ORGAN TRANSPLANTS

 

Organ transplant is the last suggested procedure in cases of organ failure, and is undertaken only in critical cases and emergency medical situations. In such situations, at the critical end of organ failure, a healthy organ/organs for transplant from a person living or deceased is transplanted into the organ transplant recipient, offering them a new chance of survival.

Organ transplant donation helps people suffering from chronic illnesses to live a more fulfilled life and a healthier one up to a normal lifespan. Organ transplantation may be required in cases of genetic organ defects such as congenital heart defects or polycystic kidney disease, and in such cases, medication can fall short of making a difference in lifestyle or lifespan of the patient.

Chronic or acquired conditions such as diabetes or physical injuries can also be reasons for requirement of an organ transplant surgery. Organs for transplant include the lungs, heart, pancreas, kidneys, liver and intestine, and transplants for the face and body are also being undertaken more recently. Of these, kidney transplants are usually undertaken as the most common form of organ transplant and see a high organ transplant success rate.

While the organ transplant process is becoming more common over the years with senior citizens being the most common demographic undergoing organ transplantation in developed countries such as the USA, the organ transplant surgery procedure remains a complex one, involving many delicate steps, and requiring a highly skilled team of surgical experts. The criteria for organ transplant include a battery of tests to determine the kind of donor organ to best fit the recipient, and prevent organ transplant rejection. Donor matching is a major part of the organ transplant process, and in cases of kidney transplant, very often a living family member with the same blood type is the donor of the organ to reduce chances or organ transplant rejection.

Once it is determined by doctors that a patient is due to undergo the organ transplant process, they are then placed on an organ transplant waiting list to await a donor organ. The requirements for organ transplant require critical organ failure in the recipient patient, and once they are placed on the organ transplant list, the health of the patient is monitored at regular intervals to determine the feasibility of the organ transplant process once an organ becomes available. Organ matching is a critical part of the organ transplant process where age, organ transplant history, blood type matching and several such criteria for Organ Transplants are considered at the time of putting the patient on an organ transplant waiting list, as well as the time for organ transplant surgery nears. Considering the severity of conditions requiring organ transplant, the organ transplant guidelines surrounding the entire process are strict and continually monitored.

2.WHY IS AN ORGAN TRANSPLANT DONE?

An organ transplant is done when a critical organ in the body is functioning very poorly, and determined to ultimately fail and cause mortality. To prevent the death of a patient whose organ failure is already determined, doctors will suggest organ transplantation as an end state measure, after determining suitability of such a procedure on the patient. Some of the chronic conditions that require an organ transplant due to terminal organ failure include chronic kidney disease, cystic fibrosis, acute diabetes, congenital heart disease (CHD). Liver failure due to cirrhosis, and accidents and injuries are also reasons that an organ transplant process may be suggested. Organ transplant offers a recipient a new lease of life in cases where they are determined to not survive due to end stage critical organ failure, and currently, organ transplant surgery has become highly specialised to cater to a significant population that can be benefitted by organ transplantation.

3.TYPES OF ORGAN TRANSPLANT

 

While organ transplant was initially restricted to transplantation of vital organs, today, medical and surgical processes have developed to allow transplantation of several organs that allow not only a longer lifespan, but an improved quality of life to recipient patients. Organ transplant types today include:

1.Heart transplant

Since a heart is a vital organ, an organ transplant is provided to the donor from a deceased patient who has suffered brain death, often in the case of an accident. This replaces the organ transplant recipient's damaged heart and offers them a completely new one to afford them a chance at an extended life. Strict organ transplant guidelines surround such a procedure, and the organ transplant surgery is carried out by highly specialised doctors working round the clock to monitor the patient's vital sign throughout the organ transplant process. Due to a scarcity of donors, heart transplants are one of the most critical and least performed organ transplant surgeries, and operations are very few annually.

2.Lung transplant

Another vital organ, healthy lungs are taken from a deceased patient and transplanted into the organ transplant recipient. Due to the lack of donors and the criticality of time of transport, lung transplants also remain rare across the globe. The organ transplant process is highly dependent on finding a highly suitable donor to prevent organ transplant rejection and avoid the immune system attacking the new transplant.

3.Liver transplant

In cases of irreversible liver disease, a patient's unhealthy liver is removed and replaced with either a portion of a liver from a living donor, such as a relative, or with a complete healthy liver from a deceased donor. End-stage liver disease, especially cirrhosis of the liver due to alcohol abuse, is the most common reason for organ transplant surgery for the liver. Other causes may include chronic hepatitis B or chronic hepatitis C, autoimmune hepatitis, metabolic disorders and non-alcoholic fatty liver disease. The organ transplant success rate for liver transplants is relatively high, and 75% of patients are alive after five years of a liver transplant.

4.Pancreas transplant

Kidney and pancreas double transplant is the most common type of organ transplant surgery requiring a pancreas transplant; it is seldom carried out alone. Type 1 diabetes causing kidney failure is the reason for this type of organ transplant surgery, and in most cases, both organs come from a single deceased donor. It is possible, however, that in the kidney-pancreas double transplant, the kidney comes from a living donor, usually a relative, and only the pancreas from a deceased donor. In rare cases of Type 2 diabetes, and organ transplantation involving a kidney as well as the pancreas may be advised.

In type 1 diabetes, the pancreas does not make enough insulin, and the kidney failure is progressive. In order to help a patient survive through this, an organ transplant may be advised, and the transplanted pancreas can produce adequate insulin.

5.Cornea transplant

In cases where corneal tissue is scarred or otherwise irreparably damaged due to disease or injury, a corneal transplant is suggested. The organ transplant statistics for this type of organ transplant surgery shows a high rate of success and this is one of the more commonly performed organ transplantations. Since corneal eye disease is one of the most common reasons for blindness, corneal transplants are becoming more commonly suggested, and the advances in this organ transplant type has been immense from a surgical perspective.

Some reasons making a corneal transplant necessary include scarring from eye infections such as keratitis or herpes, and other eye diseases such as keratoconus where the shape of the cornea is distorted, making an organ transplant the only way to restore complete vision. Hereditary conditions can also cause corneal disease. Organ transplantation involving the cornea may also be suggested in cases where cataract and LASIK surgeries have been unsuccessful and caused further complications..

6.Kidney transplant

Renal disease affects a large part of the population today. Kidneys are an essential part of the human mechanism, helping to filter out toxins from the blood, and ensuring an electrolyte balance that allows the body to function normally. Kidney failure can be contained by either dialysis or kidney transplants. In cases where dialysis is ruled out for the patient due to the severity of the kidney failure or overall health conditions, an organ transplant surgery is suggested. Either one, or both kidneys may be replaced for such patients. A single kidney transplant usually involves a living organ transplant donor and both of them are put on specialised diets and medication to reduce chances of organ transplantation complications such as rejection of the donor organ or blood infections. Patients with cancer, hepatitis or cardiovascular disease are not chosen as candidates for most organ transplant processes, including kidney transplant.

Receiving a kidney from a living relative reduces the chance of rejection of the organ and is suggested as a better choice of organ transplant. This also enables the patient awaiting transfer to bypass the wait of many years to receive the organ transplant.

7.Trachea transplant

One of the least conducted organ transplant surgeries, tracheal transplant is performed when the trachea or the airway hardens or is scarred due to disease or injury. Tracheal transplant helps patients who are unable to have a normal life due to trauma from tracheal dysfunction to have a more normal life. The organ transplant process involves procuring the trachea from a deceased donor and replacing the patient's trachea.

8.Skin transplant

Burn or other skin injuries that are too severe to be repaired by the body's own system can be helped through skin transplants. This type of organ transplantation involves grafting of donor skin onto a patient's body and the use of immunosuppressive drugs to prevent graft rejection. Once the organ transplant surgery is carried out, the patient is kept under medical observation for a length of time. This organ transplant process is usually only carried out in cases of severe injury where a patient's own skin cannot be grafted. Once the donor skin is successfully transplanted, doctor's may also transplant the patient's own skin onto other parts of their body.

More often, however, organ transplantation involving the skin does not require a donor, and healthy skin is grafted from the patient's own body onto the burnt area. The injured skin can be more easily replaced as chances of rejection of the organ transplant is lowered.

4.FINDING A DONOR

Organ donation lists are lengthy and patients awaiting Organ Transplants have to wait for several years before receiving a donor organ. It is more feasible for a living donor to be found in case they are relatives, which enables patients to bypass the organ transplant waiting list and receive a transplant less likely to be rejected. However, organ transplant donation itself is often as easy as filling a card, and any organ donor can donate multiple organs, saving many lives in the process.

Finding a donor is usually done by a doctor in touch with a medical board. Once a thorough evaluation is conducted of a patient, deeming them suitable for organ transplantation, the patient is put on an organ transplant list. This list matches an organ transplant patient with a donor at the earliest available opportunity. The donor is usually deceased and has granted permission for organs to be donated after death.

5.BECOMING A DONOR

Becoming a donor will allow you to help a patient in need of an organ transplant is easy, and worth considering. All people are potential organ donors, regardless of age or health considerations. Most people are able to donate at least some organs such as cornea or skin. Organ transplant lists are long, and becoming a donor can help save many patients once the donor is deceased. Even newborns and senior citizens can register as organ donors. If one is under 18 years of age, they require parental consent to sign up as donors for organ transplant patients.

It is also possible to become a living donor. In cases where the organ transplantation involves a kidney, pancreas, lung or liver, an organ donor can donate either a single kidney or lung or part of the pancreas or liver. The body compensates for the loss through regeneration or reduced activity.

6.PREPARING FOR AN ORGAN TRANSPLANT

Organ transplantation requires financial, psychological, mental as well as physical preparation. Once a patient is on the organ transplant list, it is essential that they cultivate patience and a positive attitude to enable themselves to look forwards towards a time without disease. It is necessary to be upfront with the medical team in charge of the organ transplant regarding psychological conditions, and undergo treatment, if deemed necessary. Once a patient is deemed fit to undergo the organ transplant surgery, attention should be paid to financial conditions that accompany such a situation. The waiting time for a patient awaiting an organ transplant from a deceased donor is often the best time to prepare for the organ transplant surgery. Physical fitness, as much as can be achieved, should be aimed for, and any suggested medication regimen should be rigorously followed.

7.THE ORGAN TRANSPLANT PROCEDURE

 

The organ transplant procedure depends completely upon the organ transplant type, and in simple terms, involves the removal of a healthy organ from a donor, either living or deceased, and transplanting this into a patient with end-stage irreversible organ damage. The organ transplant surgery is preceded and succeeded by the use of drugs to prevent transplant rejection, as well as continuous medical evaluation to determine the feasibility of the transplant.

8.RISKS AND COMPLICATIONS

The major risk from an organ transplant surgery is the risk of rejection of the transplanted organ. The body's immune system automatically rejects what it immediately perceives as foreign tissue, causing several reactions in the body. Wherever possible, doctors performing the organ transplant surgery will try to match the donor's and the recipient's blood and tissue types to reduce the chances of organ transplant rejection after organ transplantation is carried out, and also use immunosuppressant drugs to help the recipient body accept the organ more readily.

Other risks of organ transplant surgery also involve infection resulting from the surgery, heart failure during the organ transplant process, excessive bleeding and drug reaction. However, most of these threats are not manifest in most procedures today due to the diligence of the teams involved in organ transplant surgery, and organ transplant rejection remains the most critical and constant risk.

9.MEDICATIONS REQUIRED AFTER ORGAN TRANSPLANT

Most patients immediately enjoy a better quality of life after an organ transplant, but constant vigilance in terms of lifestyle and medication are strictly necessary and remain a lifelong process for patients who have undergone organ transplantation. Risky behaviours such as smoking, excessive consumption of alcohol, and often any consumption of alcohol, use of recreational drugs, and skipping prescribed medication increase chances of organ transplant failure and morbidity. Medication required after organ transplant is prescribed by the doctor and their team of medical experts and should be followed as a strict regimen. It is also important to schedule regular check-ups with the medical team who have the organ transplant history of the patient.

Immunosuppressant drugs that are prescribed before and after the organ transplant surgery may be subject to change dependent on the patient's reaction, and some drugs do not perform as well over time. This necessitates regular follow ups with the medical team for the patient to aid in near-complete recovery.

10.PRECAUTIONS TO TAKE

While the quality of life is improved for a patient who undergoes a successful organ transplant surgery, they have to continually take several precautions, often requiring a change in lifestyle. In addition to a medication regimen, patients will have to monitor their activity, and depending on their doctor's advice, they may be prescribed higher or lower levels of physical activity. Patients who have undergone organ transplantation will also have to ensure a nutritious diet that allows their body access to all micro and macronutrients on a regular basis. Organ transplant surgery will also see patients having to maintain strict hygienic conditions around their homes and offices, and in many cases, receive professional help from therapists to help with their mental and psychological conditions.

11.ROAD TO RECOVERY AND AFTERCARE

Recovery after any surgery is something that needs to be paid attention to, and despite feeling better overall, the body can undergo many changes resulting from an organ transplant surgery. Therefore, the road to recovery is something that is planned for since before the surgery itself, and must be adhered to by the patient. Most patients who have undergone organ transplant surgery can return to normal life after a span of 2-3 months, and sometimes earlier in case of a skin or corneal transplant. The patient is kept under medical observation for a certain length of time after undergoing the organ transplant process where their condition, response to drugs and vital signs are continuously monitored by the medical team. Once a patient is discharged into the care of family, they are required to follow lifestyle guidance and medication regimens, and come in for regular follow-up medical evaluations.

If all steps are strictly followed, it is possible for patients to live a fulfilling life after an organ transplant.

12.ORGAN TRANSPLANT FAQS: ALL YOUR CONCERNS ADDRESSED

1. Can I become an organ transplant donor?
2. Yes, you can become an organ transplant donor by signing up for donation. If you are below 18 years of age, you will require parental consent to pledge your organs. Signing up to be a donor for organ transplant can help save many lives once you are deceased, and does not hamper your current life in any way.
   If you are legally an adult, you can directly register as an organ transplant donor to consent to the use of your organs for organ transplant process after your death.
3. What are the chances of recovery after an organ transplant surgery?
4. Depending on the type of organ transplantation, overall health and the body's immune system response, the chances of successful organ transplant surgery and subsequent recovery range from the single digits to over 73% percent for a five year period. It is advisable to follow all instructions of the doctor in charge of the organ transplant surgery if you deemed suitable to become an organ recipient to aid chances of recovery.
5. What organs and tissues can be transplanted?
6. Organs and tissues that can be transplanted include:
   • Heart
   • Heart valves
   • Lung
   • Liver
   • Kidney
   • Pancreas
   • Intestine
   • Cornea
   • Skin
   • Bone and bone marrow
   • Middle ear
   • Connective tissue
   • Vascularized composite allografts

1. Does becoming an organ donor mean that I won’t be eligible to receive the best medical care possible?

1. Your decision to donate an organ has no effect on the quality of medical care you can receive.
2. What are the benefits of organ transplantation?
3. Depending on the organ a person receives, the benefits of transplantation can vary. Some of them may include:
   • Living a healthier and longer life
   • No more pain due to a failed or dysfunctional organ
   • Avoiding medical procedures such as dialysis
   • Improved quality of life.
   • Treating congenital disabilities that endanger an individual’s life
   • Needing fewer surgeries or taking fewer medications.

1. What are the signs of organ rejection?

1. Some of the general signs of organ rejection include:
   • Pain at the transplant site
   • Flu-like symptoms
   • Children may feel cranky
   • Feeling unwell
   • Fever
   • Swelling
   • Changes in weight
   • Urinating less often
   • Changes in heart rate

1. What can you expect from organ transplantation?

1. Organ transplant is performed in people who have a serious illness and will die without a new organ. There are other cases as well, where the transplant is done to improve a person’s quality of life, such as restoring the sight with a cornea transplant.
   
   The first step of the transplantation process is to get one’s name on the organ transplant list. To do this, the doctor has to examine the person, diagnose a serious medical condition and conclude that they match all the criteria to receive an organ transplant.
   
   The process of organ transplantation is a complicated one. The donor must be a close match to the recipient and have compatible blood types for the transplantation to work. There are other relevant factors as well depending on the organ involved. For instance, in kidney transplantation, it is necessary for the donors and their recipients to have compatible antibodies and similar body sizes.
   
   Once a person reaches the top of the waiting list, they can receive an organ transplant depending on the availability of the next matched donor. When an organ is available, immediate surgery is arranged and the recipient gets the transplant. After the transplant, the recipient has to stay in the hospital for a few days so that their condition can be monitored. The length of the stay will depend on their overall health and how well the surgery went.
2. What are the types of living-organ donation?
3. The living-organ donation can be of two types – directed donation and nondirected donation.
   
   Directed donation: Directed donation is a common type of organ donation, where the donor directs the organ to a specific recipient for transplant. The donor can be the following –

• A first-degree relative, such as a parent, brother, sister or adult child
• Biologically related relatives, such as uncles, aunts or cousins
• The donor can also be a biologically-unrelated person who has a connection with the transplant candidate, such as a spouse, friend, or a co-worker
• A person who has heard about the transplant candidate’s need and offered to help

Nondirected donation: Here, the donor does not name the recipient. The nondirected donation is also called as good Samaritan or altruistic donation. The organ will be donated to a recipient based on the medical requirement and blood type compatibility. In some cases, the donor may choose not to know the organ recipient, but in other cases, the donor and the recipient can meet if both agree and the transplant centre allows it.

