Transplant surgeries are one of the most crucial procedures where protocol is strictly followed by our team of experts with regard to evaluation, procedure and post-operative treatment methods.
The Institute of Hepatology and Liver Transplantation at Kamineni Hospitals has been at the forefront in providing comprehensive, holistic healthcare to patients with advanced liver and pancreato-biliary disorders. We have been caring for patients with difficult and complex liver and pancreato-biliary disease, with a strong emphasis on prevention as much as treatment of such diseases.
A combination of internationally and locally trained doctors with extensive experience, a multidisciplinary team approach to patient care and state-of-the-art infrastructure, has enabled us to deliver excellent results that meet national benchmarks and achieve unparalleled patient satisfaction.
Our team includes Hepatologists, HPB surgeons, Transplant Anesthetists and Intensivists. The core team is supported by a host of allied specialities including interventional radiology, pathology, specialized nursing, physiotherapy, transplant coordinators and nutritionists. We have state-of-the-art infrastructure dedicated to liver transplantation including operation theatres, ICUs and wards.
We at Kamineni Hospitals are at the forefront of the management of such patients. Our trained medical and allied personnel strive towards the betterment of such patients using up-to-date treatment protocols and the latest advancements in the field of liver failure. We are equipped with a rapid response state-of-the-art dedicated Liver Intensive Care Unit with an International Ambulance Facility for transporting seriously ill patients for urgent liver transplants and other advanced liver disease treatment.
Kamineni Hospitals is one of the leading liver transplant facilities with state-of-the-art infrastructure and the best team of transplant surgeons, hepatologists, anaesthetists, and ICU staff, providing the most comprehensive and advanced liver care for adults and children of all ages. Currently, the success rate is over 95%, with a 10-year survival rate close to 80%, which is on par with major transplant centres worldwide. Our dedicated staff will provide the best possible experience to the patients from the moment they step into our premises all the way from OPD consultation, diagnosis, counselling, and treatment plan to post-treatment care, ensuring that you are given the utmost care at every stage.
Transplant surgeries are one of the most crucial procedures where protocol is strictly followed by our team of experts about evaluation, procedure and post-operative treatment methods. The surgery is scheduled only after both the donor and the patient clear an extensive medical fitness check.
Conditions we treat:
- Acute liver failure
- Severe acute hepatitis
- Jaundice
- Liver cirrhosis
- Portal hypertension
- Chronic hepatitis
- Hepatitis B and C
- Alcoholic liver disease
- Fatty liver disease
- Autoimmune liver disease
- Liver cancer
- Liver trauma
- Liver metastases
- Gall bladder and Bile duct cancer
- Metabolic liver diseases
- Biliary atresia
- Acute and chronic pancreatitis
- Pancreatic cancer
- Splenic disorders
What is liver transplantation?
Liver transplantation (orthotopic liver transplantation) is a procedure in which the diseased or damaged old liver of a patient is removed completely and replaced with a new liver. The donor liver can be from a dead person (the entire liver is used for transplantation) or a living person (a family member who donates a part of his or her liver). The liver has a huge extra reserve for functioning and an amazing capability of rapid regeneration that enables surgeons to harvest parts of the liver. Both of these parts regenerate quickly to almost their original sizes (though the shape may differ), taking care of all bodily functions.
Who needs to seek help for Liver Disease?
Patients with diagnosed or suspected liver disease, liver cancer or liver failure can benefit from consultation with our interdisciplinary team of specialists in liver disease.
Liver diseases are usually complex and need coordination between multiple allied specialists. By bringing together a set of specialists needed for the care of such patients, the Liver clinic aims to provide comprehensive liver care under one roof.
Services Offered
- Specialist evaluation and consultation with multi-disciplinary team consisting of
– Hepatologist
– HPB surgeon
– Liver transplant anesthesia and intensive care specialist
– Physiotherapist
– Dietitian - Liver transplant coordinator
- Onsite laboratory service
- Liver Elastography
- Day care unit – for convenient administration of treatments that require short hospital stays for a few hours and procedures such as paracentesis, endoscopy and biopsy.
