KokilabenDhirubhaiAmbani hospital undertakes a rare dual-lobe living donor liver transplant


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Performspath breaking medical procedure to give the patient a new lease to life

Mumbai, June 25, 2015: When acute liver disease threatened Mahendra Bari, world-class medical expertise, combined with a supportive family, came to the rescue. Today, following a path-breaking and complex dual-lobe living donor transplant, undertaken at the Kokilaben Dhirubhai Ambani Hospital in Mumbai, the 41 year-old patient has a new lease on life.

The surgery was undertaken and monitored by Dr Vinay Kumaran and his team of professionals who made this rare and difficult surgery possible. Speaking on the surgery Dr Vinay Kumaran, Consultant & Head – Hepatobilliary Surgery & Liver Transplant at KokilabenDhirubhaiAmbani hospital said “Owing to low organ donation rates in India, most patients with liver failure either die on the waiting list for an organ or undergo a living donor liver transplant,where a family member donates part of the liver. A living donor transplant is much more complex than a transplant from a brain-dead donor; the blood vessels and bile ducts are small and multiple and require careful reconstruction to ensure the liver is well perfused and drained.In most living donor transplants, if the patient is an adult, the right side (the larger side) of the liver is donated—the part of the liver donated is required to be at least 0.8 per cent of the patient’s weight. For instance, a patient who weighs 80 kg would require at least 640g of liver. The remaining liver of the donor should be at least 30 per cent.”

Dr Ram Narain, Executive Director, KokilabenDhirubhaiAmbani Hospital added “For Mahendra Bari, who had been undergoing treatment for decompensated cirrhosis of the liver at Mumbai’s KokilabenDhirubhaiAmbani Hospital for the past year, a liver transplant was the need of the hour. Despite the best available treatment, he underwent repeated admissions with life-threatening complications of cirrhosis: internal bleeding that had to be controlled endoscopically; hepatic encephalopathy (drowsiness and confusion that can progress to coma); and the beginning of kidney failure (hepatorenal syndrome).”

As there was little progress on the waiting list for a liver from a brain-dead donor, his family came forward to donate. His wife and brother were found to have severely fatty livers and ruled out. His nephew Sandeep was found to have a less severe fatty liver. While it was deemed unsafe to use Sandeep’s right lobe, his left lobe could be used as it was only 30 per cent of his liver and could be safely removed. However, the estimated volume of the left lobe was only 441 cc, which would have been insufficient for Bari. At this point, his niecePayal volunteered to donate part of her liver. Though, Payal had a normal healthy liver, she is much smaller than Bari and the volume of the right lobe of her liver was only 480 cc,far short of the 640 cc he needed. However, when both Payal’s right lobe and Sandeep’s left lobe were combined, the total was 921 cc, enough for a safe transplant.

Explaining the complexity around the surgery Dr Kumaran added “post observing the patient and his medical condition we decided to perform a dual-lobe transplant, a technically challenging and rare procedure that was pioneered by Asan Medical Center in Korea. It involves three teams of surgeons operating in three operation theatres simultaneously. The patient’s liver is removed; parts of the donors’ livers are removed; and work is required on the bench to prepare the partial livers for implantation. The reconstruction of the two liver lobes in the recipient is very complex because of the number of structures required to be reconstructed and the limited time available (if more than an hour is taken, the livers can be damaged by lack of oxygen and nutrition). Indeed, very few such transplants have been performed in India.”

Dr Narian concluded that the “doctors have successfully completed the dual-lobe living donor liver transplant,both the donors and patient have recovered and are living a healthy life today. Such cases further cements our reputation for path-breaking medical procedures and upholds ourexcellence as a fully equipped centre for liver transplant.

About Kokilaben Dhirubhai Ambani Hospital

Kokilaben Dhirubhai Ambani Hospital is designed to raise India’s global standing as a healthcare destination, with emphasis on excellence in clinical services, diagnostic facilities and research activities.

Our Unique Features

  • The only hospital in Mumbai to function with a Full Time Specialist System (FTSS) that ensures availability and access to dedicated specialists exclusively attached to our hospital.

 

  • State-of-the-art infrastructure, cutting edge technology and Full Time Specialists our system ensures the best outcomes for our patient.
  • We are an Institution that offers comprehensive healthcare services under one roof, creating a platform for transparent patient-centric care where every life, indeed, matters.

A true confluence of the best talent in the world, the latest in technology, state-of-the-art infrastructure and most importantly the human touch make Kokilaben Hospital a marvel in the truest sense of the word. Here, there is room for everyone and for people from every walk of life. Kokilaben Hospital aims and lives up to its credo of being a global healthcare institution that combines the best in medical treatment, with strong ethical principles and a culture of care and compassion.

About Centre of Liver Transplant

In India, out of 25,000 patients with liver failure, only 1100 patients undergo liver transplantation. Of this, only 5% is performed in Western India due to the lack of a comprehensive facility.

To bridge this gap, Kokilaben Dhirubhai Ambani Hospital has started a comprehensive liver transplant programme, transplanting livers both from living donors and cadavers. It is the first-of-its-kind, state-of-the-art comprehensive liver transplant centre in Western India. The centre is a complete unit consisting of expert doctors specially trained to provide comprehensive care to all patients across the entire spectrum of liver disorders involving dedicated and full time specialist Transplant Surgeons, Hepatologists, Anaesthetists, Intensivists, Radiologists, Haematologists, Blood Bank Specialists, Transplant Coordinators, and trained OT and ICU Nurses supported by dedicated operation theatres, ICUs and other high-tech infrastructure and equipments necessary for such complex procedures.

In India, every year, around 2.5 lakh patients die of liver failure due to cirrhosis. There are more than 25,000 patients who need a liver transplant every year. However, only around 1100 liver transplants are done in a year mainly in the North and South India, which accounts for almost 95% of these transplants.

Only 5% of these are performed in Western India, that too, primarily by visiting surgeons. Thus, through out Western India, a comprehensive Liver Transplant setup has never come up during these years.

Therefore, Kokilaben Hospital, in their quest to bridge every gap in Mumbai and Western India’s healthcare sector, is launching a Comprehensive Centre of Excellence for Liver Transplant – the first of its kind in Western India.

We at Kokilaben Dhirubhai Ambani Hospital have started a comprehensive liver transplant programme, transplanting livers both from living donors and cadavers with dedicated Liver Transplant Operation Theatres (OT) and a dedicated Intensive Care Unit (ICU).

Besides, it is supported by a dedicated team of the following specialists to ensure the best outcomes:

  • Transplant Surgeons
  • Hepatologists
  • Anaesthetists
  • Intensivists
  • Radiologists
  • Haematologists
  • Blood Bank Specialists
  • Transplant Coordinators
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