Liver transplant in Pakistan: Procedure, cost and transplant centers in Pakistan


Liver transplantation- Procedure, cost and transplant centers in Pakistan

A liver transplant is a procedure in
which the liver of someone which has stopped or poorly working can be replaced
with the healthy liver. This article explains what the indication for liver
is and describes how it is performed. A liver transplant is a
surgical procedure which replaces a disease-struck liver with a healthy,
complete and healthy one of the patients. This article provides the latest
indications on liver transplantation types, operations in general and
immunosuppression required following transplantation.

do people need liver transplants?

transplant is a way to manage patients with liver failure, although liver has
the capacity to regenerate but in the events when chronic infections like
hepatitis B & C, tumors, fatty liver or metabolic disorders lead to chronic
liver damage or even acute events like poisoning, acute hepatitis leading to
liver shutdown, often liver transplant is the only way to save lives. As
currently there is no liver replacement therapy like dialysis in kidney

 Liver transplant in PKLI Liver transplant in Gambat

happens during a liver transplant?

to liver transplantation, there is an entire evaluation process, during which
patients that are candidates for liver replacement are evaluated in depth.

transplant evaluation process in Pakistan

evaluation is often done in steps, the first step is to establish how advanced
is the liver disease, what are the complications, can the patient be managed
medically or transplant is absolutely necessary. Your treating physician will
take your detailed history to establish the stage of disease and what
decompensations have occurred e.g. Ascites, Upper gastrointestinal bleeding,
Encephalopathy, Jaundice, Liver tumors i.e. HCC , hepatorenal syndrome or
hepatopulmonary syndrome. In addition, your doctors will look into your past
medical history and evaluate for cardiac or pulmonary disease or any other
contraindications to your surgery.

from the history, you will get some blood works done to establish your blood
group if not already known, and baseline liver tests to calculate your liver
scores using scoring tool like Meld Na Score and Child Pugh score.

follows an in-depth discussion by the transplant hepatologists with transplant
surgeons alongwith discussion with the patient to decide future course whether
to continue medical treatment for some time or liver transplantation has to be
proceeded with. The risks and benefits of the surgery and post-op care and

next step involves extensive investigations to workup for any infections, any
underlying diseases, cardiac fitness and liver imaging with C.T scans.

are offered vaccinations for common infections e.g. pneumococcal, meningococcal
and influenza prior to liver transplant.

final step for the patient is to get fitness from relevant doctors in order to
proceed with surgery, e.g. anesthesia evaluation will be done at this stage and
decided whether patient is fit anesthesia or not similarly fitness evaluation
is done by all concerned sub-specialties e.g. nephrology, cardiology,
physiotherapy, psychiatry, pulmonology, infectious disease etc.

above is a brief outline that entails the work-up process that occurs from the
time patient is seen in clinic for transplant consideration to being listed for
the surgery, minor variations or addition of steps might be present depending
upon the hospital and local regulations and whether cadaveric or live donor
liver transplant is being considered.

transplant types: live vs cadaveric

the countries where cadaveric liver transplant is commonly done e.g. USA, UK,
ITALY, SPAIN, FRANCE etc, once the patient is evaluated he is put in the
transplant waiting list and his surgery is proceeded with when his turn comes
up depending upon the urgency of liver transplant and the availability of
transplant organs.

the countries where mostly Liver donor liver transplant is done i.e. most
eastern countries like Pakistan, China, India and Korea. The potential donor
evaluation is done simultaneously.

donor evaluation process

criteria established for liver donor by most centers is that, donor should
blood group should match with the recipient. Positive and negative blood groups
are not considered just the main group e.g. A, B, O is considered.

should be medically fit and have no underlying medical condition.

be obese as fatty liver can’t be transplanted. Age should be around 18-50

to the patient the donor has to undergo medical tests and liver imaging e.g.
c.t scans to assess his liver and plan re-section of liver along-with fitness
evaluation for surgery.

depending upon the institute / local regulations, permission from ethical
review boards or transplant regulatory authority need to be taken.


transplant surgery in Pakistan

transplant surgery takes around 7-8 hours, the patient is put under anesthesia, the
diseased liver is removed followed by transplantation of the donor liver.

are usually kept in ICU for 2 days following the surgery for observation
followed by the next 10-14 days in the ward, where daily observation is made of
patients wound, liver functions and optimization of immunosuppression

me the risk of liver transplant surgery?

the liver transplant surgery was established their has been excellent advances
in the surgical techniques, pre and post op management and managing the
immunosuppression after the transplant. Having said that, considering it’s a
major surgery, the patients undergoing the surgery are mostly not in their best
of health. There are some risks associated with surgery.

the success rate varies from center to center but broadly speaking the average
success rate for liver transplant surgery is 85 %.

addition, about 20 % of the patients might face some adverse effects, most of
which can be managed medically or via minimal invasive procedure.

Infections: These can occur during
the immediate period or over the course as patient is on immunosuppressive

Strictures: These are the narrowing
of liver ducts mostly at the place where patient and donor organs are attached.
If this occurs, this is managed via ERCP i.e. endoscopy.

Liver rejection: Finally the
transplanted liver might not work at all, though this number is very, very small, most patients might have to face deranged liver functions as a result of
inadequate medication dose.

Relapse of primary disease: Some
disease like autoimmune hepatitis might relapse and affect the transplanted


major risk is about 0.5 % i.e 1 in 200. Though similar to a recipient, donors
can face some minor complications e.g. infections, leakage from the surgery
site, hernia and anesthesia related adverse effects.


the liver is a major vital organ involved in the normal functioning of the body,
whether, metabolizing the absorbed nutrients or detoxifying the harmful
substances. Our body can’t function without a healthy liver.

what about those donating the liver?

liver donors, only a part of liver is removed, not the full liver. After the
surgery, the remaining portion of the liver increases in size to reach the
pre-surgery level.

transplant cost in USA

approximate cost of liver transplant in USA ranges from $ 163,438 ( 145k to
180k). Cost varies depending upon the center and insurance coverage. In private
setups full costs may reach $ 300,000 – 


transplant cost in UK

to the USA, liver transplant surgery is cheaper in UK. The exact value depends
upon the center and nhs.

rate vary from 13-15000 GBP. Some sources quote $80,000.


transplant cost in Pakistan

Pakistan, liver transplant is done both in private sector and public sector

the public sector hospitals, the specialized centers doing transplant in bulk

PKLI, Lahore, Punjab

Gambat Institute, Khairpur, Sindh

the public sector hospitals, transplants are done on a discounted rate or even
almost free of charge as well. The cost for liver transplant in PKLI as a
private patient varies from Rs. 30,00,000 to 40,00,000.

the private sector institutes are Shifa hospital, Islamabad. Bahria hospital,
Lahore and some other hospitals.


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