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Ramesh HospitalsRamesh Hospitals

Aster Ramesh Multi Organ Transplant Programme

An outstanding team of doctors working dedicatedly in a state-of-the-art Multi Oragn Transplant Complex with Transplant Operation Theatres and Transplant ICUs for liver, kidney, heart transplantation surgeries provides the best service in the region.

What is Organ Transplant?

Organ transplant, as the name suggests, is replacing one’s diseased organ like liver, heart etc. with healthy donated organ. There are two types of transplant: Solid Organ Transplant and Bone Marrow Transplant/ Peripheral Blood Transplant. Solid Organ Transplant is replacing organs like the kidney, liver, pancreas, heart, lungs and small intestine. Bone Marrow / Peripheral Blood Transplant are non-surgical procedures that involve infusing healthy blood cells to replace the diseased cells. 

Liver Transplant Programme

What is a liver failure?

When the liver is irreversibly damaged and loses its ability to carry out its normal functions, it is called liver failure.

Acute Liver failure, wherein the liver fails to work all of a sudden, is usually caused as an after-effect of certain medication or infection.

Chronic liver failure or complete damage of the liver is a life threatening condition that sets in gradually, over many years. The causes can be cirrhosis or cancer of the liver.

What causes chronic liver failure?

Liver cirrhosis is a slowly progressing disease in which scar tissue replaces healthy liver tissue, causing permanent and irreparable damage to the liver.

The reasons for liver cirrhosis can be:

  • Hepatitis B or C infection
  • Alcoholic liver diseases
  • Non-alcoholic fatty liver disease (fat build-up in the liver cells)
  • Genetic and auto immune disorders
  • Congenital birth defects

According to the National Institute of Health, liver cirrhosis is the 12th leading cause of death by disease in India.

What are alcoholic liver diseases?

Alcohol is a toxin that can cause irreversible damage to your liver. Every time you drink, your liver does its best to break down the alcohol and expel the toxins from your body. However, if the alcohol content is beyond what the liver can handle, it will gradually start losing its ability to function, which in turn leads to several complications.

What are the different types of alcohol-related liver diseases?

The three major liver diseases induced by alcohol are alcoholic fatty liver disease, alcoholic hepatitis and alcoholic cirrhosis.

Alcoholic Fatty Liver

Excess alcohol consumption leads to accumulation of extra fat in your liver.
The first stage of alcohol-related liver disease, this condition usually goes unnoticed as there might be no symptoms at all. However, some patients do present symptoms like unexplained fatigue and weakness. The fat accumulation in the liver will mostly go away by itself if you stop drinking alcohol at this stage. Those who are overweight and have diabetes will need to be extremely careful, for the risk of permanent liver damage is way higher in them.

Alcoholic Hepatitis

This is a condition that causes the liver to swell, in turn damaging it. The symptoms of alcoholic hepatitis include loss of appetite, vomiting, abdominal pain, fever, and jaundice. It is estimated that one out of every three heavy drinkers develops alcoholic hepatitis. Alcoholic hepatitis can either be mild or severe. Mild liver damage can be reversed; all you need is to quit drinking. However, if one continues to consume alcohol despite having mild alcoholic hepatitis, the liver will slowly start becoming dysfunctional. According to reports, more than 50% of patients with severe alcoholic hepatitis do not survive.

Alcoholic Cirrhosis

Alcoholic cirrhosis is permanent scarring of the liver caused due to excessive alcohol consumption. A life-threatening condition and the most serious alcohol-related disease, the liver fails to function normally as healthy liver tissue gets replaced with scar tissue. The damage caused to the liver is usually irreversible.

Though stopping alcohol consumption may help prevent further damage, related complications are not curable.

In addition to the symptoms of alcoholic hepatitis the patient may develop severe bouts of jaundice, vomit blood, suffer from fluid accumulation in the abdomen and feet, get mentally disoriented or worse, slip into a coma.

Estimates say that almost 20% of heavy drinkers develop liver cirrhosis. 

How do alcohol-related liver diseases progress?

Heavy drinkers usually progress from fatty liver to alcoholic hepatitis to alcoholic cirrhosis over time. However, one may develop alcoholic cirrhosis without getting alcoholic hepatitis first. Besides, obesity, diabetes, and chronic Hepatitis C infection increase the chance of liver diseases substantially.

What are the complications that arise from alcohol-relatedliver diseases?

