Live Organ Transplant

Kidney Transplant

Kidney transplant operation involves taking out a kidney from the body of a person (either living or deceased donor) and transplanting it surgically in the body of another patient whose kidneys have failed. Patient with end stage kidney failure have two choices, either lifelong dialysis or kidney transplantation. Transplantation offers better quality of life, better long term rehabilitation and is more cost effective than lifelong dialysis. VPS Lakeshore has highly specialized nephrologists, urologists and transplant surgeons, who work as a close knit unit and has produced the best outcomes in kidney transplantation.

1.Why it’s done

End stage renal disease (ESRD) is diagnosed by blood tests that show the blood urea and creatinine levels to be elevated above normal, and scans (ultrasound scan, usually) that shows the kidneys are shrunken and replaced by scar tissue.

The residual function in the scarred or irreversibly damaged kidneys can be calculated by a formula easily available on the internet called the GFR calculator ( there are 2 widely used formulas: MDRD and Cockroft-Gault) that takes into account the lab values and age and height of the individuals.

When GFR falls below 20 or the patient is very symptomatic due to deranged renal function, it is time to consider RENAL REPLACEMENT THERAPY. This means dialysis and /or kidney transplant.

2. Risks of

a.Surgery

The actual operation of kidney transplant is not very stressful to the patient. The heart has to do extra work to meet the demands of the new organ and making sure the heart is able to cope with increased workload is a major part of the evaluation before surgery.

Dialysis and skillful management by experienced Nephrologists make the operation very safe. Most transplant centers report less than 5% mortality and normal function of the transplanted kidney is achieved in over 90% of patients.

b. Anti-rejection medicine

Anti rejection medicines are required lifelong. The number of medicines and the doses are maximum in the first year and require close monitoring. After this, with modern transplant medicine, the side effects are minimal and patients lead a normal life with minimum increased susceptibility to infections and tumors that require lifelong follow-up with the Nephrologists.

3.How you prepare yourselves for the transplant?

Keep all other organs in good condition, especially heart and lungs. Smoking increases the risk of death and graft failure. A sedentary lifestyle with no exercise result in poor cardiac reserve and risk of death. Exercising for 1 hour on every non-dialysis day is important. Weight control is critical and staying within 10 Kg of ideal body weight makes chances of a good long term outcome very high.

4. What can you expect?

Post OP ICU stay up to 1 week and 3 weeks in hospital is the normal practice.

5. Results

Patient survival >95% and Graft survival > 90%.

Liver Transplant

A liver transplant is a surgical procedure to remove a diseased liver and replace it with a healthy liver from a living or deceased donor. Our Liver Transplant program is most successful and boasts of one of the highest success rates (83%). Combined liver-kidney transplantation is regularly performed by the team. The year 2013,2014 and 2015 saw continuing growth of the deceased donor program with 42 liver transplants being performed with the support of KNOS – Mrithisanjeevani initiated by the Kerala Health Ministry.
The goal is to follow global norms for evidence-based best practice, at the same time striving for innovation of safer and more effective treatments.

The core team involves the following personnel;

  • Transplant Surgeons
  • Hepatology Physician
  • Anaesthesiologist
  • Intensivist
  • Nurse Practitioner
  • Transplant Co-ordinators

1. Why it’s done

  • End stage liver diseases – usually cirrhosis or development of tumors (HCC) in the cirrhosis liver.
  • Recurrent gastrointestinal bleeding and development of fluid buildup in the abdomen, fatigue and weight loss are reasons to consider transplant.
  • Frequent hospitalization, spontaneous infections requiring multiple antibiotics and kidney impairment make surgery costly and risky. Better not to delay transplant to this stage.

2. Risks of

a.Surgery

This is major surgery requiring total removal of the diseased liver. In the presence of poor coagulation and reduced platelet count this can be a major undertaking. However, patients with cirrhosis, if they are not smokers or diabetic, have good cardiac reserve and can withstand this operation. If the donor liver is good and starts working immediately (as is usually seen with live donors), the patient’s condition dramatically improves.

b.Anti-rejection medicine

Anti rejection medicines are required lifelong. The number of medicines and the doses are maximum in the first year and require close monitoring. After this, with modern transplant medicine the side effects are minimal and patients lead a normal life with minimum increased susceptibility to infections.

3. How you prepare

Calculate your MELD score. This is easily possible on the internet by searching for ‘MELD Calculator’ and putting in the values of Billirubin, INR, Creatinine and Sodium. These tests should be done every 3 months in patients with cirrhosis. In addition Ultrasound scan must be done every 6 months to look for development of tumor (HCC).

When MELD is over 12 or if there is suspicion of HCC it is time to consider Liver Transplant. Development of “Ascites” (fluid in the abdomen) and “SBP” (Spontaneous infection in the Fluid) are serious complications that result in a life expectancy work than most cancers today.

Avoid smoking and regular exercise – walking briskly for 20-30 mins every alternate day is the best way to keep fit and get the best outcome of transplant. Diet with adequate protein and calories is critical to maintain muscle mass and strength.

4. What can you expect?

One to 2 weeks in ICU and 3-4 weeks in hospital.

5. Results

Over 85% survival after transplant. Since re-transplant is usually not an option for a poor quality graft, careful selection of a deceased donor organ, or having a good live donor (less than 45 Yrs ideally) is the critical factor for success.

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