Liver Lessons

Dr. Thomas Cherian, FRCS (G Surg), FRCS (I-Collegiate), CCST (UK), Liver transplant surgeon, Global Hospitals
After receiving medical qualifications from Bangalore University, Dr. Thomas Cherian completed three years of basic surgical training and passed his FRCS in Stoke-on-Trent, England. He was then selected for higher specialist training in hepatobiliary and transplant surgery at Paul McMaster’s Liver Unit in Birmingham.

Dr. Cherian obtained his sub-speciality FRCS from the Royal College of Surgeons and, in 2008, received his Certificate of Completion of Specialist Training (CCT) in London. Upon finishing his training, he spent four years at King’s College Hospital in London, at Europe’s largest liver transplant programme, before joining Global Hospitals in 2012.
Dr. Cherian is versed in all liver and pancreatic pathology procedures, for both malignant and benign disease. He has significant experience (more than 100 cases) in advanced pancreatic surgery, including Whipple’s and Frey resections; and major liver resections, including extended trisegmentectomies. He is currently gaining further experience in laparoscopic anatomical liver resections. In addition, Dr. Cherian has played a major role in more than 200 liver transplants (43 of which were performed on child patients) and has about four years of experience in complex transplant procedures, performing more than 80 split, living-related, domino, and auxiliary liver transplants. This week, Dr. Cherian shared with You & I some of the complexities and latest advances in the field.
Can you start by telling us some of the basics of a liver transplant?
A liver transplant is an operation to remove a diseased or damaged liver from the body, replacing it with a healthy one. Due to innovations in surgical procedures and the enhanced quality of ICU care and technology, liver transplantation survival rates have improved significantly. Thousands worldwide benefit from liver transplant surgery every year. In 2011-12, a total of 726 liver transplants were carried out in the UK and more than 5,000 in the US
When is this procedure required?
A transplant is recommended when the liver has been damaged to the point where it cannot recover or perform its normal functions (cirrhosis), and is likely to fail. Once liver cirrhosis reaches a certain level, the damage is irreversible and the liver gradually loses all its function. This is known as liver failure, or end-stage liver disease. The only hope for the long-term survival of a person with liver failure is a transplant.
How long does it take to recover after surgery?
If everything goes well, patients can go home 12-15 days after the transplant. A full recovery and return to work can take anywhere from two to four months. Though today a fairly common surgical procedure, liver transplant is still a major operation. The leakage of bile, vessel thrombosis (formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system), and even mortality (5-10% risk worldwide) can occur after surgery. One of the more serious risks is that the body may reject the new organ. To prevent this from happening, anyone who receives a transplant needs to take medication to suppress the immune system for the rest of their life. However, a balanced lifestyle and proper diet can help lower the initial levels of dependency. Nonetheless, a certain amount of medication is inevitable.
Can a patient lead a normal life after having a liver transplant?
Yes. We have seen teachers, businessmen, and even a water-skiing instructor go back to work. Even children who have undergone liver transplants have led near-normal lives after the surgery. If the transplanted liver works well, and once the scar has healed, there are really very few restrictions. Transplant patients can pretty much live and eat normally.
How frequent is the required medical follow-up?
Initially, it is once or twice a month; later, it’s once in three to six months. After the first two years, once the liver is working normally, it comes down to just once a year.
Is a transplant a viable treatment for liver cancer?
It is not a common indication, but for certain cases of hepatocellular carcinoma, transplantation can be an option.
How can individuals donate their organs?
Deceased organ donation involves a liver that has been removed from a person who has been declared brain-dead. For this, you need to register on the organ donation list.
A living donor transplant is when a section of liver is removed from a living person and given to another individual.

A healthy liver can regenerate, so both the transplanted section and the remaining section of the donor’s liver are able to grow into normal-sized organs.    

– as told to Anahita