The complications of liver diseases start showing very slowly, over many years. Symptoms usually aggravate with time and become life threatening. The patient may suffer from

  • Build-up of fluid in the abdomen (ascites) and legs (edema)
  • Vomiting blood due to rupture of veins in the food pipe or stomach
  • Deliriousness or confusion (Hepatic Encephalopathy)
  • Coma
  • Kidney failure
  • Liver cancer

How is alcohol-related liver disease diagnosed?

Your doctor can diagnose whether you have any alcohol-related disease based on your medical history, physical examination, blood tests and radiological investigations such as Ultrasound or CT scan.

If required, you may need to undergo a liver biopsy. This will help your doctor to understand the extent of damage caused to your liver. During the biopsy, a small portion of the liver tissue will be removed with the help of a needle and tested in the laboratory.

Remember, it is possible that a patient can suffer from multiple liver problems like Hepatitis B and Hepatitis C infection at the same time.

When does one need a liver transplant? 

If the liver gets irreparably damaged and cannot be managed medically anymore, your doctor might recommend a liver transplant, depending on your health condition.

How is a patient chosen and enlisted for a liver transplant?

The first thing we do is to assess the patient as a team to determine whether transplant is the best way forward.

Secondly, his or her medical fitness for the transplant is assessed. Our team comprises hepato pancreato biliary/ multi organ transplant surgeons, hepatologists, transplant anesthesiologists, liver anesthesiologists, Intensivists, critical care experts, diagnostic radiologists, interventional radiologists, infectious diseases/ infection control physicians, psychiatrists and clinical psychologists supported by transplant coordinators, substance dependency experts to help those with a history of alcohol/drug use and social workers.

All medical records are reviewed carefully, and a comprehensive pre-transplant diagnostic and pathological investigations are done to understand the extent of liver damage, ascertain blood, heart and lung health and check for any other major infections or diseases.

If everything is acceptable, then we register the patient for a liver transplant, according to blood type, body size, medical condition and a priority score based on three simple blood tests known as MELD (model of end-stage liver disease) in adults and PELD (pediatric end-stage liver disease) in children.

Patients with the highest scores are transplanted first.

What is liver transplant?

Liver transplant put simply, is the process of replacing the diseased liver with a donated, healthy liver an extremely advanced procedure, it banks heavily on the expertise and experience of the transplant team and of course, high-end medical technology, transplant team and high-end medical technology. There are two types of liver transplant: living donor transplant and cadaveric donor (deceased donor) transplant.

When a healthy person donates part of his or her liver for transplantation, it is called living donor transplant. Living donor liver transplant has its advantages. If someone, preferably a family member is willing to donate part of their liver and the blood type matches, there is no need to wait.

The liver regenerates itself and will grow to its normal size in both the donor and the recipient in 6-8 weeks.

In case there is no live donor available, then one has to wait for cadaveric organ transplant (the liver of a donor who is brain-dead). In some cases, one donor liver can be transplanted into two people. This is called Split Liver Transplantation.

Worldwide, the success rate of a liver transplant- both live and cadaveric – is quite high.

Patients undergoing liver transplantation can expect a success rate of over 90%. We also perform pancreas transplant, which in most cases, is carried out simultaneously with a kidney transplant.

What are the possible post-surgery complications?

Like every advanced surgery, liver transplant too can have possible complications in some cases.

Your body’s immune system is programmed to destroy foreign substances that invade your body. This means your immune system may attempt to attack your new liver. This is called rejection and is seen in more 30% liver-transplant patients within the first year of transplant.

The doctors will give you anti-rejection medications to counter the immune attack.

How is it going to be after the surgery? 

Post-surgery, you will need to stay in the hospital for 2 to 3 weeks, so that we ensure you recover well. However, it is different for different people, as some might need more time to recover from post-surgery complications.

Our doctors will always take time out to listen to you and to take good care of you, supported by our award winning team of CLS/BLS/ATLS/PALS certified nurses.

In order to ensure your smooth recovery even after you get back home, our nurses and transplant coordinator will prepare well in advance prior to discharge.

What you should do and what not will be explained to you in detail, along with your new medications that will help you overcome possible post-surgery complications. You will need to take these medications all your life.

Our medical team will also tell you how to keep a watch on signs of rejection and infection and when you should seek immediate medical help.

Follow-up 

It is very important to follow-up as advised after the surgery. You should do every single health check-up as prescribed without fail. You will become a participant in your own healthcare, and we will do everything possible to ensure you remain safe and healthy.

Kidney Transplant Programme

Understanding Kidney Failure

Kidneys are your body’s filters. They purify blood several times a day, maintain your body’s fluid and electrolyte balance and produce urine.

