Indian Transplant Newsletter. Vol.04 Issue No.15. June- October 2003
Print ISSN 0972 - 1568

Issues related to Liver Transplantation

Indian Transplant Newsletter.
Vol.04 Issue No.15. June- October 2003
Print ISSN 0972 - 1568
Print PDF


Liver transplantation in India

            Is liver transplantation in India a viable proposition? The experience at Indraprasatha Apollo Hospital, New Delhi definitely suggests that in time India could become a major referral center for liver transplantation.

Drs. Koushik Bhattacharya, D.V. Rajkumari, A. Sibal and M. R. Rajashekhar did a retrospective analysis of 42 patients who had undergone liver transplantation (from the year 1998). The major causes of liver failure in these patients were alcoholic cirrhosis in 12, Hepatitis C cirrhosis in 8, biliary artesia in 4and cryptogenic cirrhosis in 5 patients. 16 cadavers, 18 live related and 8 pediatric transplants were done. The average duration  of transplantation was 9 hours in cadaver 18.5 hours in liver donor transplant. The major technical problems encountered were portal vein thrombosis in 2 patients, bile leak in 1, Cytomegalovirus infection in 2 and rejection in 3 patients. In the postoperative period, the majority had seromilus  or tacromilus based immuno-suppresive theapy. Out of the 42 recipients, 25 are well and alive.

Anatomical Basis of Liver Controlled Partition of Liver 

            An in-depth study of the of the prevailing intrahepatic and extra hepatic anatomy of portal and hepatic veins was done by Drs. O. P. Pathania, P. Chibber, G. Rath and R. Anand, Department of Surgery, Anatomy and Radiology, Lady Hardinge Medical college, New Delhi on 50 adult cadaver livers. This kind of study has become important in the light of more split-liver grafts and reduced size liver grafts being done than before.

Then cadaveric livers with long hepatoduodenal segments obtained at autopsy were studied radiologically by injection of thin barium sulphate and then dissected manually to study the venous anatomy.

The main findings were:

            1) Portal venin division into right and left main divisions was always extra hepatic and in 10% of specimens anterior and posterior segment branches arose directly from the main trunk.

            2) There main hepatic veins were always present with type i(right)and type II (Left)being the most common variants.

            3) Caudate lobe venous anatomy studies should drainage into both halves of the liver.

            4) Liver can be split into fight and left lobes by splitting along the principle fissure. A left lateral segment can also be created with independent venous drainage in anatomically favourable situations.

            5) Caudate lobe (segment I) has to sacrificed in creation of right lobe graft and in left lateral segment graft, the quadrate lobe (segment IV) needs to be resected on account of venous anatomy drainage patterns.

 

Indian Cadaver Figures 1995-2003

Place

Kidney

Liver

Heart

Chennai

178

7

15

Vellore

37

3

 

Coimbatore

28

   

Madurai

8

   

Mumbai

55

1

 

N Delhi

55

20

20

Bangalore

24

1

1

Hyderabad

12

3

 

Pune

40

   

Ahmedabad

52

   

Indoare

6

   

Kochi

8

 

1

Lucknow

5

   

Ludhiana

4

   

Chandigarh

6

   

Nasik

4

   

Nadiad

2

   

TOTAL

524

35

37

Note: One lung transplant has been done in Chennai and a pancreas transplant was done at Ahmedabad

 


To cite : Shroff S, Navin S. Issues related to Liver Transplantation. Indian Transplant Newsletter. Vol.04 Issue No.15. June- October 2003.
Available at:
https://www.itnnews.co.in/indian-transplant-newsletter/issue15/ISSUES-RELATED-TO-LIVER-TRANSPLANTATION-952.htm

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