What is Liver Failure?
As the name implies, livers can fail to function to their full capacity due to a variety of reasons. Loss of liver function results in life-threatening complications such as deep jaundice, bleeding, coma, and accumulation of fluid in the abdomen. Broadly, liver failure can be classified into acute (developing over a short period) and chronic (developing over a long period. Advanced stages of liver failure need liver transplantation as a definitive treatment. However, liver transplantation is not always feasible or available to such patients. Such patients need medical management for the optimization of their clinical conditions. Sometimes, liver failure is reversible and patients can avoid transplantation.
Types of Services & Treatment Provided
- Dedicated liver intensive care unit
- Therapeutic plasma exchange
- Continuous renal replacement therapy
- 24-hour Blood Bank with apheresis facility
- Advanced laboratory and microbiology (infection control) support
- Round-the-clock dialysis and CRRT support
Liver Transplantation
Who needs a Liver Transplant?
Chronic liver disease (any aetiology), liver cancer, acute liver failure (hepatitis B/C/E/drugs/toxins/autoimmune/shock/venous disorder), pediatric conditions (biliary atresia, hepatoblastoma, hepatocellular carcinoma), and metabolic liver diseases such as propionic acidemia, Wilson’s disease, agile syndrome, alpha-1 antitrypsin Antitrypsin Deficiency, Budd Chiari syndrome, Criggler-Najjar syndrome, primary biliary cholangitis, etc.)
Types of Liver Transplants Offered
There are two major types of liver transplantation based on the source of donated liver. Liver transplantation using an organ procured from a brain-dead donor is known as deceased donor liver transplantation (DDLT). Similarly, liver transplantation done partial liver graft from the living donor is called living donor liver transplantation (LDLT). Deceased donor Liver Transplant
Deceased donor Liver Transplant
Globally, most liver transplantations use livers from deceased donors. In this procedure, the liver usually comes from a donor who has irreversible severe brain damage incompatible with life. Massive strokes and head injuries are common causes of such major brain damage. Healthy livers from these donors are harvested after consent. Donated liver is then transplanted in patients with various types of liver disease.
To receive a DDLT, patients are required to register with a government agency regulating organ donations and transplantation activity. Unfortunately, there is a massive shortfall in organ donation compared to people waiting for transplantation. This means that people have to go on a waiting list before they get a transplant. Sometimes, a considerable length of time passes before a matched deceased donor liver becomes available.
Living donor Liver Transplantation:
In LDLT, as the name implies, the organ comes from a living donor. Commonly, such a donor is either the spouse of other close family members. A part of a liver from an otherwise healthy individual having a compatible blood group is removed and transplanted into the recipient. Because the liver can regenerate, the liver portion remains in the donor, and the liver graft in the recipient can grow to normal capacity.
ABO incompatible liver transplant:
Transplanting a liver from a blood group incompatible donor
Split Liver Transplantation:
A healthy liver from a deceased person is split into two parts and transplanted to two different patients after their damaged livers are removed.
Auxiliary Liver Transplantation:
Here, only a part of the liver is removed, and the remaining liver is left to recover or regenerate over a period of time during which the bodily functions are maintained by the transplanted liver.
Domino Liver Transplantation:
The recipient liver (usually with some genetic abnormality) is removed and transplanted to another liver disease patient (usually an elderly patient).
Swap Liver Transplantation
A swap transplant allows an incompatible live donor-recipient couple to exchange their liver with another incompatible live donor-recipient couple so that a compatible transplant can be performed.
Mono-segmental Liver Transplant:
This is a highly specialized technique used in very young pediatric patients who need very small livers for their bodies, where donor livers are reduced in size to match the body habits of such young babies.