So when the kidneys fail to function, your body starts getting poisoned. Each of your kidneys comprises a million microscopic filtering units called nephron. The most dangerous fact about kidney or renal failure is that one might not know about it till 90% of the function is lost.

The symptoms of kidney or renal damage include symptoms like swollen ankles, vomiting, weakness, poor sleep, and shortness of breath. If not addressed medically, the kidneys will eventually become dysfunctional – a condition that’s life threatening.

What causes kidney failure?

Chronic kidney disease (CKD) occurs when your kidneys have been malfunctioning for more than 3 months. It’s an irreparable, life threatening condition and there might be no visible symptoms at all.

Diabetes (types 1 and 2), high blood pressure, immune system diseases such as Lupus and chronic viral illnesses like AIDS, Hepatitis B and Hepatitis C can also cause kidney failure.

The other reasons for kidney failure include:

  • Multiple episodes of urinary tract infection
  • Post-strep infection
  • Polycystic kidney disease
  • Inherited kidney diseases
  • Congenital or birth defects – In many cases, the defect is rectified while the baby is still in mother’s womb; whereas those with major complications can only be managed at a later stage.
  • Drugs and toxins, including long-term use medications like NSAIDs (Non-Steroidal Anti Inflammatory Drugs
  • Long-term exposure to certain chemicals 

What is Kidney Transplant?

The kidney transplant is the process of replacing the diseased kidney with a healthy, donated kidney. It is recommended only if the kidneys are so damaged that they cannot be managed medically (Chronic Kidney Disease or End Stage Renal Disease).

In some cases, a transplant might not be a practical solution if the patient has an active infection or another life-threatening disease such as cancer, severe heart or lung diseases.

Fortunately, according to worldwide figures, the success rate of a kidney transplant is above 95%. This not only comes as a reassurance for those opting for transplant but also reaffirms the fact that kidney transplant is indeed an effective mode of treatment.

What are the types of a kidney transplant?

There are two types of kidney transplants: Live donor Transplant and Cadaver Transplant

When a person is transplanted with a kidney from a live donor, it is called Live Donor Transplant. The donor could be anyone – a family member, friend, colleague or even a random person who is generous enough to gift life by donating one of his/ her kidneys.

Usually, the success rates of kidney transplants in which the donor and recipient belong to one family (parent/ sibling) are higher. This is because of high donor-recipient compatibility, which means the chances of rejection are very low. A live donor makes things easy as the waiting period is lesser and the patient gets well faster.

Cadaver transplant is when the kidney is got from a donor who is certified brain-dead. He or she would have would have signed up for donation before death. The kidney is surgically removed after obtaining consent from the deceased’s family and transplanted in the recipient.

What are the pre-transplant formalities?

You will have to go through a series of investigations before the surgery to ensure that the donor’s kidney matches your tissue and blood type. You will also be screened for other health problems including heart or lung diseases.

After these tests, you will be enlisted on the transplant list and also on the organ sharing network list. As soon as a matching recipient is available, we will let you know; and if all factors are favorable, our entire team will work as one to ensure you undergo the surgery without any issues.

What are the possible post-transplant risks?

The post-surgical risks, like every other transplant surgery, include rejection, infection, bleeding or reaction to anaesthesia.

Rejection happens when the body fails to recognize the new kidney and fights to destroy it. During the first few weeks or months post-surgery, your body may try to reject your new kidney. This is called acute rejection and occurs in 25 – 55% of the recipients. You’ll be given immuno-suppressants to counter this problem. Remember, it is mandatory to continue these medicines for the rest of your life.

There is also a chance of chronic rejection – a gradual, progressive loss of kidney function that may occur over many years. Unfortunately, there’s no known treatment for chronic rejection and the patient may have to depend on dialysis again or opt for another transplant.

Aster Centre of Excellence in Multi-Organ Transplant has a very strong infection control system that’s managed by a highly-trained team of infectious diseases & infection control Physicians. Besides, we also have advanced technology like the HEPA Filter that purifies air to 0.3 microns, creating a safe and sterile environment for the patient.

What will it be like after the surgery?

You’ll be under continuous medical observation for 7 to 10 days post surgery so that we can check whether your new kidney is functioning properly. At times, the new kidney might take some time to start functioning and produce urine. You might have to undergo dialysis till then and also take medications like diuretics to help the kidney expel excess water and salt from your body.

Our nurses and rehabilitation experts will take good care of you and guide you through your recovery.