 

1.WHAT IS CONGENITAL HEART DISEASE?

 

Congenital heart disease, or a congenital heart defect, refers to an abnormality that is present in an individual at birth. It can affect the heart’s walls, valves, and blood vessels.

There are different types of congenital heart defects, ranging from simple conditions that don’t cause symptoms to complex ones that cause severe, life-threatening symptoms.

Common conditions of the heart that can co-occur with these include blockage of blood flow from the right ventricle to the aorta or variations in the course of the coronary arteries.

Treatments and follow-up care for congenital heart disease have improved a lot over the past few decades so that nearly all children with heart defects survive into adulthood. Some need continuous care throughout their lives.

However, many live active and productive lives despite their condition.

2.TYPES OF CONGENITAL HEART DISEASE

The main types of congenital heart disease which consist mostly of structural issues are as follows:

1. Heart Valve Defects

In heart valve defects, the valves in the heart that direct blood flow closes up or leak. This, in turn, interferes with the heart’s ability to pump blood correctly.

2. Heart Wall Defects

Here, the walls between the upper and lower chambers and left and right sides of the heart do not develop correctly, causing blood to flow back into the heart or to build up in inappropriate places. Under such conditions, the heart is forced to work harder, which, in turn, may result in high blood pressure.

 

 

3. Heart Blood Vessel Defects

In heart blood vessel defects, the blood vessels that carry blood to the heart and back to the body do not function as they should. This can cause blood flow to reduce, or even block blood flow, leading to numerous complications.

4. Heart Muscle Defects

In heart muscle defects, the heart does not pump blood as efficiently as it should. This can result in heart failure.

3.CYANOTIC AND ACYANOTIC CONGENITAL HEART DISEASE

Congenital heart disease can be either cyanotic or acyanotic, these are the conditions that exhibit in these types of defects.

Cyanotic Defects

Defects that lower the amount of oxygen in the body are called cyanotic. In cyanotic congenital heart disease, oxygen-rich blood and oxygen-poor blood mix together. This causes less oxygen-rich blood to reach the tissues of the body which, in turn, results in the development of a bluish tint - cyanosis - to the skin, lips, and nail beds.

Acyanotic Defects

Defects that don't affect the amount of oxygen in the body are called acyanotic. In acyanotic congenital heart disease, the bluish tint of the skin isn't common in babies, although it may occur.

4.CAUSES OF CONGENITAL HEART DEFECTS

Where congenital heart diseases are concerned, early developmental problems in the heart’s structure is seen as the cause. The defect usually interferes with the normal flow of blood through the heart. This may, in turn, affect breathing.

Although the process of development of the heart is not fully understood yet, the suspected causes of congenital heart defects include the following:

• These defects may run in familial genes.
• Certain medications, taken during pregnancy, leave the child at a higher risk for a heart defect.
• The use of alcohol and/or illegal drugs during pregnancy can increase the child’s risk of having a heart defect.
• Mothers who, during the first trimester of pregnancy, suffered from viral infection have a higher probability of giving birth to a child with a heart defect.
• Increased blood sugar levels, such as what is seen in diabetes, may affect childhood development.

5.CONGENITAL HEART DEFECTS IN CHILDREN

 

A child who has a congenital heart defect is one who was born with a problem in the structure of his or her heart. Some of these defects are simple and require no treatment. Others may call for multiple surgeries over the course of years before they are corrected. The more serious defects become evident during the first few months of the child’s life or even soon after birth, in some cases.

Signs and symptoms of congenital heart defects in children could include pale grey or blue skin color (cyanosis), swelling in the legs, abdomen or areas around the eyes, rapid breathing, and shortness of breath during feedings leading to poor weight gain.

Some congenital heart defects which are less cause for concern may not get diagnosed until late childhood as the child may not have any evident signs of a problem. If signs and symptoms present themselves in older children, they may include:

• Shortness of breath during physical activity
• Easily tired during physical activity
• Fainting during physical activity
• Swelling in the hands, ankles or feet

6.PRECAUTIONS TO TAKE DURING PREGNANCY

To lower the risk of congenital defects in children, women who are pregnant or plan on becoming pregnant can take the following precautions:

• Inform your doctor about any medications you may be taking.
• In case you are a diabetic, ensure your blood sugar levels are under control before becoming pregnant.
• In case of a lack of vaccination against rubella, avoid exposure to it and consult your doctor regarding options for prevention.
• In case of a family history of congenital heart defects, consider genetic screening.
• Ensure you are vaccinated against rubella and flu.
• Take 400 micrograms of folic acid supplement a day during the first trimester (first 12 weeks) of your pregnancy.
• Avoid contact with people who have an infection.
• Avoid exposure to organic solvents. Eg. those in dry cleaning, paint thinners and nail polish remover
• Work with your doctor to manage diabetes, if present, while pregnant.
• Avoid drinking alcohol and using illegal drugs during pregnancy.

7.CONGENITAL HEART DEFECTS IN ADULTS

Based on the nature of the defect, diagnosis may happen soon after birth, during childhood, or in adulthood. Some defects may not become apparent until adulthood. In such cases, the symptoms of a newly discovered congenital heart defect may include shortness of breath, chest pain, a reduced ability to exercise and becoming easily fatigued.

There could also be cases where defects treated in childhood can occur again in adulthood. This can happen because the repair may be ineffective or the defect has outgrown over time. Another problem that may arise is scar tissue, such as in heart arrhythmias.

The treatment for congenital heart disease in adults varies depending on its severity. Some patients may only need constant monitoring, while others may require surgeries and medications.

The quality of life (QOL) of individuals living with Adult Congenital Heart Disease (ACHD) has been a subject of much interest to researchers. While earlier studies showed that those with this disease suffered a low QOL, recent studies, most encouragingly, show the opposite.

Women with ACHD also need not worry as, today, there exist many birth control options for those suffering from ACHD. Or, if pregnant, a successful delivery can be guaranteed through careful planning and management. However, it is important to remember that there are higher risks for the mother and foetus in case of ACHD and, in some cases, abstaining from getting pregnant is advised.

8.SYMPTOMS TO LOOK OUT FOR

A wide range of symptoms is possible in case of Congenital Heart Disease, depending on the type of defect involved. An ultrasound during pregnancy is often how congenital heart defects are detected. An abnormal heartbeat picked up during an ultrasound, for instance, may become the reason for further investigation. These may include an MRI scan, a chest X-ray, or an echocardiogram.

In other cases, the symptoms of Congenital Heart Disease may not appear until after birth. Newborns having a congenital heart defect may show the following symptoms:

• Bluish fingers, toes, lips, and skin.
• Chest pain
• Delayed growth
• Breathlessness
• Difficulty feeding
• Low birth weight

In still others, the symptoms may not appear until many years into childhood. Once they do develop, they may include:

• Trouble breathing
• Fainting
• Abnormal heart rhythms
• Dizziness
• Fatigue
• Swelling

However, the general signs of congenital heart disease normally include:

• A blue tinge to the skin (cyanosis)
• Rapid breathing
• Rapid heartbeat
• Swelling in the legs, tummy and around the eyes
• Shortness of breath in babies during feeding (making it hard for them to gain weight) and in older children and adults during exercise
• Extreme tiredness and fatigue
• Fainting during exercise
• Swelling in the hands, ankles or feet

 

 

 

 

9.DIAGNOSIS

 

Diagnosis may take place prior to, soon after, or much after birth.

An abnormal heartbeat - a heart murmur or an unusual sound, for instance - is often how congenital heart defects are diagnosed as this leads to further tests, such as:

• Echocardiogram

An echocardiogram is a type of ultrasound that clicks images of one’s heart. It uses sound waves to make a moving picture of the heart and heart valves. This test may show a transposition of the great arteries or TGA. Different types of echocardiograms are available. Ensure the one most well-suited to your needs is chosen.

• Cardiac Catheterization

Cardiac catheterization allows a cardiologist to obtain direct information about the blood pressures and patterns of blood flow within your heart. A doctor inserts and guides an extremely thin tube or catheter through a blood vessel to your heart. They insert the dye into the catheter and use X-ray videos to view the inside of one’s heart.

• Chest X-Ray

Chest X-rays are capable of revealing signs of heart failure. They give your cardiologist information about the size and shape of your lungs and the heart. The amount of radiation here is extremely small and doesn't cause any long-term side effects.

• Electrocardiogram (ECG or EKG)

An ECG or EKG measures the heart’s electrical activity. It also shows abnormal rhythms (arrhythmias or dysrhythmias) and spots heart muscle stress. It receives tiny electrical impulses that the beating heart makes and records them on a moving strip of paper.

10.TREATMENT

 

Depending on the severity and type of congenital heart defect involved, its treatment varies. Some babies may have mild heart attacks that get cured by themselves over time. Other children may have a more severe manifestation of defects that call for extensive treatment. In such cases, your options include:

• Medications

Numerous medications can help the heart function more efficiently. Some may also be used to prevent the formation of blood clots and to control an irregular heartbeat.

• Implantable Heart Devices

Certain devices such as pacemakers that help regulate an abnormal heart rate and implantable cardioverter defibrillators (ICDs) that can correct irregular heartbeats, can prevent some of the complications associated with congenital heart defects.

• Catheter Procedures

These permit doctors to fix or repair congenital heart defects without opening the chest and heart surgically. Here, the doctor inserts a catheter through a vein in the leg and guide it up to the heart. Using small tools threaded through the catheter, s/he then proceeds to correct the defect. With advancement of technology most of heart defects can be closed in the Cathlab with catheter procedures. It decreases risks & complications of cardiac surgery.

• Open-Heart Surgery

These may be required if catheter procedures are unable to repair a defect. These can close holes in the heart, widen blood vessels, or repair heart valves.

• Heart Transplant

In cases where a congenital heart defect is too complex to be repaired, a heart transplant may be resorted to. During this procedure, a donor’s healthy heart replaces the patient’s heart.

 

CONGENITAL HEART DEFECTS FAQS: ALL YOUR CONCERNS ADDRESSED

1. What does a congenital heart disease mean?
2. Congenital heart disease, also known as a congenital heart defect, is an abnormality within the heart’s structure and a person is usually born with it. This is a common birth defect that changes the way blood flows through the heart. Many types of CHD take place in newborn infants. Some of them include ventricular septal defect, atrial septal defect, Tetralogy of Fallot, coarctation of the aorta, and pulmonary (valvular) stenosis. Most of the pediatric doctors practice cardiology to diagnose and treat CHD.
3. Is there a cure for CHD?
4. Congenital Heart Disease (CHD) has no cure. Patients have had surgeries to repair their hearts, but they are not completely cured. There may be long term side effects after heart surgery, one of the major ones being abnormal heartbeats. Its recommended that you visit a cardiologist as they can detect your heart problems before you notice any symptoms.
5. Is congenital heart disease genetic?
6. The defect can be genetic. When the heart, or blood vessels near the heart, do not develop fully before birth that’s when the heart defect takes place. Some congenital heart defects take place as a result of drug or alcohol consumption during pregnancy.
7. Can you prevent congenital heart disease?
8. The prevention measures should be taken before birth. So, during pregnancy, the mother should avoid drinking alcohol or taking any medication without consulting their doctor. You will have to take 400 micrograms of folic acid supplements during the first trimester of the pregnancy. By taking your supplements you are reducing the risk of birthing a child with congenital heart disease, along with other birth defect types.
9. What foods to avoid if you have congenital heart disease?
10. Here are some of the major adjustments you can make to your daily diet if you have congenital heart disease:
    • Eat loads of fruits and vegetables, also keep your sodium intake low
    • Opt for lean meats, fish, organic foods, poultry, dairy, and complex carbohydrates.
    • Avoid using salt, and if you want to add flavor then you can go for sodium-free herbs
    • If you find it hard to cut out sodium completely, then you can reduce it to a significant amount. Get creative and cook in onion, garlic, and citric juices as they will add a load of flavor to your dishes
    • Be vary of condiments like ketchup, mayonnaise, and mustard. Always check the ingredient list before purchasing these products
    • Avoid eating junk food

1. What are the early signs of congestive heart failure?

1. Here are the early signs of congestive heart failure-
   • Shortness of breath when you lie down or exert yourself
   • Weakness and lethargy
   • Swollen ankles, legs, and feet
   • Irregular heartbeat
   • The inability to exercise
   • Persistent cough and wheezing, with blood-tinged phlegm
   • Frequent urinating at night
   • Rapid weight due to fluid retention
   • Nausea and no appetite
   • Difficulty focusing
   • Chest pain
2. You have to see a doctor immediately if you are experiencing the following:
   • Chest pain
   • Severe weakness
   • Irregular heartbeat with fainting and chest pain
   • Coughing up pink and foamy mucus

1. When should you suspect that your child could have heart disease?

1. When the child displays rapid and distressed breathing, blue discoloration of the nails, lips or tongue, feeding difficulty including not sucking well and breathlessness, recurring cough with fever and/or chest infection. When the child is showing inadequate weight gain, and her physical milestones are not in keeping with her age.
2. What is the health impact of congenital heart defects?
3. CHDs are the most common cause of death among infants with birth defects. Approximately 25% of children born with a CHD will need heart surgery or other interventions to survive. Having said that, today, over 85% of babies born with a CHD now live to at least age 18. People with CHDs face a life-long risk of health problems such as issues with growth and eating, developmental delays, difficulty with exercise, heart rhythm problems, heart failure, sudden cardiac arrest or stroke.
4. As an adult having a congenital heart defect, do I need to do regular follow-ups with my doctor?
5. Adults who have hadheart surgery as a child must visit a doctor regularly for life. If you experience your heart racing, extra heartbeats, trouble keeping up with usual exercise routines or feel easily exhausted, you would do well to consult a specialist.
6. What is congenital heart disease?
7. It is heart disease which is present since birth. It may be diagnosed later in life.
8. Can congenital heart disease be cured?
9. Yes, many congenital heart diseases can be cured. Diseases like Atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA) can be cured by surgical or device closure. Even cyanotic heart diseases like tetralogy of fallot can be treated surgically.
10. How serious is congenital heart disease?
11. Congenital disease has a wide spectrum and the outcome varies. Some of them are very severe, and the baby may die inside the mother’s womb. Some require immediate intervention immediately after birth. If prompt action is not taken, they succumb. Some like Atrial septal defect (ASD), ventricular septal defect (VSD), patent ductus arteriosus (PDA) have very good outcome if timely intervened either by surgical closure or device closure.
12. Can we have normal life with congenital heart disease?
13. Yes, patients with diseases like ASD, VSD, PDA can have normal life after their closure. Some patients with diseases like patent foramen ovale (PFO), very small ASD, mitral valve prolapse can have normal life, the disease may not be diagnosed till late age and may not require any treatment.But some diseases cannot be cured completely and require regular medical surveillance. Compliance with medicine, life style modification as advised and regular follow up is very important.
14. What are the signs and symptoms of congenital heart disease?
15. Signs and symptoms of congenital heart disease vary. Patients may have recurrent chest infections (pneumonia), fatigue, growth retardation, breathing difficulty, palpitations. Child with cyanotic congenital heart disease is blue. Physical features of specific syndromes like Down syndrome, Turner syndrome, etc may be a clue to underlying congenital heart disease
16. What are the causes and risk factors for congenital heart disease?
17. Congenital heart disease may be due to maternal diabetes, maternal rubella infection, chronic maternal alcohol use, ingestion of certain drugs by mother during pregnancy (like thalidomide, isotretinoin, valproate, etc).Congenital heart disease may have a genetic basis. Some of them are associated with specific syndromes like Down syndrome, Turner syndrome, etc.
18. Do congenital heart defects run in families?
19. Some of the congenital heart diseases may be familial. Family studies indicate a 2-fold to 10-fold increase in the incidence of CHD in siblings of affected patients or in the offspring of an affected parent.
20. Is there a diet to ward off the risk of congenital heart diseases?
21. Living with congenital heart disease is not an easy task that you can google and finish. In case you have a family history of congenital heart disease, then it's for your betterment to follow these dietary restrictions.
    1. Eat vegetables and fruits
    2. Drink non-fat or low-fat milk
    3. Encourage eating home-made food
    4. Deplete the intake of sugar-sweetened beverages
    5. Eat whole-grain
    6. Avoid eating refined-grain bread and cereals
    7. Reduce the intake of salt or sodium
    8. Can yoga help in precluding congenital heart disease causes?
22. The 21st century is an era with no age factors that determine heart diseases. People in their 20s are facing the agonies of different types of congenital heart diseases. Yes, there is an option for precluding congenital heart disease causes, and that is Yoga. Below we've outlined eight Yoga poses for a healthy heart.
    7. Tree pose (Vrikshasana)
    8. Mountain pose (Tadasana)
    9. Chair pose (Utkatasana)
    10. Extended hands and feet pose (Utthita Hastapadasana)
    11. Triangle pose (Trikonasana)
    12. Warrior pose (Veerabhadrasana)
    13. Cat pose (Marjariasana)
    14. Downward facing dog pose (Adho Mukho Svanasana)
    15. Can cyanotic congenital heart disease patients meditate?
23. The medical treatment is not potent enough to abolish cyanotic congenital heart disease. Along with medications, patients should follow a strict diet plan, practice yoga, and meditate for complete disease remission. By meditating for 30 minutes, you can maintain heart health in the following ways.
    15. Keep your blood pressure under check
    16. Deplete your bad cholesterol levels
    17. Improve blood circulation
    18. Boost immunity
    19. Increase lung capacity

1.WHAT IS THE KIDNEY?