The type of liver transplant to be undertaken is based on the state of the diseased liver and the availability of donors.
INTERVENTIONAL RADIOLOGY
What is the role of Interventional Radiology in Liver Disease?
Interventional radiologists aim to manage liver-related problems using minimally invasive procedures avoiding the need for surgery. These procedures can be both diagnostic and therapeutic. IR can provide tissue samples for diagnosis, ablate liver tumours and create a liver bypass.
Treatments Provided
- Liver biopsy
- TIPSS (liver bypass) for refractory ascites and variceal bleed
- BRTO/PARTO/CARTO for fundal variceal bleed
- MWA, RFA, TACE & TARE for HCC ablation
Facilities
- Advanced Cath lab for IR procedures
- Portable color Doppler ultrasonology
- Liver Elastography
- 64-slice CT scanner
- 3 T MRI
At Kamineni Hospitals, we use the latest advances in technology to treat patients. We are one of the few hospitals to use cutting-edge medical equipment. Our doctors and staff are skilled at using these types of equipment and have updated knowledge about the latest technological advancements in their areas of specialization.
What is the procedure for liver transplantation?
At Kamineni, we follow a systematic process in accordance with the majority of hospitals across the world.
Assessment: As it is a major surgery, a patient should be considered for transplantation only if they are well enough to sustain the operation and if the procedure improves survival. A good quality assessment (to confirm that a transplant is needed and the patient is fit for such a major procedure) involves a very detailed evaluation of the severity of liver disease and other organ systems like the heart, lungs, and kidneys. Patients will be reviewed by consultants of various specialities to identify problems, strategize the risk of surgery, and treat them to optimize the condition for surgery.
Who is the donor?
The source of a liver donor could be a dead (brain death) person or a living (family member) donor.
Living donor liver transplantation:
This is the most common type of transplantation in India, where a close relative who is fit and healthy voluntarily donates a part of his or her liver. The new liver starts working immediately and grows rapidly, reaching the necessary size over the next 3 to 6 weeks. The advantages of liver donation are avoidance of prolonged and uncertain waiting times for a cadaveric organ; getting the transplant done at the earliest possible time (before the recipient deteriorates and becomes sick); better quality of liver when compared to a dying patient; optimization of the recipient if needed; and electively planning the surgery when it is convenient for the patient, donor, and treating team.
a. Who is a suitable living liver donor?
A healthy adult between the ages of 18 and 50 (the upper limit can be extended up to 55 years in exceptional cases) who is group-compatible and is a close family relative is considered a potential liver donor. The donor should not have any liver problems himself and, ideally, should not be obese. The senior transplant coordinator will guide you through the prescribed documentation preparation as required by the governmental authorities to prove the blood relationship.
b. How is a living liver donor assessed?
Each prospective living donor undergoes a battery of tests/ scans (CT and MRI)/speciality consultant visits to assess his fitness and get risk stratification in 3 stages over 1 to 2 days. If any significant problem that increases the risk of surgery for the donor is identified at any stage, further testing is stopped, and the donor is informed about the same (in private if required by the donor). In general, up to 40 to 50% of the donors will end up being fit for liver donation. The various aspects evaluated are blood group compatibility, liver function, size of liver and remnant liver (which would be sufficient for the patient to recover after donation), fitness of other organ systems (heart, lung, kidney), looking for any comorbidities (diabetes, thyroid, blood pressure, etc.), a private discussion with the transplant team, and whether donation is voluntary or not.
c. What are the risks of living liver donation?
Even though experience with living liver donation has increased drastically over the last decade, the risks of the procedure are very low but not zero. The risk of major complications leading to death is rare (approximately 1 in 400 to 500 donors). Other complications like bleeding, infection, bile leaks, and blood clots in leg veins occur in about 5–10% of donors and can be effectively managed by medications or minor procedures.
d. What is done in donor surgery?