We have state-of-the-art hemodialysis and peritoneal dialysis facility, complete with a water treatment plant to ensure high-quality dialysis for patients.

Follow-up 

It is very important to visit your consulting doctor regularly and undergo all prescribed follow-ups and test to make sure that your new kidney is functioning well. Remember, a transplant surgery is a second chance at life and you need to be responsible for your own well-being.

 

Heart Transplant Programme

When does one need a heart transplant?

Heart transplant means replacing one’s diseased heart with a healthy donated heart. An extremely complicated procedure is suggested only when the heart failure is so severe that it cannot be managed with medication or any other mode of treatment.

Cardiac care has evolved phenomenally in the recent times, enabling us to treat complex heart problems effectively – medically and surgically. However, if the condition of the heart is such that no medications or surgical solution can bring any sort of relief, we have no choice but choose heart transplant as the way ahead.

What leads to the need for a heart transplant in children?

Children and infants are also highly susceptible to heart disease and might require heart transplant due to severe cardiomyopathy (weak heart muscles) and congenital heart disease that cannot be medically managed. Some children who have already undergone corrective cardiac surgeries might also require heart transplant due to re-occurrence of problems (continued cardiac problems).

What all do you need to do before a heart transplant?

If your doctor recommends a heart transplant, there are many formalities and tests you will need to complete before you undergo the surgery. You will need to go through an extensive screening process involving Radiological and Pathological Investigations. Our transplant team comprising Cardiac Surgeons, Cardiologists, Cardiac Anesthesiologists, Pulmonologists, and Pathologists will thoroughly review your reports to ensure that your medical fit for the surgery. We will then enlist you on the Heart Transplant List till we get notified of a suitable donor. Remember, waiting for a heart transplant might be a long drawn one for getting a donor – a suitable donor – is not easy. We will continuously monitor your health during this waiting period through regular check-ups and investigations. As soon as we get information that there is a donor heart available, we will contact you and if all factors are favorable, the transplant will be performed.

Who gives you your new heart? 

The donor from whom you get a new heart is usually someone who would have signed up for organ donation before he or she died.

The heart is surgically removed, with the full consent of the donor’s family, once the donor is certified brain-dead.

The availability of donor organs are informed through an organ sharing network and the recipient is chosen based on the best possible match – with respect to the blood type, body type, recipient’s medical condition, and the waiting period.

The religion/ race/ gender of the donor or the recipient does not matter (in any organ transplant for that matter) while determining the match.

All donors are mandatorily screened for Hepatitis B and C and for HIV.

When it comes to pediatric heart transplants, we make sure that your child gets the best care possible. Our team of experts comprises Paediatric Cardiac Surgeons and Paediatric Interventional Cardiologists with decades of experience to their credit. We have specialized, state-of-the-art facilities for this programme including a Level 3 PICU that’s managed by internationally trained pediatric intensivists.

Waiting for a heart can be quite distressful, but if everything goes well, it’s definitely a second chance at life.

How is the heart transplant done?

Once a donor’s heart becomes available and all other factors are ascertained favorable, our entire transplant team gets ready for the surgery.

Our transplant surgeon will remove the diseased heart of the patient, except the back walls of the atria – the heart’s upper chambers.

The backs of the atria of the donated heart are opened and sewn into place; and blood vessels are connected, allowing the blood to flow to the heart and lungs. As the heart warms up, it starts beating.

You’ll be able to sit up and walk within a few days after the surgery, and if there are no signs of organ rejection, you can go home in probably about two weeks.

What are the possible post-surgery complications?

The two major complications that can arise after a heart transplant surgery are an infection and rejection.

Rejection occurs when your body’s immune system fails to recognize the transplanted heart and tries to destroy it. We will put you on immune-suppressants to minimize this risk. You might also be required to undergo a procedure called Myocardial Biopsy at prescribed intervals to check for signs of rejection.

Infections can occur post surgery, posing a threat to life. However, we have the most advanced infectious diseases and infection control wing, which include facilities like the HEPA Filter that purifies the air to 0.3 microns.

There’s also a possibility of coronary artery disease in patients who’ve received a transplant. This is a life-threatening condition because most of them feel no symptoms such as angina (chest pain) as they have no sensation in their new hearts.

You should seek immediate medical help if you notice symptoms like fever, chills, aches, dizziness, nausea, shortness of breath, chest pain or tenderness, unexplained fatigue, a spike in blood pressure, persistent cough, white patches in your mouth or tongue, foul-smelling urine, nasal congestion, and diarrhea.