Kidneys are small bean-shaped organs which are located behind the belly and under the ribs. There are two kidneys and each one is located on either side of the spine. The size of each kidney varies from 4 to 5 inches which are roughly the size of a fist.

2.WHAT FUNCTION DOES THE KIDNEY PERFORM?

 

The kidneys consist of many small filters called nephrons and its purpose is to purify the blood by extracting waste out of the blood and the waste is converted into urine. This urine is accumulated in the kidney's pelvis and then passed through a tube called the ureter and the bladder. This helps in balancing body fluids and levels of electrolytes in the body. This process continues several times a day. Kidneys are vital organs which help in maintaining healthy salt, pH, phosphorus and potassium levels in the body. They also generate enzymes called renin which adjusts blood pressure levels. It monitors the production of red blood cells by making a chemical called erythropoietin and helps in absorbing calcium for healthy bones and teeth.

Once the kidney is damaged the filtering of blood is halted which leads to piling up of fluids and waste in the body and this shows out symptoms such as poor sleep, nausea, shortness of breath, weakness and swelling in the ankles. Kidney needs to be treated to prevent further damage, if ignored it can lead to serious health issues and even death.

3.TYPES OF KIDNEY DISEASES AND PROBLEMS

Chronic Kidney Disease- This is the most common type of kidney disease. When the kidneys stop functioning for a longer period like 3 months or more it is called chronic kidney disease. This is generally caused due to high blood pressure in the body. Maintaining blood pressure levels in the body is very important as increased blood pressure damages glomeruli in the kidneys which leads to kidney failure. The tiny blood vessels that clean blood in the kidneys are called glomeruli. Chronic kidney disease can also be caused due to diabetes. High sugar levels cause severe damage to blood vessels in the kidneys. Once the condition is diagnosed the patient is advised to undergo dialysis. Dialysis is a process that helps in extracting extra waste and fluids from the blood. This process can help kidneys to perform better but it cannot cure the disease.

Kidney Stones - Kidney stones are formed due to crystallisation of minerals and other substances absorbed from the blood. These kidney stones are discarded from kidneys through urination when they are small and tiny. However, the condition worsens and becomes difficult to pass through urine when the stones grow big. This causes severe pain and needs medical attention to cure the condition. This disease is curable and does not cause major health hazards.

Glomerulonephritis - This is a condition caused due to swelling of tiny blood vessels in the kidneys called glomeruli. Glomeruli filter blood that passes through the kidneys. Glomerulonephritis is caused due to allergies from drugs, infections or a disorder which occurs shortly after birth. Glomerulonephritis does not need any treatment and heals on its own.

Polycystic kidney disease - Growth of many small cysts filled with fluids in the kidney are called polycystic kidney disease. This is usually a genetic disorder passed on from ancestors. The kidney function is interrupted by these cysts leading to kidney failure. This is a serious issue and needs medical attention. Individual cysts are also formed in kidneys but these are very common and non-hazardous when compared to polycystic.

Urinary tract infections - An infection caused in the urinary system is called Urinary tract infections also known as UTIs. Most often urinary infection begins in the bladder and urethra. This infection is very common and can be cured easily, however, if left untreated it can cause serious health issues and kidney failure.

4.SIGNS AND SYMPTOMS OF KIDNEY DISEASE

Kidney diseases show no symptoms in the beginning stages and they only become evident in the final stages. Some of the most common symptoms of kidney diseases are-

• Pressure and pain in the chest.
• Poor sleep
• Difficulty in breathing
• Dry and scaly skin
• Frequent urination at night
• Swelling around the eyes
• Loss of appetite
• Swollen ankles and feet
• Muscle cramping
• Insufficient sleep
• Tiredness
• Poor Concentration

Once the condition gets severe other symptoms develop such as-

• Changes in urine output
• Decreased sex drive
• Hike in potassium levels, this condition is called hyperkalemia
• Anaemia
• Fluid retention
• Vomiting and nausea
• Swelling in the fluid sac that covers the heart called pericardium.

5.RISK FACTORS FOR KIDNEY DISEASE

 

Diabetes - The increased sugar level in the body damages blood vessels and filters in the kidneys that purifies the blood. This leads to the retention of more blood and water in the body and accumulates more wastes. This causes nerve damage and blocks urine from passing out which leads to kidney failure.

High Blood Pressure - Increased blood pressure causes severe damage to blood vessels in the entire body. Increased blood flow weakens and scars the blood vessels in the kidneys and stops it from discarding waste from the blood. The accumulation of extra fluids, in turn, raises blood pressure level causing severe damage to kidneys. High blood pressure can be treated through medicines and by bringing lifestyle changes like diet, exercise and stress levels.

Lupus - It is a condition that allows the immune system to attack a few parts of the body including the kidneys. The condition affecting the kidneys are called lupus nephritis. This causes severe damage to blood vessels in the kidneys by scarring and swelling of blood vessels. This can be cured through medications to correct the immune system and blood pressure levels.

Anorexia Nervosa - This condition is found in people who are anaemic and those who weigh 15% less than their ideal body weight. This is caused due to lack of salt and water in the body which leads to severe damage and kidney failure.

Multiple Myeloma - In multiple myeloma, excessive production of white blood cells in bone marrow overshadows healthy blood cells. These cancer cells produce abnormal proteins that affect the kidneys and cause kidney failure.

Hemolytic Uremic Syndrome - This condition is caused due to piling of red blood cells in the kidney's filtering system that leads to kidney failure. The most common symptom of Hemolytic Uremic Syndrome is continuous diarrhoea for 4 to 5 days. Seek medical help if you are feeling tired and unable to pass urine with continuous diarrhoea for several days. This condition can be cured with medication if diagnosed earlier.

ANCA Vasculitis - This kidney problem is caused when small blood vessels of kidneys and other organs are attacked by the body's antibodies which fight germs. This allows the blood and proteins to mix up with urine and leads to kidney failure. The condition can be identified with certain symptoms such as joint and muscle pain, high fever, body aches, brown or tea-coloured urine.

Urine Blockage - When you face difficulty in passing urine this could be mean the urine is blocked. Blocking of urine can cause several kidney disorders by increasing pressure and infection in the kidneys. This condition could also occur due to another underlying disease such as kidney stones, prostate cancer, colon cancer, bladder cancer, blood clots in the urinary tract, etc. It needs medical attention and can be cured with medication if diagnosed earlier in certain conditions.

Blood Clots - Blood clots in the kidney caused due to blood disorder called thrombotic thrombocytopenic purpura can lead to severe kidney damage. It is a condition in which the heart and brain are affected too. It can lead to serious health issues if it is not treated at the earliest. Some of the usual symptoms of this disease is bleeding from nose and gums, fever, tiredness, nausea, severe headache, chest pain, bruising and diarrhoea.

Scleroderma - This kind of disease affects the blood vessels and connective tissues and are rarely found. It hardens and tightens the blood vessels and connective tissues which affects the kidneys by leaking proteins into the urine. This increases blood pressure levels and leads to rapid kidney failure.

Polycystic Kidney Disease - The presence of several small lumps filled with fluid in the kidney is called polycystic kidney disease. This is a condition acquired genetically that leads to swelling in kidneys. If not treated at the earliest it could lead to severe kidney damage and will eventually lead to kidney failure.

6.HOW TO KEEP YOUR KIDNEYS HEALTHY

A healthy kidney can be maintained by leading a healthy lifestyle. Following a healthy diet and leading a stress-free life can improve the functionality of kidneys. Here are a few tips to keep your kidneys healthy-

• Avoid food which increases cholesterol levels
• Keep blood sugar levels under control and take proper medication to control them if affected by diabetes.
• Reduce the intake of salt.
• Eat a balanced diet that includes the intake of fresh fruits and vegetables, low- dairy products and whole grains.
• Quit smoking
• Exercise regularly
• Do not overdrink. Keep alcohol consumption under control.
• Reduce weight if you are suffering from obesity.

7.DIAGNOSIS OF KIDNEY DISEASE: ESSENTIAL TESTS

As soon as you see the signs and symptoms of kidney problems you need to consult a doctor. The doctor will put you through a series of tests to diagnose the problem further. Here are a few important procedures followed to diagnose kidney disease.

Glomerular filtration rate (GFR) - This is a test done to monitor the filtration rate of the kidney and its functions to determine the stage of the disease.

Urine analysis - The urine sample is observed under a microscope to look for bacterial infections, bleeding and other signs of kidney problems.

Kidney Ultrasound - Ultrasound of kidneys give out clear images of the kidneys with the help of a probe which is placed on the skin to create images of the kidney with the help of sound waves. These images show damage in kidneys such as blockage of urine, the appearance of stones and cysts.

Computed tomography (CT) scan - A CT scan helps to take sectional pictures of the organs through X-ray which gives out clear details of the problem in kidneys.

Kidney biopsy - A small piece of the tissue is extracted from the diseased kidney in this procedure. The sample obtained is further studied under a microscope to conclude the severity of the issue. This procedure is followed after you are sedated with local anaesthesia.

Magnetic resonance imaging (MRI) scan - High-resolution images of the kidney is captured through a scanner which emits radio waves in a magnetic field. This helps the doctor to diagnose the problem with great clarity.

Blood creatinine test -A blood analysis is done to check the level of creatinine in the blood. Creatine are waste products of molecules present in the muscles called creatine. The increased level of creatinine in the blood helps in diagnosing the severity of the issue.

8.TREATMENT OF KIDNEY DISEASE

 

Most often kidney diseases are caused due to another underlying issue such as diabetes, cholesterol or high blood pressure levels. Kidney diseases are easy to cure when diagnosed earlier and the survival rate is high. Doctors provide treatments depending on the severity of the disease. This means not all kidney disease patients will undergo the same treatment. Some of the effective treatment methods for kidney problems are -

Antibiotics - Depending on the results of your blood and urine test your doctor will prescribe antibiotics to fight against bacteria. This is called antibiotic therapy.

Nephrostomy -It is a procedure followed to drain out the urine blocked in the kidneys and further relevant treatment is provided to clear the blockage. This procedure is done by passing a catheter through the skin to reach the kidneys.

Lithotripsy - This procedure is done by a machine to project ultrasound shock waves that pass through the body to break large kidney stones into small pieces. These small pieces can easily pass through urine later.

Nephrectomy - This is a surgery performed in patients suffering from kidney cancer and other severe kidney problems. The damaged kidney is removed completely during this surgery.

Dialysis - It is a method followed to purify the blood with the help of machines. This procedure is done when the kidneys are close to failing or damaged completely. It is a repetitive process which should be done once in a few days or weeks. This is process is done until you find a donor. There are two types of dialysis-

• Hemodialysis - In this type, the impure blood from your body is pumped into a machine that helps in extracting all the impurities and passes the pureblood back to the body. This procedure can be done at home or in a hospital according to your convenience. The procedure is repeated thrice a week. Some common side effects of this dialysis are muscle cramping,low blood pressure and itching.
• Peritoneal dialysis - This procedure is conducted by passing a large amount of fluid called dialysate into the abdomen through a catheter. Waste products are passed from the kidneys through the peritoneum (a membrane that covers the abdominal wall ) to reach the fluid in the abdomen. Once the fluid collects all the waste products it is later extracted out of the abdomen and discarded.

Kidney transplant - It is a procedure done when both kidneys fail. Transplantation of a kidney can bring back life to normal. This is done by obtaining a healthy kidney from a living or a deceased organ donor.

9.UNDERSTANDING KIDNEY FAILURE

Kidney failure is a condition occurs when the kidneys lose their capabilities to filter impurities from the blood. This is often caused due to an underlying reason like -

• Exposure to toxic chemicals and medications
• Severe dehydration
• Acute and chronic diseases like diabetes, high blood pressure,cancer, etc
• Kidney trauma

Kidney failure is classified into five types, which are-

Acute intrinsic kidney failure - A condition that damage the kidneys directly through trauma such as an injury or an accident is called acute intrinsic kidney failure. This trauma raises the level of toxins and ischemia in kidneys and reduces the flow of oxygen in them leading to kidney damage.

Acute prerenal kidney failure - Acute prerenal kidney failure occurs when the kidneys are not supplied with sufficient blood flow. Kidneys require adequate blood flow to remove toxins from the blood. Blood flow can be obstructed due to several other underlying diseases which will show up during diagnosis.

Chronic prerenal kidney failure - When the kidneys do not receive blood supply for a long time they begin to shrink and stops functioning further. This condition is called Chronic prerenal kidney failure.

Chronic intrinsic kidney failure - This condition occurs when kidneys are being affected for a longer period due to intrinsic kidney disease. This leads to a lack of oxygen and severe bleeding in kidneys.

Chronic post-renal kidney failure - When urine is blocked for a long term in kidneys it raises pressure levels in kidneys to cause kidney failure.

10.STAGES AND PROGNOSIS

There are five stages of kidney failure. The symptoms and severity of the disease get complicated at the later stages.

Stage 1 - At this stage, the condition is not severe and symptoms are not visible. Recovery from damage is very easy by bringing healthy lifestyle changes into practice.

Stage 2 - The condition is still mild with very little or no symptoms shown. This condition is mostly diagnosed during a urine test where an increase of protein level is identified in urine. The disease is curable by bringing healthy lifestyle changes and by consulting a doctor for medications.

Stage 3 - At this stage, 50% of the kidney is damaged and evident symptoms can be seen. This condition can be treated by medication to stop further damage and you will be advised to bring in some healthy lifestyle changes.

Stage 4- At this stage kidney failure is severe but hasn't stopped working completely. This condition needs immediate medical attention and treatments to slow down the damage. The condition is difficult to reverse at this stage.

Stage 5 - Kidney are close to complete failure or they stop working entirely. The survival rate at this stage is very difficult unless there is a kidney transplant. Patients at this stage undergo dialysis regularly to survive.

11.KIDNEY HEALTH FAQS: ALL YOUR CONCERNS ADDRESSED

1. How long can I live with chronic kidney disease (CKD)?
2. Living with CKD depends on your age, other health problems, and how involved you become in your care. Most people with early CKD will never have kidney failure. Others will reach kidney failure and may live for decades with dialysis or kidney transplants. The survival rate for kidney diseases depends on treatment methods and healthy lifestyle habits.

 

 

1. How does diet affect kidney function?
2. One way to preserve your kidney function is to modify your diet. Propernutrition can reduce the workload of the kidneys and preserve or delay further progression of your kidney disease. A renal dietitian can help you make good choices with the foods you normally eat and make suggestions on foods to add and foods to moderate in your diet. The dietitian is an important part of your healthcare team and can assist you in living well with chronic kidney disease.
3. Can I still have a good life if I need dialysis?
4. Yes, you can live long and live well with dialysis. It is often observed that people who are very sick before they start dialysis feel much better a few weeks or months later. Feel free to consult a doctor to clear all your doubts on kidney dialysis.
5. What are the first signs of Kidney Diseases?
6. Few early signs that you might have kidney disease:
   • Fatigue
   • Poor appetite
   • Chills (Even if the weather is warm)
   • Shortness of breath
   • Dry and itchy skin
   • Trouble thinking clearly or concentrating
   • Swelling of ankles, legs and hands
   • Ammonia breath
   • Urge to urinate more often
   • Bloody or foamy urine
   • Persistent puffiness of eyes
   • Muscle twitching or cramping

1. What Causes Chronic Kidney Disease?

1. CKD typically develops over a long period of time. It often develops due to underlying health conditions that can affect the kidneys. Causes of CKD include:
   Diabetes: When the blood sugar is too high for a long time, it causes damage to many body organs, including the kidneys, heart, the blood vessels, nerves and eyes.
   2. High blood pressure: High BP or Hypertension, if poorly controlled for long, it can be a leading case to strokes,heart attacks and chronic kidney disease.
   3. Glomerulonephritis: It is a group of diseases that cause inflammation and damage to the kidney's filtering units.
   4. Polycystic kidney disease: It is a genetic condition which causes large cysts to form in the kidney and damage the surrounding tissue.
2. Does Chronic Kidney Disease (CKD) always lead to kidney failure?
3. Chronic kidney disease is a condition that damages your kidneys and their ability to perform the kidney functions decline. If not treated properly, the amount of wastes can build in high levels in your blood and make you feel sick. When CKD progresses, if not treated medically, it may eventually lead to kidney failure, which requires dialysis or a kidney transplant to maintain life. Also, it increases the risk of having heart and blood vessel disease.
4. What are the 5 stages of chronic kidney disease (CKD)?
5. Estimated Glomerular Filtration Rate or eGFR is a number based on your blood test for creatinine, a waste product in your blood. It indicates how well your kidneys are working. The stages of kidney disease are based on the eGFR number.
   Stage 1 CKD: eGFR 90 or greater, which means your kidneys are healthy and working well
   Stage 2 CKD: eGFR Between 60 and 89 indicates you have mild kidney damage
   Stage 3 CKD: eGFR Between 30 and 59 means that there is some damage to your kidneys and they are not working as well as they should.
   Stage 4 CKD: eGFR Between 15 and 29 which means your kidneys are moderately or severely damaged. This stage should be taken very seriously.
   Stage 5 CKD: eGFR Less than 15 means the kidneys are getting very close to failure or have completely failed.
6. What should I do to maintain a good GFR?
7. GFR is an equation that uses your age, race, gender and the creatinine level in your blood to see how well your kidneys are working. If your eGFR is less than 60, talk to your doctor soon! At this stage, proper medication and few healthy tips for a better lifestyle can help you win the battle of Kidney Disease. You can take the following steps to keep your kidneys as healthy as possible:
   • Maintain a healthy blood pressure
   • Control your blood sugar level if you are diabetic
   • Improve your heart and lung health
   • Follow a low-fat, low-salt diet
   • Do 30 minutes of exercise (at least 5 days a week)
   • Keep a healthy weight
   • Do not smoke or use tobacco
   • Talk to your doctor about medicines that might help protect your kidneys

1.WHAT IS A KIDNEY TRANSPLANT?

