Excellent long-term survival following living donor liver transplantation

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By: Dr. Sanjiv Saigal

This is the story of 41-years old lady who was suffering from Autoimmune related chronic liver disease and underwent successful Living Donor Liver Transplantation (LDLT) in 2006 by a team led by Dr. Subhash Gupta & Dr. Sanjiv Saigal. The case is of great significance as those were the early days when living donor liver transplant was still evolving, and Dr Saigal have been the pioneers in getting it firmly established in India.

This lady, who was a school teacher, was diagnosed as suffering from autoimmune cirrhosis about a year back, and despite all measures, her disease continued to worsen. She developed liver decompensation in the form of ascites, jaundice and recurrent episodes of hepatic encephalopathy. This greatly compromised her routine day to day lifestyle, and it was unlikely that she could survive beyond a few months.

Due to her rapidly worsening condition, the only option to save her was liver transplantation. Getting someone to donate a part of his / her liver was indeed hugely challenging and uphill task.

Luckily, her 44-years old husband volunteered to be the liver donor. After thorough evaluation and counselling, she underwent right lobe living donor liver transplantation on 16th March 2006 on an urgent basis. Thankfully she had a dramatic recovery, and the liver graft started working well under the cover of immunosuppressive medications. In the post-operative period she had biliary issue for which she needed laparotomy and hepaticojejunostomy. In view of her biliary problem, she needed percutaneous biliary intervention & multiple stent exchanges, which she tolerated very well. Gradually, she returned back to her full active life. She diligently remained under the close follow up of Dr. Saigal. Presently, after nearly 15 years, she is doing very well & leading a healthy productive life. This case highlights how a successful LDLT can become a boon & offer long-term survival even in end stage liver disease patients.

It is important to note that there is a huge burden of liver diseases in our country, and for those who develop end-stage liver disease, the only definitive treatment is liver transplant. However, there is a huge scarcity of brain dead organ donors in our country due to lack of awareness. In such circumstances, living related organ liver donor remains the only feasible option.

Hepatitis B, Hepatitis C, Alcohol and Non-alcoholic fatty liver disease are among the top causes of chronic liver disease in our country. There are several other causes, such as autoimmune liver disease as in this lady, which if not diagnosed and treated early, can lead to end-stage liver failure necessitating liver transplant.

An important message to share with all is that even in patients with advanced liver disease, liver transplant can be performed as a life-saving procedure in highly specialised hospitals with an excellent outcome.

The writer is Principal Director and Head, Hepatology and Liver Transplant, at Centre of Liver and Biliary Sciences, Max Hospital, Saket, Delhi.

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