Donor surgery lasts for about 5 to 8 hours under general anaesthesia. The liver is divided into two parts as per preoperative imaging and plan. The removed part is flushed with an ice-cold preservative solution and stored in an ice bag. A plastic drain tube is placed in the abdomen, and the wound is closed in a way to minimize the skin scarring. The drain tube will usually be removed after 2 to 3 days.
e. What happens after donor surgery?
After surgery, the donor is shifted to the liver ICU for monitoring. The donor is kept pain-free through various intravenous injections and epidural infusions to keep them comfortable. Regular blood tests and scans are done to ensure the liver is recovering well. He or she will be made to walk and have food from postoperative day 1 and will be shifted to a personal room on day 1 or 2 after surgery. The average hospital stay for donors ranges from 5 to 7 days. At the time of discharge, the donor will be well, on a regular diet, walking comfortably, and pain-free.
f. Are there any long-term risks or adverse effects on other organ systems after liver donation?
Donating a part of the liver does not have any impact on the donor’s studies, career options (like an army, gym trainers, police services, etc.), diet, exercise, pregnancy, or family. There are no long-term side effects after liver donation.
Cadaveric (deceased donor) liver transplantation:
This involves transplanting a healthy liver from a brain-dead person (who suffered irreversible brain damage due to a road traffic accident, fall, stroke, intracerebral bleed, etc.) in the ICU. Once the treating team confirms brain death through a series of confirmatory tests, the patient’s family is counselled about organ donation. After the family consents, the surgical team will harvest the organs carefully in the operation theatre and pack them in an ice-cold preservative solution until they are transported to the recipient side.
a. Waitlisting for cadaveric transplantation:
Once the patient is worked up and found fit for liver transplantation, he or she will be registered on the official state (Jeevandan) waiting list. The offer of a donor’s liver is based on the blood group and severity of the disease. Considerations such as the relative size of the patient and the donor, the quality of the donor’s liver, and the condition of the patient are also taken into consideration when deciding on the best match.
b. Life while waiting for a cadaveric donor:
It is important to maintain the recipient’s health in the best possible condition so that when a liver becomes available, we can proceed with transplantation. He or she should be under regular follow-up and should continue the prescribed medications timely so that any complications can be addressed and treated early. You may be asked to get regular blood tests or scans that can have an impact on the safety of liver transplantation. In cases of deterioration of liver function or any infection, you may need to visit the hospital or even need intensive care unit admission.
c. What is the time to get a donor liver?
The average waiting list period varies from a few weeks to a few months. This time period depends on multiple factors, like blood group, time period of waiting, severity of liver disease, etc. Unfortunately, with time, there is a risk of deteriorating while waiting for a new liver and becoming too sick for a liver transplant. In the Indian scenario, the number of cadaveric donations is very low when compared to Western countries, and the risk of dying while on the wait list is approximately 25%. It is always advisable to continue to explore the options of a family donor during this period, as that will ensure a timely transplant.
d. What to do when you get a call about liver donor availability?
Once the surgical team deems you appropriate or compatible for a liver transplant, you will be contacted and advised to come to the hospital immediately. You may be called at any time of the day and are expected to reach within 6 hours of calling (you are advised to stay in Hyderabad once you get to the top of the waiting list or to be thorough with various transport options available regardless of location). You should always be contactable while on the waiting list and inform the transplant coordinator about any changes in your telephone number, email address, etc.
The liver transplant operation:
Recipient surgery lasts about 8 to 12 hours, during which the entire damaged liver is removed and a new graft liver is placed at the same place, joining various blood vessels and bile ducts. The wound is closed after placing two drain tubes to drain out the excess fluid that forms after surgery. They are usually removed after 5 to 10 days, depending on the amount of fluid draining per day.