A kidney transplant is a surgery done to replace a diseased or dysfunctional kidney in a person with a healthy kidney from a living or deceased donor.When a kidney is used from a deceased donor, the procedure is called a cadaveric renal transplant. The kidneys perform the task of waste removal from your body. They filter waste from your blood and expel it from the body through urine. Kidneys also play an important role in the maintenance of the body’s electrolyte and fluid balance. When the kidneys do not do their job, toxic waste builds up in the body and can make you really ill.

Humans have two kidneys, one on each side of the upper abdominal region of the body. The right kidney is located slightly lower than the left one so that there is space to accommodate the liver, which is situated immediately above the right kidney. They are each around 5 inches in length and approximately the size of a big fist. In addition to removing wastes and excess fluid from the body, kidneys also control the metabolism of electrolytes in the body, such as calcium, potassium, sodium, and more. It regulates blood pressure by producing hormones that maintain the pressure. Although humans have two kidneys, the body is capable of surviving with only one functioning kidney.

2.WHY IS A KIDNEY TRANSPLANT DONE?

Kidney transplant, also called renal transplant, is performed to treat kidney failure in humans. When kidneys stop functioning,patients are put through the dialysis treatment. It is a process that filters waste from the blood mechanically, and performs the job that the kidneys are unable to.

The other treatment option for kidney failure is an organ transplant. In this procedure, a surgeon takes a donated kidney from a dead or live donor and places it in the body. After this, immune-suppressive medication is given to make sure that their own immune system does not treat the new kidney as a foreign object and attack it.

A kidney transplant may be the only option for people whose kidneys have completely stopped working. This is called end-stage renal disease (ESRD). If you have ESRD, you will need dialysis to survive, and a kidney transplant can remove your dependency on a dialysis machine for the rest of your life. Only one healthy kidney is required to replace two failed ones. This makes it possible for a living person to donate one of their kidneys to a patient with ESRD.

3.DISEASES AND CONDITIONS THAT MAY REQUIRE KIDNEY TRANSPLANTATION

Kidney transplants are required for people who have kidney failure - that is, the kidneys have lost 90% of their ability to function. Various diseases and conditions can cause kidney failure. In India, nearly 60% chronic kidney disease and ESRD cases are attributed to complications from lifestyle diseases like diabetes and hypertension. The major reasons for kidney failure are:

• Type 2 diabetes:Also known as Diabetes mellitus, this is a disease where the body is unable to metabolise glucose properly, resulting in high blood sugar levels. Over a span of time, the excess sugar in the blood vessels destroys millions of little blood-filtering units present inside the kidney. This eventually causes the kidneys to fail.
• High blood pressure:Also called hypertension, this condition is the second leading reason for kidney failure. In the course of time, chronic high blood pressure can make the arteries around the kidneys hard, narrow, or weak. The damaged blood vessels are unable to supply enough blood to the tissues of the kidney, depriving it of oxygen and nutrients. This eventually causes kidney failure.
• Glomerulonephritis:The kidneys contain little filters called glomeruli that filter wastes, electrolytes, and excess fluid from your blood. The inflammation of these filters is called glomerulonephritis. It can be caused by conditions such as diabetes, faulty immune responses, bacterial and viral infections, lupus, and vasculitis.
• Polycystic kidney disease:This is a genetic disorder where clumps of fluid-filled sacs called cysts form in the kidneys and affect the kidney’s ability to filter blood.
• Serious defects in the urinary tract:These may be genetic or birth defects, due to which normal kidney function is affected, leading to kidney failure after a while.

4.UNDERSTANDING RISKS ASSOCIATED WITH KIDNEY TRANSPLANTS

A kidney transplant is a serious surgery, and as with any major surgery, there are several risks associated with this procedure. These risks include:

• An adverse reaction to generalanaesthesia
• Formation of blood clots
• Internal bleeding
• Ureter Blockage or leakage
• Infection
• Stroke andheart attack
• Donated kidney being rejected by the body
• Donated kidney also failing

However, despite these risks, kidney transplantation may be the best treatment option for a person with chronic kidney disease or end-stage renal disease. After the procedure, one may have to take anti-rejection medication for the rest of your life. These medicines also come with several risks and side-effects, such as thinning of bones, high cholesterol, hypertension, hair loss or excessive hair growth on the body, weight gain, skin problems like acne, infection, and even increased risk of lymphoma and skin cancer.

5.UNDERSTANDING THE KIDNEY TRANSPLANT PROCEDURE

 

A kidney transplant can be done if a suitable match is found from a live or a cadaveric donor. The kidney transplant procedure is done with the patient under general anaesthesia. The team of surgeons, nurses, and anaesthetists monitors the patient’s blood oxygen level, blood pressure, and heart rate continuously during the procedure. The actual renal transplant procedure is as follows:

• An incision is made in the lower portion of the abdomen on one side and the kidney is placed inside.
• The failed kidneys are not removed unless they cause complications like pain, infections, kidney stones, or hypertension. They are left in place.
• The new kidney’s blood vessels are attached to the blood vessels in the lower portion of the abdomen, right above one of the legs.
• The ureter is a tube that runs from the kidney to the bladder and carries urine from the kidney into the bladder for storage. This ureter from the new kidney is attached to the patient’s bladder.

After the surgery, the patient has to stay in the hospital for some time. They will also need several check-ups as they recover, and may have to take medications like immunosuppressants and antibiotics for the rest of their life.

6.KIDNEY TRANSPLANT CRITERIA AND REQUIREMENTS

A person with ESRD qualifies for a kidney transplant. However, there are some requirements and criteria that a person must meet to qualify:

• They need to be healthy enough to withstand a serious surgery and a lifelong medication routine.
• They also have to be willing to follow the doctor’s instructions and take medicines without fail.
• If they have conditions like cardiovascular disease,liver disease, cancer, infections like hepatitis, tuberculosis, or bone infection, they will not make a good candidate for kidney transplantation. The new kidney will most likely fail after it is transplanted.
• One should also be a non-smoker, and avoid alcohol and drugs if they want the kidney transplant to be successful.

The doctor will assess and evaluate in order to determine if a person will make a good candidate for a successful kidney transplant. People at advanced ages, who have mental illness, and people who are alcoholics or drug addicts will not make good candidates for a transplant.

7.FINDING A DONOR

Finding a kidney transplant donor is the toughest part of the kidney transplantation process. There are two types of donors:

Living donor: Since humans can lead healthy lives with just one kidney, a family member or friend can choose to donate one kidney . Familial donors are a better option as they may be a better match and the body is less likely to reject the new kidney. India’s live kidney transplant program is the second- largest in the world, just after the United States.

Cadaveric donor: The kidney of a healthy person who has died in an accident is transplanted into the patient. In India, not many people choose to register as organ donors in the event of an accidental death. As a result, the number of kidney transplants in India via cadaveric donations is quite low. To help with this, the government amended the law in 2011 and introduced a ‘required request’, making it mandatory for intensive care doctors to request the family members to donate the deceased person’s organs in case of a brain death.

Finding a Match: Finding a donor means finding someone whose kidney will be a good match for the patient’s body. This means the donor will have to be tested for matching blood type. Incompatible blood type donations are possible, but the patients need additional medical treatment before and after the transplant. Also, the likelihood of the new kidney being rejected by the patient’s body is much higher in such cases.

Once a donor is found who matches the blood type, they will be tested for tissue typing. This means they will be tested for HLA (Human Leukocyte Antigen) typing. This test matches genetic markers that will increase the possibility that the transplanted kidney will function efficiently in the patient’s body. A good tissue type match means that the body will not reject the new kidney.

The final step in the donor matching process is a ‘crossmatch’. In this process, a tiny bit of the patient’s blood is mixed with the donor’s blood sample in a lab. The lab technician checks for antibodies reaction against antigens present in the donor’s blood. If they don’t react, it is called a negative crossmatch, and this means that the patient’s body will not reject the new kidney. A positive crossmatch means the risk of rejection is higher, and the patient needs extra medical treatment pre and post-transplant.

8.ROAD TO RECOVERY AND AFTERCARE

Recovery after a kidney transplant requires several days of hospital stay to ensure that the new kidney is functioning well and that the patient’s body is not rejecting the transplanted kidney.They may have to stay for 1-2 weeks in the hospital, even if they feel well enough to be discharged.

The new kidney may begin working immediately or take a few weeks before it starts to function properly. Kidneys donated by family members start working faster than ones donated by unrelated or cadaveric donors. Patients go through pain around the incision site as they begin healing.

They will also be on immunosuppressant medicines to stop the body from rejecting the new kidney. Instructions are given on aftercare and medication routine, which is needed to be followed strictly. The doctor will advise the level of physical activity that the body can withstand while it is recovering.

The donor’s diet needs to change after a kidney transplant to remain healthy. Thedoctor will specify what kind of foods to eat or avoid. The recommended diet and nutrition instructions may include:

• Having at least 5 servings of fresh vegetables and fruits per day
• Including enough fibre in the diet
• Avoiding fruits like grapefruit that can affect the functioning immunosuppressant drugs
• Including dairy products in their diet to maintain adequate phosphorus and calcium levels.
• Having lean meat, fish, and poultry
• Having a low-salt and low-fat diet
• Drinking enough water and fluids daily to remain hydrated

Once the patient has recovered, they need to make moderate exercise a part of daily routine to ensure they stay healthy and that the new kidney functions properly. Activities like walking, jogging, swimming etc. can become a part of their lifestyle after the transplant. However, the doctor must be consulted before starting exercises post-transplant.

9.KIDNEY TRANSPLANT FAQS: ALL CONCERNS ADDRESSED.

1. How long does the kidney transplant surgery take? Can I eat or drink before the surgery?
2. Kidney transplant surgery takes two to three hours as it has to be done with the patient under general anaesthesia. You should not eat or drink anything including water after midnight the day before the renal transplant procedure. Avoid heavy meals the evening before surgery. Your doctor will give you detailed instructions on how to prepare for the surgery and what you can eat or drink.
3. What is the cost of a kidney transplant in India?
4. Kidney transplant in India cost between Rs. 5-6 lakhs (Purely indicative). After the surgery, it could cost Rs. 15,000 a month for the after care and another Rs.10,000 a month for immunosuppressive drugs. Kidney transplant cost in Delhi, Bangalore and Kolkata can be more than the cost in tier 2 cities like Jaipur.
5. What is kidney transplant success rate?
6. The success rate of kidney transplants in India is among the highest in the world. The current success rate is around 90%. However, there are various factors that influence the success rate of a kidney transplant, such as the choice of hospital, the expertise of the surgical and post-operative care teams, the tissue matching and compatibility of the donor, whether the donor is blood-related, and more. Post-surgical infection is a big risk that can affect the success rate, so choose a hospital with the best hygiene standards to make sure you do not get any infections.
7. Why do I need a kidney transplant? Why can’t I remain on dialysis instead?
8. Dialysis is a process where a machine does the job of filtering and purifying the blood. However, the kidney also performs other functions, like producing hormones to regulate blood pressure and maintain electrolyte balance. A dialysis machine cannot do this. Haemodialysis is a type of dialysis that uses an artificial kidney (hemodialyzer) to filter wastes from blood.
   
   Also, the lifelong cost of dialysis can work out to be expensive. You will also have to go to a dialysis centre regularly to get this done. There are many cities where these centres are not available nearby. Also, dialysis makes your blood super-clean and nutrient depleted and this blood keeps getting more and more toxic until the next dialysis session.
   
   A kidney transplant works out to be more economical than lifelong dialysis. Kidney transplant price in India is much lesser than the cost of dialysis. It also lets you have a normal life as it is natural. Not only this, the survival rate and life expectancy of transplant patients are much better compared to people on dialysis. For example, it was found that the life expectancy of a person in the age group of 40 live 7.3 years on dialysis, but 22 years after a transplant.
   
   After a successful transplant, you can live a normal, healthy life and even indulge in physical activities like swimming, cycling, etc. However, a person on dialysis will not be able to lead a normal healthy life and may not be able to travel to places where there are no dialysis centres. Thus, kidney transplantation is the best treatment option for a person with end-stage kidney disease.
9. Which is the best hospital for kidney transplant in India?
10. Narayana Health’s nephrology department has the most skilled and experienced kidney transplant team. They have specialists who work together to perform even the most complex transplant surgeries. They also provide premium-quality care at affordable costs. The team’s post-operative care and the follow-ups are best-in-class and NH’s hygiene standards are top-notch as well. The hospital has state-of-the-art facilities for peritoneal dialysis and haemodialysis in addition to the latest equipment and a world-class operating theatre.
    
    For live kidney donors, the surgeons at NH perform a minimally invasive keyhole surgery to remove the donor kidney, to ensure a quick recovery for the donor. The transplant team also make sure the recipient has a rapid recovery. NH also has advanced diagnostic facilities and top-class infrastructure that ensure the best kidney care. Thus, NH is one of the best hospitals for kidney transplants in India.
11. What are cadaveric donors? How is it possible for a dead person’s kidney to start working after transplantation?
12. Cadaveric donors are deceased people. They are people who have died as a result of an accident or injury. Either they or their family members have chosen to donate organs after death. When a person is brain dead, the heart still keeps pumping – for hours or even days. As a result, the internal organs are still working and alive, though the person is no more.
    
    If a person is declared brain dead, and has chosen to donate his/ her organs after death, the person’s body is rushed to the operating room and the organs for donation are removed and preserved until they can be transplanted into the recipient. Thus, it is possible for a dead person to donate a kidney that will start working in the recipient’s body.
13. Will my new kidney start working immediately after the transplant surgery?
14. When a newly-transplanted kidney starts working, it depends on how good a match it is to the recipient's body. A kidney from a blood relative is more likely to start working sooner than a kidney from an unrelated donor or cadaveric donor. This is because the family member’s kidney will be a better blood and tissue-type match to the recipient and the body will accept the new transplant faster. A new kidney can start working the same day after surgery or take a few weeks to begin functioning.
15. What are paired kidney matches?
16. Paired kidney donors are a pair of people who want to donate their kidney to a family member or friend, but are not a good match. For example, if patient A is not a good match to donor B, but is a good match to an unrelated patient C. At the same time, patient C’s donor D is a good match to patient A. In such a case, donor D will donate a kidney to patient A and donor B will donate a kidney to patient C. Thus, both patients get a kidney from unrelated donors.
17. What is the life expectancy after a kidney transplant?
18. People in the age group of 40 can have a life expectancy of around 22 years after a kidney transplant, while people in the age-group of 50 have a life expectancy of 16 years. People in their 60s have a life expectancy of 11.5 years after a successful kidney transplant.
19. Why are the existing kidneys not removed when a new kidney is transplanted?
20. Research has found that removing the existing kidneys of a person while transplanting a new donated kidney increases the chances of surgical complications and even death. Therefore, the failed kidneys are left in place and the new kidney is placed in the lower part of the abdomen on one side.
21. How dangerous is a kidney transplant?
22. Although kidney transplantation can help treat several kidney diseases and kidney failure, it doesn’t remove the possibility of a kidney disease returning after transplant. The risks of kidney transplant lie with the surgery itself, rejection of the donor kidney and the adverse effects of medications such as immunosuppressants administered to prevent the body from rejecting the new kidney. Some of the risks that may arise during the procedure are:
    • Blood clots
    • Leaking from the ureter connecting the kidney to the bladder
    • Infection
    • Rejection of the new kidney
    • Heart attack or stroke