Post-surgery care 

Post-surgery care is extremely crucial and you have to take up the responsibility of your own health and well-being.

Make sure you take your medications on time. And remember that these medications must be taken for life.

Exercise – we encourage heart transplant recipients to increase physical activity to improve the functions of the heart and avoid weight gain. However, you’ll need to take the advice of your Cardiologist and Rehabilitation Therapist before you start on your regime.

We’ll give you specific instructions on what you should eat and what you should not. A low-fat, low-sodium diet will decrease the risk of heart diseases, high blood pressure and fluid retention.

Remember, how you recover, how well you recover and how quickly you recover depend on many factors including your age, general health and your response to the transplant.

Patients, especially children will need to be monitored all their life to ensure nothing is wrong. Fortunately, according to worldwide statistics, almost 85% heart transplant recipients get back to their normal life within a reasonable time.

The most important of all is regular check-ups. Missing even one means you are neglecting your health. So visit your doctor at regular intervals, get your investigations done on time and lead a healthy lifestyle. It’s a second chance at life; make sure you live it well.

Doctors

P-Ramesh-babu

Dr P Ramesh Babu

Chief Cardiologist & Managing Director

Dr. Jayanth Reddy, J Praveen Kumar, KSN Chary, G Rama Mohan Rao, Dr. Raju Badipati, K Pavan Kumar ,K Pavan Kumar, Niti Singhal, P Geetha Vani, Dr D Naveen Chandra Rao, BV Sudheer Kumar, B Sudeena, Dr R John Satish, Dr K Raja Ramamohan Rao , Dr B M V Krishna Chaitanya , Dr. T Sai Prasad ,Krishna Chaitanya, Lakshmi Kantham , Dr.T Lakshmi Kantham, Neurologists, Dr. K .Naga Kalyan Ram, Gastroenterology , Dr.Y Karthik Chowdary, Dr K Hima Bindu,Dr P Chayadevi

Dr Sonal Asthana

Sr Consultant – Hepatobiliary & Multi-Organ Transplantation Surgery

Sr Cardiothoracic Surgeon At Ramesh Hospital, Tonse Jaya, Dr. Tonse Jaya Ram Pai

Dr T Jaya Rama Pai

Sr Consultant – Cardiothoracic Surgery

Dr. Jayanth Reddy, J Praveen Kumar, KSN Chary, G Rama Mohan Rao, Dr. Raju Badipati, K Pavan Kumar ,K Pavan Kumar, Niti Singhal, P Geetha Vani, Dr D Naveen Chandra Rao, BV Sudheer Kumar, B Sudeena, Dr R John Satish, Dr K Raja Ramamohan Rao , Dr B M V Krishna Chaitanya , Dr. T Sai Prasad ,Krishna Chaitanya, Lakshmi Kantham , Dr.T Lakshmi Kantham, Neurologists, Dr. K .Naga Kalyan Ram, Gastroenterology , Dr.Y Karthik Chowdary, Dr K Hima Bindu,Dr P Chayadevi

Dr G J Narasimha Rao

Sr Consultant – Cardiothoracic Surgery

Dr. Jayanth Reddy, J Praveen Kumar, KSN Chary, G Rama Mohan Rao, Dr. Raju Badipati, K Pavan Kumar ,K Pavan Kumar, Niti Singhal, P Geetha Vani, Dr D Naveen Chandra Rao, BV Sudheer Kumar, B Sudeena, Dr R John Satish, Dr K Raja Ramamohan Rao , Dr B M V Krishna Chaitanya , Dr. T Sai Prasad ,Krishna Chaitanya, Lakshmi Kantham , Dr.T Lakshmi Kantham, Neurologists, Dr. K .Naga Kalyan Ram, Gastroenterology , Dr.Y Karthik Chowdary, Dr K Hima Bindu,Dr P Chayadevi

Dr K Srinivas Babu

Sr Consultant – Cardiothoracic Surgery

Dr KR Prakasam

Sr Consultant – Gastroenterology

Dr. Raju Badipati, Dr. HIMA BINDU BOLLA, DR B THANUJA , Dr.Shaik Moulali, Dr Biju Govind , Dr. Srinath Reddy , interventional cardiology- consultant

Dr Jayanth Reddy

Consultant – Hepatobiliary & Multi-Organ Transplant

Dr. D Vani, Best Multi Organ Transplant Doctors In Vijayawada, Guntur

Dr D Vani

Consultant – Nephrology

Radiologist

Dr I Nalini Prasad

Consultant – Gastroenterology