Post-operative care:
The recipient will be shifted to the liver ICU on a ventilator after surgery. You will be removed from the ventilator on postoperative day 1. You will start feeling well within 2–3 days after surgery. In the usual 3- to 4-day stay in the ICU, you will undergo regular blood tests and scans to ensure proper liver recovery. Once stable, you will be shifted to a ward where you are supposed to do breathing exercises, ambulate as per expert physiotherapists, and be provided with a diet (as per senior dieticians) as part of the standard recovery plan. The average stay in the hospital is about 2 to 3 weeks. At the time of discharge, you will be able to eat and walk normally, taking some medications for proper liver functioning (which you will be taught during your hospital stay).
Life after liver transplantation:
There will be quite a few medications at discharge time, of which “immunosuppressants” (usually three in number) are the most important. These keep the liver functioning well and prevent your body from rejecting it. You will be on regular follow-up after discharge, during which the number of tablets and their dosages are gradually reduced. Various other medications, like antibiotics, antifungals, antivirals, and multivitamin supplements, will be gradually stopped in the next few weeks to months after discharge.
The initial frequency of follow-up visits is once or twice per week. It is gradually reduced to once weekly, then fortnightly, and later monthly. Once the liver function is stable, you can visit once every 6 to 12 months. At each visit, your LFT (liver function tests) and blood immunosuppressant levels are checked to adjust the medications. The blood sample should be given in the morning while fasting, and you should visit the OPD in the afternoon so that blood reports will be ready by that time. New medications may be added, previous medications discontinued, or their dose changed, depending on the clinical status and blood results. The recipient should discuss any new problems with the team at that point.
You can also contact the transplant team via telephone or email for any queries in between the visits. You are advised to come to the casualty in an emergency. You will be educated about lifestyle changes that need to be adopted after liver transplantation and also about the various complications after surgery (rejection, infections, drug-related complications, and those pertaining to original liver disease) in order to identify and treat them early.
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Meet Our Specialists
At Kamineni Hospitals, we strive to offer healthcare excellence through concerted efforts by an esteemed panel of medical experts who consistently strive to enhance as many lives as possible.
Liver Transplantation
- Dr. V Lal Meher Pradeep
- MBBS, DA, DNB, Indian Diploma in Regional Anaesthesia
- Consultant Liver Transplant Anaesthetist & Critical Care Physician
About Me
Dr. V Lal Meher Pradeep
Qualifications: MBBS, DA, DNB, Indian Diploma in Regional Anaesthesia
Occupation: Consultant Liver Transplant Anaesthetist & Critical Care Physician
Expertise: • Pre Anaesthetic Assessment • Administering Anaesthesia and Analgesia for routine and emergency surgeries in various surgical specialties – Orthopaedics and Trauma, General surgery. Vascular surgery, E.N.T., Maxillo-facial and Dental surgery, Neuro surgery, Paediatric surgery, Gynaecology , Urology, HIPEC and ROBOTIC SURGERIES • Had good exposure in Liver and Kidney TRANSPLANT ANAESTHESIA • Providing Anaesthesia and Epidural Labour Analgesia in Obstetric Unit • Good experience in Acute and Chronic Pain management • Placing Central Venous lines, Arterial Cannulas and Epidural Catheters ( Lumbar and lower thoracic)