1. What happens during a kidney transplant?

1. In case you’re receiving the kidney from a living donor, then your doctor can schedule your transplant in advance. However when it comes to a deceased donor, then you’ll have to rush the moment it’s found. To this end, sometimes, pagers are provided by transplant hospitals so that you can be reached quickly. The first step taken after you reach the hospital is collecting your blood sample for the antibody test. This helps to determine whether you’re a match for the surgery or not. The surgery is performed after applying general anaesthesia. An incision is made into your abdomen to put the new kidney. The arteries and the veins to the kidneys are connected. The new kidney’s ureter is attached to your bladder to help your urinate properly. The existing kidneys are kept within the body unless there is a need to remove them like an infection.
2. When is the best time to get a kidney transplant?
3. If you find a matching live donor kidney transplant, then it’s best to complete the transplant even before you start your dialysis. This is known as a pre-emptive transplant. However, if you have been on dialysis for quite some time, it’s still possible to have a live donor kidney transplant. In most cases, a live donor kidney transplant is recommended more than remaining on dialysis. In case of a deceased kidney transplant, it’s not possible to schedule the transplant in advance.
4. How do I know if I’m a good candidate for a kidney transplant?
5. In order to become a potential transplant candidate, you must meet specific requirements, which depend on the specific organ required. Some of the factors that can make you an ideal candidate for a kidney transplant are:
   • If you’ve end stage kidney disease and are on dialysis
   • If you’ve advanced chronic kidney disease at stage IV or V with an estimated GFR lesser than 20 ml/min
   • If you’ve chronic kidney disease at stage IV with GFR less than 30 ml/min
   • If you’ve chronic kidney disease with type 1 diabetes that has failed to respond to medical treatment

1. Is there a special diet to follow after a kidney transplant?

1. Your diet plays an important role after a kidney transplant. Maintaining an ideal diet is important in keeping a healthy weight and exercising regularly. It will also help in preventing high blood pressure, blood sugar, and excessive weight gain. After a transplant, you should follow a diet which is low in salt and fibre. The ideal diet should contain fresh fruits and vegetables, lean meats, reduced-fat dairy products, whole grains, and lots of fluids. It’s also important to be careful while handling foods like washing hands before touching any food items, reducing eating outside, and avoiding high-risk foods that can cause infection.
2. What happens if I reject my new kidney?
3. Immunosuppressants can be used to help your body accept the new kidney, however there still can be times when your body recognises your transplanted organ as a foreign object. Studies reveal 10-20% patients experience at least one episode of rejection. However, rejection doesn’t necessarily mean that your new kidney isn’t working or you’ll lose your new kidney. Rejections generally occur in the first 6 months of the transplant. In case you develop any rejection symptoms such as flu-like tendencies, reduced urine production, excessive weight gain, and fatigue, then you should get in touch with the transplant team.
4. Is there a difference between a living or deceased donor transplant?
5. There are subtle differences between a transplant from a living owner and a deceased donor. In case of a living donor transplant, you get a healthy kidney from a person who is alive. In case of a deceased donor transplant, you get the kidney from a person who is dead. Living donor kidneys last longer in comparison to deceased donor kidneys. Moreover, they also work better since they are outside the recipient’s body for a lesser time than the deceased donor. You can get a living donor kidney transplant even before you’re on dialysis.
6. How long does it take for a kidney to wake up after transplant?
7. Hospital recovery after a kidney transplant may take four to five days if you are free from complications. On the contrary, the time of your stay in the hospital varies depending upon your medical condition. If you have diabetes or high blood pressure, then after renal transplant, you should have to keep it in control. It can create insurmountable barriers in your kidney transplant recovery.
8. How much does a kidney transplant cost in India?
9. The charge of renal transplant varies from the determination and condition of the patient. Along with that, the kidney transplant cost varies from one hospital to another. Most kidney transplant procedures don’t demand any imported material. If we make an estimate, so 5 to 20 lakh, a kidney transplant surgery costs you.
10. What precautions should I take before a kidney transplant?
11. A renal transplant is not immune to complications. There are some precautions that a person planning for a transplant should take before opting for a kidney transplant surgery and they are:
    1. Deplete your high cholesterol levels
    2. Manage your elevated levels of blood pressure
    3. If you have diabetes, then keep it in control.
    4. Ask your physician about the risk for heart and blood vessel disease with a transplant.
    5. Keep your diet and lifestyle healthy.
    6. The person has a higher risk of cancer. Talk to your physician about reducing the risk of cancer.
    7. Avoid transfusion of blood and other blood product

1.WHAT IS A HEART TRANSPLANT?

A heart transplant is a medical procedure that involves replacing a failing heart with a healthy heart from a donor. The process is seen as a last resort for treating heart conditions and is generally recommended by doctors when other treatments haven’t been fruitful. These treatments are surgeries, and they use medications to treat heart problems.

Heart failure is a condition where the heart is not working as efficiently as it usually should. Your entire body needs blood to perform all the necessary functions. When the blood flow becomes insufficient, due to the heart being unable to pump blood adequately, then disruption occurs; this makes your heart weak. Heart failure can affect any side of your heart, or it can affect both sides of your heart at the same time.

2.ELIGIBILITY FOR A HEART TRANSPLANT

You need to meet the eligibility criteria before you can undergo heart transplant surgery. Not every individual who needs a heart transplant can get a heart transplant procedure done because in some cases, it can be dangerous. Several factors determine your eligibility, and your doctor will ensure you're eligible before you are recommended to get a heart transplant procedure.

The following are some factors that affect your eligibility for a heart transplant.

• When you have an active infection then your doctor will not recommend heart transplant because it can cause more complications.
• If you are not ready to take precautionary measures to ensure you keep your new heart healthy, your doctor won’t recommend the heart transplant procedure.
• If your doctor thinks that recovering from a heart transplant surgery will be difficult for you then he may not recommend the procedure.
• If someone in your family has cancer, or if there is a history of cancer, then you might not be a good candidate for a heart transplant procedure.
• When you are suffering from another health issue that can potentially cut your life short, even after receiving a healthy heart, then your doctor won’t recommend a heart transplant.

The eligibility criteria for getting a heart transplant, will be determined by your doctor based on your current health, age, and lifestyle (among other factors).

3.UNDERSTANDING THE HEART TRANSPLANT PROCEDURE

 

The heart transplant procedure is complex. It takes several hours for heart transplant surgery to be completed. If this is the second time that you're having heart surgery, then the heart transplant surgery can take longer than expected; the procedure is open-heart surgery. Firstly, you will receive general anaesthesia in the form of medication so that you sleep. Your body must receive oxygen-rich blood, which is why you will be connected to a heart-lung bypass machine.

Secondly, the surgeon will make an incision, and this allows them to operate on your heart. The incision will be made such that the chest bone is separated and the rib cage is opened. The surgeon then removes the diseased heart. The healthy donor heart is then sewn in place, and the blood vessels are then attached to the new heart. This process enables blood to start flowing, and the heart then starts to beat normally. If the donor's heart has trouble beating, then an electric shock might be given.

Once the heart transplant procedure is completed, you will receive pain relief medications. A ventilator will be used so that you don't have trouble breathing after heart surgery. Fluids need to be drained after the surgery, and this is done with the help of tubes that are attached to your heart and lungs. You will receive medicines and fluids through IV tubes once the surgery has been completed. You will stay in the ICU for a few days after the heart transplant surgery.

You will then be moved to a general hospital room where you can stay for a few weeks. Your stay in the ICU and hospital room depends on your situation and the surgery. Once you are discharged from the hospital, then you will be monitored frequently to ensure your health is as it should be. The monitoring is more frequent in the first few months, after your heart transplant surgery, and afterwards, the frequency decreases.

The tests include heart biopsies and electrocardiograms, among others. Heart biopsies are used to determine whether the new healthy donor heart is being rejected by your body or not. There is a higher chance in the beginning for your new heart to be rejected by your body, which is why heart biopsies occur more at that time. Mostly, there are no symptoms that give you an indication of your body rejecting the heart.

Some of the symptoms that can indicate donor heart rejection include unexplained weight gain, inability to breathe properly, fatigue, and not urinating as much as you normally do. These symptoms can indicate an infection, too, which is why you must contact your doctor whenever you experience something out of the ordinary.

4.FINDING A DONOR FOR HEART TRANSPLANT

 

Firstly, you will be put on a waiting list after you are found to be eligible for a heart transplant. At the moment, there are thousands of people waiting for heart transplants because there are not enough hearts available. When you are waiting for a healthy donor heart to be available, your condition will be monitored by doctors. Your treatment can be changed depending on your condition when you are waiting for a heart to be available for transplantation surgery.

Some people develop severe medical conditions, where they may not be eligible for heart transplant surgery anymore. In this case, your name will be removed from the list until you recover from the health problem. Depending on your recovery, you may be put back on the waiting list for a donor's heart. When you are waiting, your doctors can recommend cardiac rehabilitation to you, which provides you with information about how to stay healthy before and after a heart transplant surgery.

When you are waiting for a donor's heart, sometimes your condition can deteriorate. This can be because the treatment that you are undergoing is unable to support your vital organs. This can cause health complications to arise. In such a case, you might need a device such as the ventricular assist device to be implanted. This helps to keep you stable until you receive a donor heart which can be transplanted in place of your diseased heart.

Once a donor's heart becomes available, several factors determine whether it is a good match or not. These factors include the duration you have for a donor's heart, the urgency of your request depending on the condition, and your blood type, among others. Only when the donor's heart makes a good match, your heart transplant procedure can be started.

5.HOW TO PREPARE FOR A HEART TRANSPLANT?

You can prepare for your heart transplant, depending on how long you need to wait for a donor's heart. You can start preparing for your surgery well in advance. This is best done by writing down any questions you may have and asking your doctor about them. For instance, you might want to know about the heart transplant cost, the duration of the procedure, and if there are any special arrangements that you need to make, in advance.

By asking questions, you will know how to prepare yourself, in the best way, for a heart transplant. This will help decrease stress because having a heart transplant can be quite stressful. Several tests will be done to ensure you are eligible for receiving a heart transplant. An evaluation will be done to ensure you are emotionally and physically ready to receive the donor’s heart. Your doctor will be best able to guide you about how you can best prepare for a heart transplant depending on your unique case.

6.RISK AND COMPLICATIONS OF HEART TRANSPLANT

A heart transplant procedure is a significant operation. Various risks and complications can arise due to heart transplant surgery. The following are some of the risks associated with heart transplant surgery.

There are various medications that you need to take after a heart transplant. These strong medicines can cause some side effects. For instance, immunosuppressants that you take after a heart transplant can cause health problems such as kidney damage. You can even get osteoporosis, diabetes, and high blood pressure as a result of taking these medications.

The body can reject the donor heart, which is one of the most significant risks of a heart transplant. About 10% of people who receive a heart transplant can show signs of heart rejection. This usually occurs in the first year after a donor's heart has been transplanted. The immune system is responsible for detecting any outside material. When a new heart is transplanted, your immune system can reject it as it starts to attack it, thinking that it does not belong in your body.

Generally, medications are given in the case of rejection. You don't need to experience any symptoms that indicate rejection. Doctors will monitor you and perform biopsies regularly, especially in the first year of heart transplantation. The biopsies are used to check the heart tissue, which is an indicator of whether the heart has been rejected or not.

Immunosuppressants lead to hampering your body's ability to defend itself against infection. Sometimes, there may be a need for the patient to be hospitalized due to a serious infection that is caused due to a heart transplant. When the immunosuppressant medicines are decreased after a while, then the risk decreases along with it too.

Coronary arteries can get affected after a heart transplant. Cardiac allograft vasculopathy, commonly known as CAV, can develop after a heart transplant procedure has been performed. In this condition, the walls of the coronary arteries become hard and thick. This leads to a problem in blood circulation which can eventually lead to other heart problems such as heart failure, heart attack, and abnormal heart rhythms. It can lead to death, as well.

Cancer is another risk of heart transplant surgery. It is recommended that regular checkups are done to ensure there is no cancer growth. Immunosuppressants are responsible for increasing the risk of developing cancer such as skin cancer, and non-Hodgkin's lymphoma after a heart transplant.

Some of the heart transplant complications include the formation of blood clots, heart stroke, bleeding, heart attack, and infection.

7.HOW DO I RECOVER FROM A HEART TRANSPLANT?

Your doctor will provide you with thorough information about recovery after a heart transplant. You will need to ensure that you listen carefully to what your doctor says and follow the instructions so that you can recover well. People who receive heart transplants are usually able to lead better lives after the surgery and can go back to their usual activities. Recovery can take six months, but it can vary from person to person.

As long as you are taking the medicines prescribed by your doctor and taking good care of yourself, as per your doctor's recommendations, there is nothing for you to worry about. If you're a woman who has received a heart transplant and you are planning to have a baby, then you should speak to your doctor about it. Usually, women don't have a problem conceiving after a heart transplant, but the medications can cause complications.

8.PRECAUTIONS TO TAKE AFTER SURGERY

Once the heart transplant surgery is completed, there are several precautions that you need to keep in mind. These adjustments might seem overwhelming, but they ensure that you can recover fast and can lead a normal life after a heart transplant.

Your doctor will prescribe immunosuppressants which are used to ensure your immune system does not attack the new healthy donor heart after it has been transplanted. Immunosuppressants ensure the risk of heart rejection is decreased. These are usually prescribed lifelong. Even with the help of immunosuppressants, your immune system might still not fully accept the new heart. The problem with immunosuppressants is there are many side effects, especially in the beginning.

Immunosuppressants can make you prone to infections because your immune system is suppressed and is not working optimally. For this, your doctor will prescribe additional medication. Sometimes, immunosuppressants can worsen some health issues, such as diabetes and high blood pressure. It can increase the risk of developing other health problems, like high cholesterol, as well.

The key to recovery, after a heart transplant surgery, is to ensure you listen to what your doctor advises. You need to make lifestyle changes so that you don’t develop any infections, in the future. You may need to include exercise and healthy eating habits in your routine.

9.LIFE AFTER A HEART TRANSPLANT

 

You will be constantly monitored after a heart transplant. In the first few months, many tests will be conducted to ensure the new heart has been accepted by your body, and to ensure additional problems won't crop up. You will need to ensure you are staying healthy at all times so that you can enjoy a good quality of life, after a heart transplant. Ensure you meet your doctor regularly and inform him about any problems you are experiencing.

10.DIET AND NUTRITION

Diet and nutrition are important aspects that you need to pay close attention to after you have a heart transplant surgery. You want to ensure you are taking care of your health and making healthy choices daily so that your heart remains healthy. Here are some diet and nutrition tips for a healthy heart.

• You should drink plenty of water and stay hydrated at all times.
• Ensure that you include lots of vegetables and fruits in your daily diet. Instead of only focusing on one type, you should have different types of fruits and vegetables daily.
• You should consume lean meats such as poultry and fish, regularly.
• If you drink alcohol then you should decrease how much you drink. However, it is best if you can avoid alcohol altogether.
• Ensure you decrease salt consumption.
• It is best if you opt for healthy alternatives such as whole-grain foods. These include whole-grain cereals, bread, and grains.
• You should avoid grapefruit, including grapefruit juice.
• You should ensure you are consuming sufficient calcium. You should choose fat-free dairy products or low-fat dairy alternatives.
• You should take precautionary measures to ensure you don’t get any infection.

Your doctor will discuss healthy eating habits with you considering your current lifestyle and you both can create an eating plan accordingly. If you are obese, or overweight, then you should consider losing weight and maintaining a healthy weight with the help of exercise and diet. This will help ensure you can live healthily for a long time.

11.HEART TRANSPLANT FAQS: ALL YOUR CONCERNS ADDRESSED

1. What difference would a heart transplant surgery make to your life?
2. A heart transplant will make you free from the agonies of the determinants and symptoms of heart failure. After the transplant, you may become healthy to perform all the physical activities without any hassle. Therefore, you have to follow all the precautions and medicine courses that your physician prescribes to keep your transplanted heart healthy.
3. How much time would I need to get discharged from the hospital after the heterotopic heart transplant?
4. The heart transplant procedure is neither too complicated nor too easy to deal with. It takes around 10 to 15 days for you to get discharged from the hospital if you have no severe complications. Sometimes, a heart recipient takes two weeks to cover up the weakness of a heart transplant.
5. Which will stand the best heart hospital in India for me?
6. You need to discover which is the best heart hospital in India. Narayana Health is here for a hassle-free heart transplant procedure. Doctors at Narayana health work diligently to render less-complexed heart treatment surgery. The doctors will guide you everything from diet to precautions. They don't leave any stone unturned in your betterment. You can trust Narayana health, where the treatment causes the most effective heart transplant surgery.
7. Can I continue to exercise after a heart transplant?
8. Exercise is great for enhancing your overall health, and it is recommended by doctors after a heart transplant, as well. Regular exercise helps you reduce stress and control other conditions, so you can stay healthy; it helps you recover faster too so that you have strength. Not all types of exercises may be recommended though depending on your particular condition. You must consult with your doctor about the types of exercise that you can perform after a heart transplant.
9. What are the chances of survival after receiving a heart transplant?
10. Survival rates, of people who have received a heart transplant, are high. With the right guidance and constant follow-up care, the chances of you surviving for five years, or more, after a heart transplant are high.
11. I have heart failure but I am managing it with medicine. How do I know when to consult my doctor, in case of an emergency?
12. You must know when you should immediately call your doctor. When you notice that you are experiencing new symptoms then you should get in touch with your doctor as soon as possible. The following are a list of symptoms that indicate heart failure and you should call your doctor immediately.

• You suddenly gain five pounds or more in a single well, or two pounds or more in a single day.
• You find it difficult to breathe even when you are resting.
• You experiencechest pain.
• You have an irregular heartbeat.
• You don’t urinate like you normally do.
• You notice your abdomen, feet, ankles or legs are swollen.
• Your heart rate is rising to new levels.
• You feel bloated all the time.
• You feel very confused all of a sudden.
• You feel more tired than usual.
• You lose your appetite.
• You are out of breath more often.
• You have a tough time doing daily activity.
• You notice a change in your sleep pattern; you may feel sleepier or have a difficult time sleeping.
• Whenever you experience something that doesn’t seem right, then it is best if you contact your doctor immediately. For this reason, you should always keep emergency contact numbers safely with you at all times, so you can easily access them whenever required.

