not agree. Very large studies across the world show one-year survival of 85 to 90% and five-year survival above 70%, and 20-year data now show around 70% of patients alive. We do not achieve this in some patients because there is no continuity of care: the patient has the transplant, goes home and succumbs to a complication, whereas in Western countries patients are followed up, complications are prevented, and they survive 15 to 20 years or more with a very good quality of life. After a successful transplant, patients who return at three months are almost unrecognisable: they are stronger, muscle mass returns and the abdomen settles. When patients travel for a transplant and return home, we are talking to the patients rather than to their doctors; they do not follow up or grasp the seriousness of complications, which is why you see survival of only three to five years.
Answered by Dr. Sandeep Jha
Why is metabolic liver disease becoming the leading cause of liver transplant, and is there any difference in outcome between receiving a right lobe and a left lobe graft?
Asked by Dr. Dion
The data come from Western countries, especially the US, where metabolic syndrome is rising because of uncontrolled diabetes and obesity, along with hyperlipidaemia and thyroid problems. We are seeing the same in India: non-alcoholic steatohepatitis, now called metabolic dysfunction-associated steatohepatitis (MASH), is rising with uncontrolled diabetes, obesity and sedentary lifestyle. At the same time, hepatitis B and C are coming down because effective drugs are available and, for hepatitis B, vaccination. Uncontrolled diabetes and obesity are the new problem, leading to cirrhosis; in the US, MASH accounted for the largest number of liver transplants in 2024 and is the fastest growing indication. On lobes: if the technique is good, there is no difference in outcome between right and left lobe transplantation. An adult needs more liver mass, so a right lobe is used; a child's metabolic demand is lower, so a left lateral segment or left lobe suffices. The only difference is for the donor: removing the smaller left lobe allows slightly faster recovery with slightly fewer complications, whereas right lobe donors recover a little more slowly because the right lobe forms the bulk of the liver and has to regenerate.
Answered by Dr. Sandeep Jha