Education & Qualifications: • Fellowship in Liver Anaesthesiology and Critical Care in RELA INSTITUTE AND MEDICAL CENTER,Chennai. • DNB from MIOT INTERNATIONAL HOSPITALS, Chennai, Apr 2019 • INDIAN DIPLOMA IN REGIONAL ANAESTHESIA (IDRA), New Delhi, Feb 2017 • DA from AMRITA INSTITUTE OF MEDICAL SCIENCES, Kochi, May 2015 • MBBS from ANDHRA MEDICAL COLLEGE, Visakhapatnam, Apr 2008
Publication & Certifications:
Experience: Currently working in Kamineni Hospitals LB nagar Convener of CPR committee in Aster Ramesh Hospitals Patient Safety Officer in Aster Ramesh Hospitals
- Dr. Kavya Dendukuri
- MBBS, MD, DM (Medical Gastroenterology),Post-Doctoral Fellowship in Hepatology & Transplant Hepatology
- Lead Consultant Hepatologist & Gastroenterologist
About Me
Dr. Kavya Dendukuri
Qualifications: MBBS, MD, DM (Medical Gastroenterology),Post-Doctoral Fellowship in Hepatology & Transplant Hepatology
Occupation: Lead Consultant Hepatologist & Gastroenterologist
Expertise: • Fatty Liver • Jaundice • Hepatitis A, B, C & E • Jaundice due to Alcohol • Pain Abdomen • Cirrhosis • Liver Cancer • Upper GI bleeds • Pancreatitis • Obstructive Jaundice • Abdominal Swelling (Ascites) • Leg Swelling (Pedal Edema) • Reduced appetite and reduced weight
Education & Qualifications: • MBBS – Mediciti Institute Of Medical Sciences. Hyderabad (Oct-2002 - May 2008). • MD (Internal Medicine) - Navodaya Medical College Hospital & Research Centre, Raichur (May 2009- May 2012). • DM - Medical Gastroenterology & Hepatology in Sri Ramachandra University (Aug 2012- Aug 2015). • Post-Doctoral Fellowship in Transplant Hepatology in Institute of Liver Disease & Transplantation, Global Health City. Chennai (Jan 2016- Dec 2016).
Experience: • Present Working as a Lead Consultant Hepatologist at Kamineni Hospitals, LB Nagar. • Consultant Lead Hepatologist at SIMS Hospital, Chennai (Jan 2023 – June 2023). • Worked as Lead Consultant Hepatologist at Kauvery Hospital, Alwarpet, Chennai (Jan 2022 - Dec 2022). • Consultant Hepatologist at Dr.Rela Institute & Medical Centre, Chennai (Dec 2016 - Dec 2021).
More Info: • Isolated Small Terminal lleal Ulcers - Diagnostic Utility of Endoscopic Biopsies in MIDTERM IS GCON- 2014, Coimbatore- India. • Presented a rare case of Hepatitis C at Singapore Hepatitis Conference- Best of EASL- May 2016. • Presented a case at a CME- February - 2016, Chennai-lndia. • Presented case series on Isolated Small Terminal ileal Ulcers-Diagnostic Utility of Endoscopic Biopsies at MIDTERM ISGCON- 2014, Coimbatore. • Presented a case of recurrent AIH in Post-transplant setting at MCLD, Jan-2017, Chennai.
- DR. KRISHNA CHOWDARY AMIRINENI
- MBBS, MS (General Surgery)
- Consultant GI, Laparoscopic and Bariatric Surgeon
About Me
DR. KRISHNA CHOWDARY AMIRINENI
Qualifications: MBBS, MS (General Surgery)
Occupation: Consultant GI, Laparoscopic and Bariatric Surgeon
About: Dr. Krishna Chowdary Amirineni is a highly skilled Consultant GI, Laparoscopic, and Bariatric Surgeon with over 13 years of extensive experience in the field of General Surgery. His profound expertise and dedication to patient care have established him as a trusted authority in surgical interventions.
Expertise: Specializing in a wide array of surgical procedures, Dr. Amirineni's focus lies on minimally invasive techniques. Some of the services provided by him include Laparoscopic Hernial Repair, Anal Fissure Surgery, Gall Bladder (Biliary) Stone Treatment, Pancreas Transplantation, and Hernia Repair Surgery. His expertise in laparoscopic techniques ensures minimal post-operative discomfort and faster recovery times for patients undergoing surgical interventions.
Years Of Experience: 13+
Education & Qualifications: MBBS from Dr. NTR University of Health Sciences Andhra Pradesh in 2011, DNB in General Surgery from Diplomate of National Board, New Delhi, in 2015.
Doctor Talks
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Patient Talks
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Life After a Successful Liver Transplant: Inspiring Stories
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