1. What if a heart transplant is not possible? Is there an alternative?
2. Some people are not good candidates for receiving a heart transplant. In such cases, doctors recommend ventricular assist device or VAD. These help pump blood and are implanted in your chest. They help to pump blood from your ventricles to your body. VADs can be used for short-term in some people or long-term in others. For instance, people awaiting heart transplant can have a VAD implanted until a donor heart is available.

• People who can’t have heart transplant can have a VAD implanted for the long term, as well.However, VAD isn’t for everyone. If your doctor notices that it is not helpful then an artificial heart is another option that your doctor can recommend.

1. I have just found out I need a heart transplant. I feel overwhelmed. What should I do?
2. It is normal for you to feel overwhelmed with the news of requiring a heart transplant because things might not be the same after transplant. Instead of worrying about the heart transplant, it is recommended that you read as much as you can about heart transplant, so that you can have realistic expectations from the procedure. You can join a support group so you can gather information about people who have gone through the heart transplantation surgery.
3. Is there a chance of the new heart failing?
4. Yes, there is. Not all heart transplants are successful and for some people, the new healthy heart might fail even after successful transplantation. Your body may reject the new heart completely even with the help of immunosuppressants or you might develop diseases such as coronary artery disease which can lead to heart failure. Your doctor will tell you about the best course of action, in each case.
5. Why choose Narayana Health for heart transplant procedure?
6. If you are looking for one of the best heart transplant hospitals in India then Narayana Health is one of them. It is one of India’s leading heart transplant hospital which has top heart surgeons in India. It has an active transplant program available for patients and provides artificial hearts and ventricular assist devices for patients who are not eligible for a heart transplant as well. Narayana Health thoroughly evaluates you so you are always given the best treatment possible according to your case.

• Doctors at Narayana Health work with you so you understand the entire procedure and why you are being given the particular treatment for your heart condition. You will be guided by the doctors and they will leave no stone unturned to ensure that you are aware of what to expect before the procedure, during the procedure, and after the procedure. This helps you understand the entire treatment without feeling stressed at any point.

1. How long can you live with a new heart?
2. After a heart transplant, your life expectancy depends on many factors like general health, your age, commitment towards a lifestyle change and response to the transplant. 75% of heart transplant patients live up to 10 years after surgery and 85% of then return to their normal work life. Many patients also enjoy light physical activities like running, cycling, swimming, etc.
3. What is the survival rate for heart transplant patients?
4. With improvement in treatments suppressing the immune system and preventing all kinds of infection, the survival rate among heart transplant patients has increased. Approximately 85-90% of heart transplant patients live up to one year after their surgery. The annual death rate after one year is 4%. The one-year survival rate in people with congenital heart disease is 79%.
5. Do you die during a heart transplant?
6. All kinds of surgeries have a risk of death, but in a heart transplant, the risk is higher than typical, especially when the donor's body does not accept the transplanted heart and does not tolerate it and functions well. Overall, a heart transplant surgery is a very high-risk procedure because the heart is not only stopped but is removed, replaced and sets up in another body to function.
7. What is the cut off age for heart transplant?
8. The maximum age limit for heart transplant varies with each institution, but 65 is the cutoff age to have this kind of transplant.
9. How long do heart transplants take?
10. Heart transplant surgery procedure takes approximately four hours. During the procedure, the patient is aided by a heart-lung machine for blood circulation throughout the body.
11. How painful is a heart transplant?
12. Most patients do not report a lot of pain after heart transplant surgery. The patient will be constantly monitored, given pain medication, and outfitted with drainage tubes to remove excess fluid from the chest cavity. Whereas the incision might cause pain or discomfort while coughing or sudden jerky movements.
13. Can a living person donate a heart?
14. Organ donors are usually deceased, but some organs can be donated by living donors. Deceased organ donors can donate both kidneys, liver, both the lungs, heart, pancreas, and intestines. Whereas living organ donors can donate only one kidney, one lung, a portion of the liver, pancreas, or intestine.

1.WHAT IS A LUNG TRANSPLANT?

A lung transplant is a surgical procedure carried out to replace a dysfunctioning and diseased lung with a healthy lung. For individuals with severe respiratory organ illness, a lung transplant procedure can bring back easier respiration and supply years of life. However, lung transplant surgery comes with some significant risks and it is essential that you read and understand the risks involved and consult a lung surgeon if a lung transplant is right for you.

2.WHEN IS A LUNG TRANSPLANT DONE?

Most people with severe, end-stage lung diseases are thought to be ideal for a lung transplant. The procedure needs to be carried out once someone appears seemingly to die without the surgery and have no other choices. A lung transplant may also be thought of in individuals whose lung disease is so severe that it is debilitating to their lifestyle.

The most common respiratory organ diseases that require a lung transplant are:

• Chronic obstructive pulmonary disease (emphysema and chronic bronchitis)
• Idiopathic pulmonary fibrosis
• Cystic fibrosis
• Idiopathicpulmonary arterial hypertension

Among individuals with these conditions, respiratory organ transplant reasons will vary. For example, in respiratory illness, lung tissue is destroyed by smoking; in idiopathic pulmonary fibrosis, connective tissues replace the healthy respiratory organs.

3.UNDERSTANDING ASSOCIATED RISKS

 

A lung transplant is a major surgery which comes with many risks. Before the surgery, your doctor ought to consult with you whether or not the risks related to the procedure outweigh the advantages. You should also talk about what you can do to reduce the risks. The rejection is the major risk for a lung transplant organ. This happens once your system attacks your donor lung as if it were an illness. Severe rejection can lead to the failure of the donated lung. Other serious complications may arise from the medicine accustomed to stop rejection. These are referred to as “immunosuppressants.” They work by lowering your immune response, making it less likely that your body will attack the new “foreign” lung. Immunosuppressants raise your risk of infections since your body’s “guard” is down.

Other risks of lung transplant surgery from the medicines you need to take afterwards include:

• bleeding and blood clots
• cancer and malignancies due to immunosuppressants
• diabetes
• kidney damage
• stomach problems
• thinning of your bones (osteoporosis)

It’s important to follow your doctor’s instructions before and after your surgery. This can help decrease your risks. Some of the instructions can include making healthy lifestyle decisions, like adopting a healthy diet and avoiding smoking. You should also try not to miss any doses of medications.

4.LUNG TRANSPLANT CRITERIA AND REQUIREMENTS

The evaluation process for a lung transplant is typically long and complex. First of all, the doctor refers the patient to a regional transplant centre. At the transplant centre, doctors meet with the person to gather information. This may happen on many visits over several weeks or months.

Besides the patient’s lung condition, the doctor looks into the person’s family support, financial conditions, psychological makeup, and any other medical situations. Numerous tests are performed throughout a lung transplant analysis, which can include:

• Pulmonary function tests
• Cardiac stress test
• Coronary artery catheterisation
• Bone mineral density test
• Chest X-ray
• Computed tomography (CT scan) of the chest
• Blood tests for kidney and liver function, and a complete blood count (CBC)
• Blood type and antibodies present within the blood, for matching against potential organ donors

Doctors sometimes will not advocate a lung transplant if conditions such as vital heart, liver, or kidney disease; alcohol or drug abuse; ongoing infections; or cancer (although if there's significant heart sickness, some patients may be considered for a combined heart-lung transplant) are present. Also, an individual who continues to smoke cannot receive a lung transplant.

5.FINDING A DONOR

After the completion of tests and interviews, if the patient is found to be a suitable candidate for lung transplant, then his/her name is listed on the region and national organ recipient list.

The Lung Allocation Score puts the individual's place on the list, which considers a sophisticated calculation that tries to predict 2 things:

• How long a patient is probably going to live without a lung transplant
• How long a patient would be expected to live once receiving a lung transplant

People with higher scores are considered initially when organ donors lungs become accessible.

6.THE LUNG TRANSPLANT PROCEDURE

What Happens During a Lung Transplant

When a compatible donor’s lungs become accessible, the transplant candidate is referred to as urgently to the transplant centre to organise for the surgery. Members of the surgical team examine the deceased donor’s lungs to make sure they're appropriate for transplant. If they're, the surgery on the recipient begins immediately, while the lungs are in transit to the centre.

Doctors may perform either one lung transplant or a double lung transplant. There are benefits and drawbacks to every possibility, and the choice varies depending on the recipient’s lung disease and other factors. An operating surgeon can create an oversized incision within the chest throughout a lung transplant. The incision varies by the sort of lung transplant:

• An incision on one side of the chest solely (for one lung transplant)
• An incision across the complete breadth of the front of the chest, or an incision on either side (for a double lung transplant)

Complete unconsciousness is maintained with anaesthesia throughout the surgery. Some individuals receiving a lung transplant will have to be compelled to maintain cardiopulmonary bypass throughout the surgery. While on bypass, the blood is pumped-up and enriched with gas by a machine, instead of by the heart and lungs.

After a Lung Transplant

The time to fully recover from a lung transplant varies widely between individuals. Some individuals might leave the hospital at intervals every week. However, it’s not that uncommon to be within the hospital for 2 weeks or longer once the lung transplant surgery is completed.

The weeks after lung transplant is busy, crammed with activities meant to make sure of the long-run success of the operation.

These include:

• Regular physical therapy and rehabilitation exercises
• Education sessions to learn a complicated new lifelong medication plan
• Frequent visits to the doctor
• Regular tests for the function of the lung, chest X-rays, blood tests, and procedures like bronchoscopy

Many transplant centres offer temporary housing nearby for patients and their families to make frequent visits easier.

7.PROGNOSIS AND OUTLOOK AFTER LUNG TRANSPLANT

 

A lung transplant will exclude dyspnea and change a lively lifestyle which will last for years. For many individuals, a lung transplant is nothing but lifesaving. After recovery from a lung transplant surgery, around eightieth of individuals say they need no limitations on their physical activity. Among individuals living 5 years or additional, up to four-hundredth still work on at least part-time. However, eventual complications after lung transplant are inevitable. The immune system’s rejection of the donor's lungs can be slowed, but not stopped entirely. Also, the required powerful immune-suppressing medicines have side effects such as diabetes, kidney injury, and vulnerability to infections.

For these specific reasons, lasting survival after a lung transplant is not as promising as it is after other organ transplants, like kidney or liver. Still, around eightieth of individuals survive a minimum of one year once a lung transplant is done. After 3 years, between 55% and 70% of those receiving lung transplants are alive. Age at the time of transplant is the most vital factor influencing lung transplant survival.

8.PRECAUTIONS TO TAKE AFTER THE PROCEDURE

You can expect to remain in the ICU for a few days after the procedure. Your vital signs will be required to be closely monitored. You’ll likely be hooked up to a mechanical ventilator to help you breathe. Tubes will be connected to your chest to empty any fluid buildup. Your entire stay in the hospital may last weeks, but it may be shorter. How long you can stay will depend on how soon you recover.

Over the next 3 months, you'll have regular appointments with your lung transplant team. The doctors will monitor any signs of infection, rejection, or other problems. You’ll be required to live close to the transplant centre. Before you are allowed to leave the hospital, you’ll be given instructions on how to care for your surgical wound. You’ll even be told about any restrictions on medication.

Most probably, your medications will include one or more types of immunosuppressants such as:

• cyclosporine
• tacrolimus
• mycophenolate mofetil
• prednisone
• azathioprine
• sirolimus
• daclizumab
• basiliximab
• muromonab-CD3 (Orthoclone OKT3)

Immunosuppressants are important after your transplant since they help stop your body from being offensive to your new lung. You’ll be required to take these medications for the remaining period of your life.

However, they leave you receptive to infections and alternative issues. Make sure to talk to your doctor about all the possible side effects.

You may also be given:

• antifungal medication
• antiviral medication
• antibiotics
• diuretics
• anti-ulcer medication

9.ROAD TO RECOVERY AND AFTERCARE

After a lung transplant, you'll step by step begin to feel stronger. The final goal is for you to live without requiring external oxygen. Making sure your body accepts the new lungs is important to your success and recovery.

Post-Lung Transplant Recovery Process

The first few months after a lung transplant surgery are when you have the highest risk of infection or rejection. That's why you will need to remain within one hour of the hospital for at least two to three months after discharge or as directed by your transplant team. You must also have a caregiver with you at all times during these first few months. You and your caregiver should arrange for a house, which is not a medical facility, close to the hospital till you can come home. You’ll also need to monitor the site of the incision to avoid chances of any infections. Follow the directions shown by your transplant nurse before leaving the hospital.

Lung Transplant Follow-up Appointments

At first, you'll have frequent follow-up visits so that the lung transplant team can be sure that you are healing properly. After that, you will return to the hospital's post-transplant clinic at least every 2 months for a 2-day visit for the first year. This will vary based mostly upon testing results at any visit.

Preventing Lung Transplant Complications, Rejection, and Infection

Lung biopsy is the sole approach for your doctor to work out whether or not your body is accepting or rejecting the new lung or lungs. That's why it's so important that you come to all your follow-up appointments.

During these visits, you will have:

• Pulmonary Function Tests (PFT) to make sure your new lung or lungs still improve
• Blood work
• Chest X-rays
• Clinic visits
• Bronchoscopy with biopsy/li>

You’ll need to continue with the anti-rejection drugs throughout your life. Your doctor will monitor how you respond to them and make adjustments if required. Anti-rejection drugs make you more susceptible to developing infections. After a lung transplant surgery, limit your exposure to people with sickness or places where people are contagious.

In case you feel you have any signs of infection including a fever over 100.4°, chills, swelling, redness, or fluid draining from the incision site, you can reach out to us.

10.POST-LUNG TRANSPLANT AFTERCARE

Being a caregiver is a big responsibility. You may want over one person to assist you for the primary few months once your lung transplant is done.

A lung transplant caregiver will:

• Make sure you take medications in the right doses at the right time.
• Help you record all the information that the lung transplant team requested.
• Drive you to and from your appointments.
• Look for signs of unusual behaviour and contact your hospital lung transplant coordinator if anything seems wrong.
• Shop for food and prepare meals.
• Run errands, fill prescriptions, and do chores around the house.
• Provide support, encouragement, and entertainment.
• Keep family and friends informed of your needs and desires.
• Assist with daily activities within the home.

11.LIFE AFTER LUNG TRANSPLANT

The transplant team will continue to be a resource for you and will remain in contact with you, even after you leave the hospital. Lung transplantation can help patients live longer and have a better quality of life. However, you will need to take an active role to help make your transplant a success.

Maintaining Your Optimum Weight

After your surgery, it’s important to maintain an optimum weight. This allows your new lungs to work at their best function. Excess weight will increase the work your lungs should do to pump your blood to all or any of the cells of your body. Excess weight will also cause stress on your joints and lead to pain; it also stresses your bones, making them more prone to breaking. The best way to control your weight is with the correct diet and exercise. After transplantation, diet becomes a very important part of your life. The drugs you take to prevent rejection have several side effects that make a “heart-healthy” diet a necessity. The doctor will work with you to develop a healthy and controlled consumption attempt to assist you to maintain your optimum weight.

Caffeine, Alcohol, and Tobacco

These commonly-used substances can be eliminated or severely restricted in your new healthy manner.

Caffeine is a stimulant of the central nervous system and can overstimulate your heart. Some are extremely sensitive to caffeine intake than others. It can cause insomnia, heartbeat irregularities, and diarrhoea. Even a moderate amount of caffeine can promote headaches, trembling and nervousness. Your doctor will advise you on the need to limit your use of caffeinated products like coffee, tea, chocolate, and sodas.

Alcohol consumption ought to be eliminated or severely restricted after your transplant. Alcoholic beverages are high in calories, low in nutrients and can increase the level of triglycerides in your blood. Even more important is the fact that alcohol can impair your liver’s function. Several transplant medications are broken down in the liver. So, for your medications to work properly and safeguard your new lung from rejection, it's essential that your liver be healthy and properly functioning.

Smoking tobacco is a high-risk activity. We strongly recommend that you do not smoke. Smoking lessens the ability of your red blood cells to carry oxygen; less oxygen reaches your tissues, decreasing your ability to heal. Smoking constricts your blood vessels, especially those in your legs, arms, and heart. All of these problems are accentuated in individuals taking immunosuppressive medications.

