Deceased 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
  • 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.

Pancreas Transplant

A pancreas transplant is a surgical procedure to place a healthy pancreas from a deceased donor into a person whose pancreas no longer functions properly. Almost all pancreas transplants are done to treat TYPE 1 Diabetes. Because the pancreas is a vital organ, performing functions necessary in the digestion process, the recipient's native pancreas is left in place, and the donated pancreas is attached in a different location.

1. Why it’s done

For Diabetes Melitus Type I – usually if onset at young age, with insulin dependence. When”Diabetic keto acidosis” occurs requiring ICU admissions; and when ‘hypoglycemic unawareness” occurs, it is time to consider Pancreas Transplant. Usually pancrease transplant is done along with kidney transplant simultaneously as kidneys are damaged in these patients and most are on dialysis.

2. Risks of

a.Surgery

Pancreas is placed on right and kidneys on left side usually. The actual 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 / Endocrinologist make the operation very safe. Most transplant centers report less than 5% mortality and normal function of the transplanted organ, in over 95% 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 / Endocrinologist.

3. How you prepare

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 results in poor cardiac reserve and risk of death. Exercising and weight control is critical and staying within 10 Kg of ideal body weight makes chances of a good long term outcome very high.

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?

7 days in ICU and 3-4 weeks in hospital. Diabetes is controlled before the operation is over. No further diet restrictions for diabetes are required.

5. Results

Patient survival >95% and Graft survival > 80%.

Intestine Transplant

Intestine transplantation, or small bowel transplantation is the surgical replacement of the small intestine for chronic and acute cases of intestinal failure.

1.Why it’s done

When the small intestine is either diseased or surgically removed to an extend that Total Parenteral Nutrition (TPN) is required lifelong. TPN is delivered through the veins. When veins start getting clotted, or TPN start causing liver dysfunction, may make transplantation the only viable option.

2. Risks of

a.Surgery

This is a major operation because these patients have had multiple operations previously, and there is little space left in the abdomen. The blood supply of the intestine graft usually has to be reconstructed to the Aorta and Venacava, as the normal intestinal vessels are thrombosed due to the original disease or previous intestinal resection surgery.

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 gastroenterologist.

3. How you prepare?

When facing lifelong TPN it is time to consider intestinal transplant.

4. What can you expect?

Prolonged hospitalization upto 3 to 6 months after transplant while the graft is monitored and nutritional and fluid requirements are supplemented.

5. Results

75 to 80% graft survival and 80 to 90% patient survival after transplant.

Heart Transplant

VPS Lakeshore is one of the few centers in Kerala licensed to do heart transplant. We have an integrated Heart Center with a dedicated team of Cardiothorasic Surgeons, Cardiologists, Cardiac Anesthetists and a Transplant Coordinator, who work in tandem and constitute the transplant team.

A heart transplant is surgery to remove a person's diseased heart and replace it with a healthy heart from a deceased donor. Most heart transplants are done on patients who have end-stage heart failure.

1. For whom and why is it done?

Heart transplants are done on patients who have end-stage heart failure. Heart failure is a condition in which the heart is damaged or weak. As a result, it can't pump enough blood to meet the body's needs. "End-stage" heart failure means the condition is so severe that all treatments, other than a heart transplant, have failed.

a. What causes heart failure?

Heart damage occurs from heart attacks. It can also be due to valve problems, high blood pressure and even unknown reasons. The terminology "Cardio myopathy" is used to denote this condition where the heart is damaged and they have heart failure.

b. What are symptoms of heart failure?

Patients may experience a variety of symptoms, including fatigue, decreased exercise tolerance, shortness of breath, or swelling. They often require hospitalization for it.

c. How is heart failure gauged?

"Ejection fraction" measured by Echocardiography is used to gauge the heart function.

2. Among the heart failure patients who should undergo transplant?

The benefit of transplantation is clear if a person requires continuous intravenous medications in the hospital. In un-hospitalized patients, the following requirements have been recommended for consideration for cardiac transplantation:

  • A history of repeated hospitalizations for heart failure
  • Need for Ventricular Assist Device (VAD) or artificial heart to support circulation
  • Increasing types, dosages, and complexity of medications
  • A reproducible VO2 (amount of oxygen required by the body) of less than 14 ml/kg per minute.

3. How is the preparation done. ?

Patients who meet requirements heart transplant are also evaluated for underlying medical problems, which may prevent a person from being eligible for transplantation. These include:

  • Irreversible pulmonary hypertension. ( Right sided pressures of the heart). And this happens as the duration of heart failure is long.
  • Active infection
  • Cancer

Other factors will also be considered, including the person's age, the presence of diabetes or lung disease, and cigarette smoking or alcohol or substance abuse.

4. If I am to undergo transplant how long does it take to undergo?

After the necessary evaluation, if a patient turns out to be a candidate he is " listed " in KNOS -Mrithisanjeevani initiated by the Govt. of Kerala Health Ministry. The waiting period is usually about 3 months.

5. What is the outcome?

Approximately 85 to 90 percent of heart transplant patients are live one year after their surgery, with an annual death rate of approximately 4 percent thereafter. The three-year survival approaches 75 percent.

6. What to expect during heart transplant.?

Heart transplant surgery usually takes about 4 hours. Patients often spend the first days after surgery in the intensive care unit of the hospital. The amount of time a heart transplant recipient spends in the hospital varies. Recovery often involves 1 to 2 weeks in the hospital and 3 months of monitoring by the transplant team at the heart transplant center.

7. How will be the follow up?

The risk of rejection is the highest early after transplantation, particularly in the first year. Immunosuppression medications are generally prescribed at the highest level during this period and slowly tapered under close supervision over the subsequent year. The higher level of immunosuppression also increases the risk of infections during this period, which necessitates the use of prophylactic antibiotics to minimize this risk.

Patients are typically required to undergo surveillance monitoring for rejection with a variety of techniques, including echocardiograms, blood tests, and heart biopsies.

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