Liver Transplant Service Update | Dr. Chetan Kalal, DM Hepatology & Transplant Physician, Mumbai Elevating Liver Transplant Care with Evidence Based Protocols, Patient First Support, ________________________________________ 1. Why This Update Matters Dr. Chetan Kalal is Maharashtra’s first DM Hepatologist and a leading Liver Transplant physician at Gleneagles Hospital, Mumbai. All protocols and outcome data are backed by peer reviewed publications and real world patient testimonials. 2. Updated Liver Transplant Protocols 2.1 Accelerated Pre Transplant Workup • Goal: Complete evaluation within 7–10 business days. • Key Steps: 1. Multidisciplinary Assessment:  Hepatology consultation (MELD score, comorbidity screening)  Transplant surgeon evaluation (anatomic mapping via triphasic CT/MRI)  Anesthesia & cardiology clearance (stress echocardiography, pulmonary function tests)  Psychosocial assessment and caregiver planning 2. Laboratory Screening:  Viral serologies (HBV, HCV, HIV)    Renal function panels, electrolytes, coagulation profile (INR, platelets)  Tumor markers (AFP, CA 19 9 if HCC suspicion) 3. Donor Selection Workflow:  Live donor counseling, compatibility blood group testing, HLA crossmatch  Nutritional screening & minor surgery evaluation for donors 2.2 Personalized Optimization Clinics • Prehabilitation Program: o Exercise physiologist–guided strength and endurance plan for sarcopenia reduction o Dietitian supervised high protein, low sodium meal plans to correct malnutrition o Stress management workshops to reduce peri operative complications • Medical Management: o Ascites Control: Outpatient diuretic protocols, outpatient large volume paracentesis in day care setting o Hepatic Encephalopathy (HE) Prophylaxis: Rifaximin + Lactulose titration with periodic cognitive testing o Variceal Surveillance: Endoscopic screening and prophylactic band ligation for high risk varices ________________________________________ 3. Cutting Edge Surgical & Preservation Techniques 3.1 Minimally Invasive Donor Hepatectomy • Laparoscopic/Robotic Approach: Reduces donor pain, shortens hospital stay to 3–5 days, and accelerates return to work. 3.2 Normothermic Machine Perfusion (NMP) • Ex Vivo Perfusion Technology: o Maintains donor graft at physiologic temperature – extends graft viability beyond standard cold storage. o Enables real time assessment of bile production, lactate clearance, and hepatocellular function before implantation. 3.3 Split Liver & Extended Criteria Grafts • Pediatric Optimization: Left lateral segment transplantation for children under 15 kg. • High Risk Donor Utilization: Strict histologic steatosis assessment and perfusion based viability scoring allow use of mild steatosis or older donors. ________________________________________ 4. Post Transplant Continuum of Care 4.1 Hybrid Follow Up Model (In Person + Telemedicine) • First 3 Months (In Person): o Weekly visits: LFTs (ALT/AST/Bilirubin), tacrolimus trough levels, Doppler ultrasound of hepatic vasculature. o FibroScan® early detection of fibrosis. • 3–12 Months (Telemedicine Transition): o Monthly virtual check ins: Digital vital sign logs, home phlebotomy services for lab draws, e prescription management. o Quarterly in person FibroScan® for graft surveillance; renal function and bone density testing. 4.2 Immunosuppression Optimization • Tacrolimus Based Regimen: o Target trough levels 6–8 ng/mL in first year; taper to 4–6 ng/mL if stable. o Switch to Everolimus in cases of renal impairment or post transplant malignancy risk. • Therapeutic Drug Monitoring (TDM): o Point of care tacrolimus measurement in clinic; adjust doses based on serum trough, renal function, and infection history. 4.3 Ongoing Support Services • Nutrition & Lifestyle Counseling: o Customized diet plans to prevent post transplant metabolic syndrome (low sugar, high protein). o Bone health monitoring: DEXA scan at 1 year; vitamin D and calcium supplementation. • Psychosocial & Pharmacy Support: o Access to monthly transplant support groups (in person and virtual). o Dedicated transplant pharmacist: Medication reconciliation, drug drug interaction review, and side effect management. ________________________________________ 5. Enhanced Virtual & International Services 5.1 Virtual Second Opinion Clinic (72 Hour Turnaround) • Process: 1. Patient/physician submits: Latest LFTs, MELD score, imaging (DICOM CT/MRI), and medical history via secure portal. 2. Dr. Kalal review: Comprehensive risk benefit analysis, candidacy determination, and tailored transplant plan. 3. Report delivered within 24 hours, complete with recommendations for local or international transplant options. 5.2 International Patient Concierge • Medical Visa Assistance: Guidance on documentation, embassy liaison, and expedited clearance. • Logistical Support: Airport pick up, accommodation near Gleneagles Hospital, interpreter services, and dedicated care coordinator. • Hybrid Workshops: o Live Webinars: “Navigating Liver Transplant: From Evaluation to Recovery” (Open to UAE, UK, USA, Singapore audiences). o Downloadable Resource Kits: Pre and post transplant checklists, lifestyle modification guide, and medication adherence tools. ________________________________________ 6. Key Patient Success Metrics & Testimonials • 85-90 % 1 Year Patient Survival Rate for living donor transplants, exceeding national average of 80-85 %. • 1, 500+ Successful Transplants Evaluations completed in the past 3 years. • Case Spotlight – Mumbai Resident (Age 35): o Diagnosed with decompensated NASH cirrhosis (MELD 34). Underwent successful living donor transplant. Returned to work by month 3 ; stable graft at 18 months. • Case Spotlight – International Patient (Age 52): o From Dubai with HBV related cirrhosis. Received transplant; 1 year graft function normal; ________________________________________ o Liver Transplant Mumbai o “Best Hepatologist India o “Liver Transplant Dubai) o “Living Donor Liver Transplant UK o “Pediatric Liver Transplant India” – ________________________________________ Contact & Next Steps 1. Virtual Consultation: o Complete our online form at www.drchetankalal.com/virtual consult o Attach recent labs, imaging (CT/MRI), and medical history via secure portal. 2. Local Evaluation (Mumbai): o Call +91 8329476669 to schedule a rapid pre transplant workup at Gleneagles Hospital. 3. Satellite Camp Booking: o Visit www.drchetankalal.com/satellite to find upcoming camps in Nashik, Nagpur, Aurangabad, Goa, Indore. 4. International Second Opinion: o Email drchetankalalclinic@gmail.com for guidance on medical visa, accommodation, and interpreter services. ________________________________________ Dr. Chetan Kalal remains committed to delivering patient centered, evidence driven liver transplant care—whether you are in Mumbai, Dubai, London, or anywhere in the world. “Our mission is to transform lives through cutting edge transplant protocols, holistic pre and post operative support, and unwavering commitment to excellence.” — Dr. Chetan Kalal