12.LUNG TRANSPLANT FAQS: ALL YOUR CONCERNS ADDRESSED

1. How long will a lung transplant last?
2. Although some individuals have lived ten years or additional after a lung transplant, solely regarding half the people that endure the procedure are still alive once 5 years.
3. Who is eligible for a lung transplant?
4. In general, you need to be physiologically sixty years aged or less for bilateral lung transplantation and sixty-five years aged or less for single lung transplantation. This means that your fitness should meet the everyday condition of somebody over sixty years or younger, or somebody over sixty-five years or younger.
5. Can you live with one lung?
6. Living with one lung doesn't usually affect everyday tasks or life expectancy, though a person with one lung wouldn't be able to exercise as strenuously as a healthy person with two lungs.
7. What are the signs of lung failure?
8. When symptoms do develop, they may include:

• Difficulty respiration or shortness of breath, particularly once active.
• Coughing up mucus.
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• Rapid breathing.
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1. Do Lung Transplants work?
2. A lung transplant is an operation to remove and replace a diseased lung with a healthy human lung from a donor. The procedure usually takes between 4 and 12 hours to complete, depending on the complexity of the operation. In case of a major operation, the patient might take at least 3 months to recover. However, eventual complications after lung transplant can happen if adequate care is not taken. The immune system of the patient may reject the newly received organ from a donor, hence immunosuppressant medications are prescribed. In the case of lung failure, a lung transplant can definitely help to improve the quality of life and the longevity of life for patients suffering from grave lung conditions.
3. What are the different types of lung transplants?
4. There are 3 main types:
   Single Lung Transplant: A single damaged lung is removed and replaced with a healthy lung. This is often used to treat pulmonary fibrosis.
   Double Lung Transplant: Both the lungs are surgically removed and replaced with 2 healthy lungs of donor. This is the prime treatment option for people with cystic fibrosis or COPD.
   Heart-Lung Transplant: It is the removal of the heart and both the lungs. This is often recommended for people with severepulmonary hypertension.
5. Why is a lung transplant performed?
6. Lung transplants are only recommended for people who have tried other treatments or medications, but their conditions haven't sufficiently improved.
   Damaged or unhealthy lungs can't intake or utilise the oxygen which the body needs to survive. A variety of medical conditions and diseases can damage the lungs and hinder the ability to function effectively. Some of the more common causes include:
   • Chronic obstructive pulmonary disease (COPD), including emphysema
   • Scarring of the lungs (pulmonary fibrosis)
   • High blood pressure in the lungs (pulmonary hypertension)
   • Cystic fibrosis

1. How long does it take to recover after a lung transplant?

1. The recovery period varies from person to person. Some leave the hospital within a few days, while some take a few weeks. However, it's not uncommon for a patient to be in the hospital for two weeks or longer. To completely recover from the condition it takes at least 3 to 6 months. One must avoid pushing, pulling or lifting anything heavy. For the long term success of the transplant, a few weeks after the surgery are filled with activities like:
   • Rehabilitation exercises
   • Regularphysical therapy
   • Informative sessions to learn the lifelong medication plan
   • Regular tests of lung function, blood tests, chest X-ray, and procedures like bronchoscopy

1. Can the lungs be detoxified?

1. Lungs are self-cleaning organs and it's completely possible to clean and detox the lungs. Here are a few tips to follow for optimal lung health:
   • Quit Smoking
   • Maintain a proper diet
   • Exercise regularly
   • Breath in the fresh air, be in a toxin-free environment.
   • Steam therapy or steam inhalation
   • COPD patients should try pursed breathing.
   • Drain mucus from the lungs. There are a few postural drainage techniques to do so.

1. What is the success rate of lung transplants in India?

1. Lung transplant is the solution for the termination of end-stage lung diseases. If you compare the preoperative and postoperative conditions of the lung transplanted patients in the developing and developed countries, they're different. Modern techniques that are used for lung transplant work on both the determinants and the failed organ. Physicians (Surgeon), along with the organ, removes the infection and pacify the causes of the ailment. You can say that lung transplant surgery has gained little success due to the new techniques.
2. How much does a lung transplant cost?
3. The shortage of donors for lung transplant procedure makes it a little expensive. Lung transplant surgery cost around 10 to 25 lakh. The ICU and medications will cost you an equal amount.
4. Does diabetes or high blood pressure affect lung transplant?
5. Unfortunately, yes, your high blood pressure or diabetes level may create insurmountable barriers in the lung transplant procedure. On the contrary, diabetes or elevated blood pressure can also augment the number of issues for your lungs. Before investing in lung transplant surgery, adopt a medication course to control your diabetes or hypertension.

1.ANATOMY OF THE LIVER

The liver is the second largest organ in the human body which is present on the right side of the abdomen. It is a reddish-brown organ with a rubbery texture and weighs around 3 pounds. The liver is protected against external injuries by a bony rib cage. It is in the shape of a triangle and consists of 2 lobes. The right lobe is larger than the left lobe and both lobes are separated by a band of tissue that keeps it connected to the diaphragm.

 

A system of tubes called the biliary tree that runs through the liver collects bile and drains it into the gallbladder or the intestine. Bile is an important digestive juice secreted by the liver. Other important components of the liver include the intrahepatic ducts that are located inside the liver and extrahepatic ducts that are on the outside.

Anatomically, the liver is positioned below the gallbladder along with parts of the pancreas and intestines. All these organs work in complete coordination to digest, absorb and process food. The liver also filters the blood from the digestive tract before it is passed to the rest of the body.

2.FUNCTIONS OF THE LIVER

The liver plays a key role in digestion and detoxification. It produces chemicals that are important for the digestion of various foods ingested through the mouth. It also breaks down unwanted compounds and detoxes the body. The liver also acts as a storage unit by storing fats that can be utilized during the phases of starvation.

Some of the key functions of the liver are as follows:

• Liver produces bile to initiate the process of digestion. Bile is an important digestive juice that is necessary for digestion.Liver converts glucose into glycogen which is stored in the liver and muscle cells
• Hepatocytes in the liver are responsible for protein synthesis which is central for many body functions including the maintenance of circulatory system
• Liver produces cholesterol and triglycerides which are essential as energy reserves.
• Liver detoxifies the body by converting ammonia into urea which is excreted through the urine
• It breaks down drugs to simple elements that can be tolerated by the body while treating diseases
• Alcohol in its original form is toxic to the human body. Liver breaks it down to a form that can be tolerated by the body
• Liver also breaks down insulin and other hormones to facilitate certain functions like blood glucose management
• Certain vitamins and minerals like B12, folic acid, iron, vitamin A, D, and K are stored in the liver. They are important for certain functions like the production of red blood cells, calcium absorption, vision and clotting of blood.

3.LIVER DISEASE AND POSSIBLE CAUSES

A healthy liver is important to support certain functions like digestion and detoxification. The liver can be damaged due to excessive alcohol consumption or an unhealthy lifestyle. Fatty liver, cirrhosis, and hepatitis are some of the most common liver diseases that need medical treatment.

Fatty liver disease:

 

Excessive alcohol consumption increases the risk of cholesterol and triglycerides. Fatty liver disease is the accumulation of these compounds in the liver but is not related to alcohol abuse. Fatty liver disease is also known as non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH).

Cirrhosis:

 

Regular consumption of alcohol can result in scarring of the liver. The liver tissues can harden and lose their function over a period. The damage is irreversible and is considered fatal as it can result in liver failure.

Hepatitis:

Hepatitis is an inflammation of the liver which can be caused by various reasons like infections or viruses. There are various types of hepatitis as shown below:

• Hepatitis A: This condition is spread by poor sanitary habits and poor handling of food. Not washing hands regularly and poor sanitation is considered one of the main reasons for the spread of hepatitis A.
• Hepatitis B and C: This spreads through the contact of infected body fluids especially with contaminated needles or unprotected sex.
• Hepatitis D: Hepatitis B and Hepatitis are spread concurrently.
• Hepatitis E: This is a water or foodborne infection.

Liver diseases due to genetic conditions:

Some genetic conditions can cause some liver problems as follows:

• Hereditary hemochromatosis promotes the storage of excess iron in the organs.
• Wilson’s disease promotes the storage of copper instead of releasing it from the body.
• Alpha-1 antitrypsin is mostly produced in the liver. Alpha-1 antitrypsin deficiency is caused by a genetic condition where the body is unable to make a sufficient amount of it.

Autoimmune Liver Disease:

The human body is supported by an immune system that defends against foreign bodies including bacteria and viruses. In some rare cases, the body’s immune system attacks healthy cells due to various reasons. The attack on healthy liver tissue can result in inflammation and scarring of the tissue. Autoimmune liver condition includes primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC) and autoimmune hepatitis.

Infections:

Some infections can cause liver disease. Some of the most common infections are caused by toxoplasmosis, cytomegalovirus, adenovirus and Epstein Barr virus.

4.SIGNS AND SYMPTOMS OF LIVER DISEASES

The liver is a vital organ of the body as it supports several important functions like digestion and conversion of food to energy. It is also crucial to store energy as a fuel to be used during starvation or excessive demand for energy. The liver also acts as a massive filter removing toxic substances from the body. Liver disease or damage to the liver can influence all these functions and can result in serious health issues. Hence it is important to identify the damage early so that necessary steps can be taken to treat the damage. The damage caused by some conditions like cirrhosis is irreversible if it is not identified early but most of the conditions can be managed with early diagnosis.

Signs and symptoms of liver disease are as follows:

• Skin develops a yellow tinge, also called as Jaundice
• Nausea
• Vomiting
• Urine develops a dark yellow colouration
• Stools look pale, bloody or black (tarlike)
• Ankles, legs, or abdomen being swollen
• Decrease in appetite
• Persistent fatigue
• Itchy skin
• Unusual bruising

Signs and symptoms of Hepatitis

The symptoms may not be visible for years as the hepatitis virus may stay dormant in the body. It may manifest as flu-like symptoms initially which can gradually emerge with the following signs:

• Yellow coloration of the skin also called jaundice
• Nausea
• Vomiting
• General weakness along with tiredness
• Aches in muscles and joints
• Abdominal pain
• Loss of appetite
• Dark urine
• Stools look pale

Signs and symptoms of Fatty liver disease:

There will be no signs in the early stages of fatty liver disease but some patients may complain of pain on the right side of the abdomen. As the disease progresses, the disease can cause fever, jaundice along with nausea and vomiting.

Signs and symptoms of and Non-alcoholic fatty liver disease:

Patients with non-alcoholic fatty liver disease do not show any symptoms in the early stages. As the disease progresses they may show the following symptoms:

• Yellow coloration of the skin also called jaundice
• General weakness and fatigue
• Inexplicable weight loss
• Reduced appetite
• Itchy skin
• Swollen legs and abdomen

Signs and symptoms of liver diseases due to genetic conditions:

• Yellow coloration of the skin also called jaundice
• Fatigue and low energy
• Pain in joints
• Pain in the abdomen
• Reduced appetite
• Swelling in legs and abdomen

Signs and symptoms of Autoimmune Hepatitis:

Early symptoms of this condition include fatigue and itchy skin but as the disease progresses it may cause the following:

• Pain in right abdomen
• Jaundice
• Leg and abdominal swelling
• Enlarged liver, spleen, or abdomen
• Unexplained weight loss

In the final stages the symptoms of an autoimmune disease will be as follows:

• Jaundice
• Fatigue and decreased energy
• Pain in joints and abdomen
• Itchy skin
• Urine looking dark and pale stools
• Nausea
• Reduced appetite

Signs and symptoms of Cirrhosis:

• Yellow coloration of the skin also called jaundice
• Fatigue and weakness
• Reduced appetite
• Unexplained weight loss
• Very itchy skin
• Nausea
• Leg and abdominal pain and swelling
• Unusual bruising or bleeding

5.HOW TO KEEP YOUR LIVER HEALTHY

The liver breaks down all the food that passes through the body. It acts like a giant filter removing toxins from the body and protecting healthy human cells from the damage. It performs this task through the following mechanism:

• The toxins, especially the fatty one, are metabolized with liver enzymes and oxygen
• The toxins are combined with amino acids and are further eliminated through urine

In extreme cases of liver injury or liver damage, the system gets loaded with toxins resulting in health issues. The liver has the responsibility to break down or convert drugs, alcohol to components suitable for the food. Overloading the liver with large quantities of alcohol, fried foods, drugs, etc., impacts the cleaning process.

Food sources to enhance the detoxification process:

Several natural food sources are available to detoxify the liver. They stimulate the liver to expel toxins from the body. Some ideal food sources are provided below:

• Garlic:This is a common ingredient in our diet and when taken with food can activate liver enzymes that can flush out toxins from the system. Garlic has a component called selenium which helps in the detoxification process.
• Citrus Fruits:Oranges, grapefruit, limes, and lemons are well known to enhance the detoxification process. When taken in moderation, they promote the release of enzymes from the liver to flush out toxins.
• Vegetables:Broccoli and cauliflower possess a compound called glucosinolate which can promote the liver to produce detoxifying enzymes. They also possess sulfur which can enhance the health of the liver. Leafy vegetables are rich in chlorophyll, a compound that can leach toxins out of the bloodstream. Chlorophyll can also neutralize heavy metals from the body.
• Turmeric:It contains antioxidants that can repair liver cells and can also promote the enzymes to flush out toxins. Turmeric can also detoxify metals while boosting bile production.
• Walnuts:Walnuts are known to enhance the cleaning of the liver and assist in detoxifying ammonia.
• Beets:They cleanse the blood and help in the quick break down of toxic waste thereby facilitating their excretion. They are also known to stimulate blood flow and boost enzymatic activity.
• Carrots:Carrots are rich in flavonoids and beta-carotene which support the overall function of the liver. Carrots are rich in vitamin A which can prevent liver disease.
• Green Tea:Green Tea is rich in antioxidants which are proven to improve liver function.
• Apples:They are rich in pectin that helps the body in detoxification.
• Avocado:This fruit helps the body to produce glutathione that helps to cleanse itself of toxins.

Recommendations to keep the liver healthy

• Maintain a healthy diet: Eating healthy food can reduce the burden on the liver. Simple adjustments to diet and lifestyle can help in maintaining a healthy liver. A balanced combination of carbohydrates, fat, and protein is recommended.
• Eat food in moderation: Overeating can increase the load on the liver which is already working hard to digest the food while getting rid of toxins. It can also influence the liver capacity to function properly. Maintain good control and what you eat and keep a check on the quantity. Consuming too many calories, especially in the form of fat and alcohol results in excess storage of fat in the liver.
• Eat raw fruits and vegetables
• Increase fiber content in the diet which can further help in the absorption of fat and cleansing the bowel
• Eat a diet with good fats in moderation. This helps the body and liver to function effectively.
• Maintain healthy hygiene. Clean your hands regularly to avoid hepatitis.
• Avoid sharing needles with others. It can cause hepatitis.
• Limit alcohol intake to prevent cirrhosis or other liver problems
• Drink plenty of fluids to facilitate the excretion of toxins. This can prevent liver injury by toxins and also reduce the load on the liver.

6.IMPORTANCE OF LIVER FUNCTION TESTS

Understanding the health of the liver regularly is important to prevent liver problems or avoid irreversible damage. Your doctor may recommend certain liver function tests or blood tests to understand the health of the liver. These tests evaluate the level of enzymes and proteins in the blood. The objective is to understand the liver’s capability of producing protein and clearing bilirubin or test the levels of enzymes in the blood. Liver function tests are used to measure the following:

• Alanine transaminase (ALT)
• Aspartate transaminase (AST)
• Alkaline phosphatase (ALP)
• Albumin and total protein
• Bilirubin
• Gamma-glutamyltransferase (GGT)
• L-lactate dehydrogenase (LD)
• Prothrombin time (PT)

Objectives of the liver function tests:

• These tests help in screening liver infections
• Liver diseases like cirrhosis is progressive. Liver function tests help in monitoring the progress of the disease and the extent of damage. They also help in understanding the effectiveness of the treatment in managing the condition
• Tests help in measuring the severity of the condition like the extent scarring of the liver in cirrhosis
• Tests can help in monitoring the possible side effects of medication

7.TREATMENT OF LIVER DISEASE

If left untreated liver diseases can cause deterioration of liver function and permanent damage. Non-surgical treatment may not be able to reverse the underlying liver damage but may offer pain relief and reduce discomfort.

You doctor may recommend some lifestyle changes and diet modification to manage your cholesterol levels. You may be asked to reduce alcohol intake and maintain a healthy weight. You should also cut back on fat and sugar consumption and switch to fiber diet.

Your doctor may recommend some of the following medicines based on the severity of the condition.

• Anti-inflammatory medications – to reduce inflammation
• Medications to treat hepatitis – Drugs against hepatitis viruses
• Medication to treat inflammation of the liver
• Medication to treatblood pressure
• Supplements – vitamins and minerals

In extreme cases, your doctor may recommend surgery like liver transplantation surgery.

8.UNDERSTANDING LIVER FAILURE

Liver failure is a life-threatening condition and will need immediate medical attention. The most common symptoms of liver failure include nausea, loss of appetite, fatigue, and diarrhea. Severe symptoms may include bleeding, yellow discoloration of skin and eyes (jaundice), swelling of the abdomen with associated pain and discomfort, and confused state of mind (hepatic encephalopathy).

The two types of liver failure are “acute liver failure” and “chronic liver failure”. Acute liver failure is usually asymptomatic and may be caused due to drug overdose. Chronic liver failure is characterized by inflammation and scarring of the liver and is usually a long-term disease caused by heavy alcohol consumption.

Causes of liver failure:

• Overdose with drugs
• Viral infections - hepatitis A, hepatitis B, hepatitis E, EBV (Epstein-Barr virus), CMV (Cytomegalovirus), HSV (herpes simplex virus)
• Herbal supplements
• Industrial toxins
• Autoimmune disease
• Excess consumption of alcohol – leads to cirrhosis

Liver failure is diagnosed based on the symptoms, physical examination findings, and diagnostic tests including blood tests, radiological studies, and liver biopsy.

Treatment varies depending on the severity of the disease and underlying medical conditions.

• Medications may be prescribed to help alleviate pain and discomfort.
• Liver transplant to restore liver function

Tips to prevent hepatic failure:

• Limiting alcohol intake
• Vaccinations for hepatitis A and hepatitis B
• Diet and proper hygiene
• Avoiding drugs and sharing needles
• Exercise and maintaining a healthy weight.

9.STAGES AND PROGNOSIS

It’s hard to diagnose liver failure and the condition requires urgent medical care. Understanding the various stages of liver disease helps to make better and early treatment choices.

Inflammation

Liver inflammation is an early sign of liver disease and is usually asymptomatic. If untreated, the inflamed liver may become hard and cause health problems.

Fibrosis

Fibrosis refers to the scarring of the inflamed liver. In this stage, the normal functioning of the liver is impaired. Fibrosis causes no symptoms and may progress to cirrhosis if left untreated.

Cirrhosis

In this stage, the liver becomes inflamed, scarred and damaged and loses its ability to function due to the reduced blood supply. Patients with cirrhosis may experience symptoms of liver disease.

End-Stage Liver Disease

End-stage liver disease (ESLD) is an advanced case of cirrhosis in which the liver fails to function normally. The condition is irreversible and will need treatment. Complications include ascites and hepatic encephalopathy. A liver transplant may be needed in severe cases of ESLD.

Liver cancer

In some cases, the liver cells may become abnormal and grow out of control causing cancer. Risk factors of liver cancer include cirrhosis, hepatitis B, and can occur in any stage of liver disease. Signs and symptoms associated with liver cancer include:

• Nausea
• Vomiting
• Weight loss, unexplained
• Abdominal pain and swelling
• Loss of appetite
• Jaundice – yellowish discoloration of skin and eyes
• White chalky stools

Treatment of liver cancer varies depending on the tumor size/location, scar tissue, liver function and may include hepatectomy, liver transplant, ablation, chemotherapy, radiation therapy, targeted therapy, embolization, and chemoembolization.

10.LIVER HEALTH FAQS: ALL YOUR CONCERNS ADDRESSED.

1. Which foods can boost liver health?
2. The following can boost your liver health and can help you maintain good health.

• Hot beverages such as tea and coffee – lowers the risk of developing liver cancer
• Fruits rich in antioxidants like grapefruit – helps to protect the liver
• Berries like blueberries and cranberries - rich in antioxidants and inhibits the growth of liver cancer cells
• Grapes – prevents liver damage and fights inflammation
• Prickly pear – The juice of the fruit help reduce inflammation
• Beetroots – These vegetables are packed with antioxidants and nitrates. Beetroot juice reduces oxidative damage and inflammation.
• High fiber plant food protects the liver from damage.
• Nuts – Nuts top the list of foods that boost liver health. Nuts are a rich source of fats and nutrients including antioxidant vitamin E. Nut intake is associated with improved liver enzyme levels.
• Fatty fish are an excellent source of omega-3 fatty acids that fights inflammation.

1. How can I identify the symptoms of liver disease?
2. There will no clear symptoms in the early stages of liver disease. As the disease progresses you may see symptoms such as nausea, vomiting, unexplained weight loss, abdominal pain and swelling, white chalky stools, mental confusion, yellow discoloration of skin and eyes, and sometimes itchy skin. Talk to your doctor to know more about liver diseases and the associated signs/symptoms. Early diagnosis can help prevent the progression of the disease.
3. Is liver damage reversible?
4. Alcoholic liver disease is reversible. It is the condition of liver damage caused by excessive alcohol consumption for a prolonged time. The disease progression can be slowed down by stopping alcohol consumption. Liver damage in cases of acetaminophen overdose is also reversible once the drug usage is stopped. The liver will sometimes recover on its own with improvement in lifestyle and diet. In the worst cases, you may need liver transplantation when the liver loses all the functions.
5. What are the early signs of liver damage?
6. Liver disease doesn't always cause noticeable signs and symptoms. Few noticeable body changes or pain can be a warning for your liver:
   • Jaundice, (a condition where the skin and eyes appear yellowish)
   • Abdominal painand swelling
   • Leg Swelling
   • Itchy skin
   • Dark urine colour
   • Pale stool colour
   • Chronic fatigue
   • Nausea or vomiting
   • Loss of appetite
   • A tendency to bruise easily

1. How do you detect liver problems?

1. To find the cause and extent of liver damage, your doctor might recommend the following tests:
   • Blood tests to detect genetic conditions or liver dysfunctioning.
   • Imaging tests like CT scan, ultrasound and MRI can show liver damage.
   • Biopsy where your tissue sample is checked to diagnose liver disease and to look for signs of liver damage.

1. What are the 4 stages of liver diseases?

1. There are many different types of liver disease. It is important to know what happens to your liver at each stage of the progression before complete liver failure. Understanding the progression of liver disease may help you make better health choices. Here are the four stages of liver disease.
   Stage 1: The first sign of liver damage is Inflammation
   Inflammation in the liver is a sign that it in no longer efficient in detoxifying your blood of toxins found in the food you eat.
   Stage 2: Fibrosis is the start of Liver Scarring
   If you do not treat the inflammation, it will start to cause the liver to scar. It is the process of Fibrosis when the scar tissues replace the healthy liver tissue and thus reduces the liver function.
   Stage 3: More severe scarring leads to Cirrhosis
   When you don't treat the fibrosis medically, you are at risk of the next stage called cirrhosis, which is severe scarring of the liver.
   Stage 4: Liver failure
   It's the final stage where your liver completely fails to heal and loses all its ability to function.
   
2. Is itching a sign of liver disease?
3. Itching (pruritus) is one symptom of chronic liver disease, though not everyone with liver disease develops it. Some people get itching sensation is one particular area like the soles of their feet, limbs or the palms of their hands, while others experience an all-over itch. When itching persists, it can contribute to Insomnia, Fatigue, Anxiety, Depression, and impaired quality of life.
4. How should I change my diet if I have liver problems?
5. Dieting is one of the main ways to treat fatty liver disease, regardless of what type of liver disease it is. Here are a few food items you should avoid or limit if you have fatty liver disease.
   • Alcohol: It is a major cause of fatty liver disease.
   • Added sugar: Avoid sugary foods such as cookies, candy, sodas, and packaged fruit juices.
   • Fried foods: These are the powerhouses of fat and calories, which increases the amount of fat buildup in the liver.
   • Salt: Limit your Sodium intake. Eating too much salt can make your body hold on to excess water.
   • White bread and Rice: White usually means the flour is highly processed, which can raise your sugar level more than whole grains due to a lack of fibre.
   • Red meat: Avoid red meat as they are high in saturated fat.

Liver Transplant & HPB Surgery

The Liver Transplant and HPB surgery team at Narayana Health is among the most experienced in India. We offer treatment for end-stage liver disease(liver cirrhosis), unresectable liver tumour or metabolic liver disease; meeting the criteria for liver transplant. The team has extensive experience of doing complex hepatobiliary surgery for both benign and malignant diseases using open and laparoscopic approach. We are a reputed liver transplant hospital in India trusted by patients from India and across the world.

Our team was the first to use the robotic surgical platform for doing liver resections in India, our work is published in indexed surgical journals. We have also been actively using this technology (da Vinci surgical system) for doing hepatobiliary cases including choledochal cyst resection with Roux-en-Y hepaticojejunostomy, liver cyst resection, and radical cholecystectomy. The team has experience in treating liver and biliary diseases as enumerated. Our experienced team of liver transplant and HPB surgeons can treat the most complex cases using state-of-the-art equipment at Narayana Health. We strive to provide world-class treatments at affordable prices for patients suffering from liver diseases, cancers, and diseases of the bile duct, gallbladder, and pancreas. This is why we are rated as one of the best liver transplant centers in India.

When Do You Need a Liver Transplant Surgery?

A liver transplant surgery is recommended when the liver gets damaged, and it is beyond the body’s regenerative capacity to repair and heal. It is generally performed when there is liver failure due to tumours, scarring of the tissues within the liver, liver diseases, or general diseases. The reasons for liver transplant surgery vary depending on the age of the patient.

Liver failure may happen quickly or gradually over time. Sudden loss of liver function is called acute liver failure while chronic occurs slowly over months and years. Major causes of damage to the liver may include:

• Hepatitis B and C.
• Alcoholic liver disease
• Nonalcoholic fatty liver disease, a condition in which fat builds up in the liver, causing inflammation or damage to the cells within the liver.
• Genetic diseases also affect the liver including hemochromatosis, which causes an excessive iron buildup in the liver, and Wilson's disease, which causes an excessive copper buildup in the liver.
• Diseases that affect the bile ducts (the tubes that carry bile away from the liver), such as primary biliary cirrhosis, biliary atresia, etc.

Liver Transplant surgery in Children

Children usually need liver transplant surgery due to a condition known as biliary atresia. The bile ducts that transport the bile juice to the gallbladder and the intestine are underdeveloped in children suffering from this condition. The condition can be corrected with reconstructive surgery in the initial few months after birth. But if the problem persists, the child may require a liver transplant surgery.

Another common ailment that needs a liver transplant in children is a tumour known as hepatoblastoma. It is crucial to choose a liver transplant hospital in India with an experienced team of surgeons to conduct liver transplant and HPB surgery for young children.

Liver Transplant Surgery in Adults

There are many reasons that may necessitate liver transplant surgery in adults. Some of them are:

• Hepatitis C virus
• Hepatitis B virus
• Primary Biliary Cirrhosis
• Non-Alcoholic Fatty Liver
• Primary Sclerosing Cholangitis
• Hepatocellular carcinoma
• Hepatitis A or B virus
• Damage caused to drug overdose
• Liver cirrhosis

Liver Transplant & Hepatobiliary Services at Narayana Health

• Orthotopic Liver transplantOrthotopic liver transplantation involves the surgical removal of a patient’s liver and replacing it with a liver harvested from a deceased donor in the same anatomic position as the original organ. During the transplant surgery, the surgeon creates a small incision on the abdomen to remove the damaged liver and replace it with a healthy liver from a donor. The surgeon positions the donor’s liver in the place of the removed liver and connects all the blood vessels and bile ducts. Once the procedure is completed, the incision is closed. The surgeon attaches drainage tubes to drain away excess fluids and transfers the patient to the ICU for further treatment and recovery
• Living donor Liver transplantThis surgical procedure involves taking a portion of the liver from a healthy living person and placing it into someone with liver failure.
  The doctors first operate on the donor to remove a portion of their liver. The surgeons can remove the right or left side of the liver, depending on the age of the patient. The right lobe or right side of the liver is bigger, and hence, it is recommended for adult patients. As the left lobe is smaller, it is suited for children.
  The surgeon makes an incision on the abdomen and removes the damaged liver. Later, the right or left lobe from the donor is placed in the position, and all the blood vessels and bile ducts are connected. The incision is closed now and the patient is shifted to the ICU for recovery and treatment.
  The donor can regrow the remaining part of their liver, which can return to its normal size, volume, and capacity within a few months after the surgery. The transplanted liver grows and restores its size and function too.
• Split donation Liver transplantDue to the anatomy of the liver, it can’t be split evenly for transplantation. For the split donation liver transplant, the organ is divided into two parts – 35-40% is the left lobe, and 65-70% is the right lobe. Since the split liver halves are smaller than the whole organ, the surgery can benefit smaller patients who weight between 100 and 160 pounds.
  To maximise the benefit of each available donor organ, the two parts of the liver can be transplanted to two different patients. This procedure is generally used if there are two patients who require a liver transplant surgery, (one an adult and the other a child). The process of the surgery is the same as the living donor liver transplant. The transplanted liver grows to the normal size through the process of regeneration.

 

 

Auxiliary Liver Transplant

This procedure is preferred for patients with hereditary or metabolic liver diseases. The surgeon removes only the diseased part of the liver, and the remaining liver is left in place for spontaneous recovery or recovery through gene therapy.

• HepatectomyIn hepatectomy, all or a part of the liver is surgically resected.The procedure is performed to remove tumours from the liver cells called “hepatocytes”. It is used for patients suffering from localized resectableliver cancer, which does not spread to the lymph nodes or other parts of the body. During the hepatectomy procedure, the surgeon can remove a part of the liver that is affected by the tumour, the right or left lobe of the liver or a larger portion depending on the location and size of the tumour.
  When only a part of the liver is removed it is known as partial hepatectomy. In this procedure, the doctors’ remove only the diseased part of the liver and leave the healthy liver to regenerate and carry its functions.
• Robot-assisted laparoscopic hepatectomyLaparoscopic hepatectomy is a modern alternative to hepatectomy. It is a minimally invasive procedure that offers a safe and effective way to treat liver diseases. Laparoscopic surgeries help to shorten the hospital stay, provide a quick return to a normal diet, and offer full mobility in a short span.
  The procedure is performed under general anaesthesia. The surgeons make three to seven small incisions on the abdomen, depending on the location of the tumour, its size and the amount of the liver to be removed.
  The robot-assisted laparoscopic hepatectomy can overcome the limitations of conventional laparoscopy. It offers increased dexterity and a three-dimensional and magnified view of the operative field.
• Combined liver and bile duct resectionThis procedure is performed to remove tumours located high in the bile ducts. The surgeons remove the gallbladder along with the common bile duct. Later, a portion of the small intestine is directly attached to the remaining part of the bile ducts. This process provides a way for the bile to flow directly from the liver to the small intestine. In case the tumour involves the liver, a combined liver and bile duct resection is performed to remove the damaged part of the liver along with the bile duct and the gallbladder.
• Pancreaticoduodenectomy or Whipple ProcedureIt is a complex operation performed to remove the duodenum, the gallbladder, the head of the pancreas and bile duct. It can also be used in the treatment of tumours and other disorders of the pancreas, intestines and the bile duct. After the procedure is complete, the surgeon reconnects the remaining organs to enable the patient to digest food normally.
  The Whipple procedure is generally recommended in case of the following conditions.
  1. Pancreatic cancer
  2. Cysts in the pancreas
  3. Tumours in the pancreas
  4. Pancreatitis
  5. Cancer of the bile duct
  6. Cancer of the small bowel
  7. Ampullary cancer
  8. Pancreas trauma
  9. The trauma of the small intestine
  10. Neuroendocrine tumours
• The Whipple Procedure aids to extract the tumour and stop the spread of cancer to the other parts of the body. It can be done as open surgery, laparoscopic surgery, or robotic surgery depending on the complexity of the procedure, and the location of cancer.
• Biliary BypassThe Biliary bypass surgery involves going around a blockage in the bile duct. A blockage can result in pain, itching, jaundice, liver failure, etc. With Biliary surgery, the bile can flow out of the liver to the gallbladder or small intestine and relieve the patient of the symptoms caused by a blockage. The procedure is recommended when other types of surgery are not useful to remove the blockage.
  The surgery can be performed either in open surgery, laparoscopic or robotic methods. It is performed under general anaesthesia. The doctor makes a cut in the bile duct before the blockage, he will also make another cut in the bile duct or the small intestine after the blockage. He then connects both the openings to create a new path for the flow of bile. The incisions are closed with sutures and drain tubes may be inserted to absorb excess fluids.
  Liver transplant surgery is an extremely complicated procedure that requires experience and expertise. Choose Narayana Health for the best liver transplant hospital in India with the world’s best team for liver transplant and HPB surgery.

Treatment Process For Liver diseases

Accurate diagnosis plays a crucial role in the determination of the treatment process for liver diseases. There are 3 types of tests that help in the diagnosis of the liver and biliary diseases.

• The first step of the process starts with blood tests such as liver function tests that help the doctors to ascertain your genetic conditions and specific liver problems.
• The blood tests are followed up with imaging tests such as MRI, CT Scan and Ultrasound scans to figure out the extent of damage to the liver and bile ducts.
• The surgeons may also conduct biopsy tests for proper diagnosis of tumours and other liver diseases.

The treatment process differs from one patient to another depending on the diagnosis, age, and the extent of the liver and biliary damage. The early stages of liver and biliary diseases can be treated with medicines and lifestyle changes. However, some serious liver problems require surgery or liver transplant.

How to Choose the Best Liver Transplant Hospital in India For Your Liver Transplant and HPB Surgery?

1. 1. Team of Specialists - The hospital should have a team of superspecialists who are experts in treating end-stage liver diseases using advanced treatment procedures. The team must consist of renowned doctors and surgeons in the liver and biliary surgery for pediatric and adult patients.
   2. Robotic Surgical Platform - The hospital should have expertise in using the robotic surgical platform for conducting liver transplant and HPB surgery. Choose a hospital that uses the advanced da Vinci surgical system to conduct various liver and HPB surgeries.
   3. Accreditation - The hospital should be accredited by NABH and JCI, which are proof of world-class standards in healthcare.
   4. Dedicated International Division - If you are not an Indian resident, it is preferable to choose a hospital with a dedicated International division to facilitate a smooth treatment process for overseas patients. The international services must include concierge service, language interpretation services, visa invitation letter, medical opinion, and a host of other services to make your treatment process smooth and convenient.
   5. Modular Operation Theatres - Choose liver transplant hospitals that have modular operation theatres, which comply with international standards. The operation theatres must be equipped with the latest technology and advanced monitoring systems that aid the surgeons to perform liver and HPB surgeries with precision.