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6.6 kg tumour removed from sexagenarian’s abdomen

The doctors Chidambara Marathe had consulted before he came to Chennai told him that a surgery was not possible.

Mr. Marathe, a 66-year-old resident of Bengaluru, had been diagnosed with Hepatitis B, after which he had two small liver tumours that were treated in January 2014.

But towards the end of February this year, Mr. Marathe developed pain and swelling in the abdomen and doctors found that another tumour had developed — but this one was so large that it was deemed too risky for a surgery.

“At one hospital, a surgery was attempted but not done. We were told that we may not find a doctor anywhere who would be willing to operate. We were told that he may live for one or two months or six months if he was lucky. And he was in intense pain,” said Kiran Marathe, the patient’s son.

That is when the family came to Gleneagles Global Health City in Chennai, and met with Dr. Mohamed Rela, chairman and director, Institute of Liver disease and Transplantation, at the hospital.

“Dr. Rela took a look at the scans and reports and said he could do it. Immediately, we brought my father to Chennai,” Mr. Kiran said.

At the hospital, doctors found that the cancerous tumour filled the entire abdomen. “It was 25 cm in size, bigger than a regulation football and got its blood supply from lots of places, making the surgery risky,” said Mettu Srinivas Reddy, senior consultant at the hospital.

After discussing it with the family, the surgery was performed on March 31, led by Prof. Rela, and it was successful. The tumour weighed 6.6 kg. “Mr. Marathe had developed liver cancer on a background of chronic liver disease caused by the Hepatitis B infection,” said Dr. Reddy.

Surgery option

Prof. Rela said that patients and their families should be aware surgery for liver cancer was possible and it did not involve transplants. “Liver resection [surgically removing a portion of the liver] is more demanding, technical and risky, especially with liver cirrhosis [scarring of the liver tissue], but should be the first option where possible. Patients need to know this option exists,” he said.

Mr. Marathe, who was working in a bank earlier, is doing well now, but needs long-term care and regular follow-ups in order to ensure new tumours do not come up.

“In February, our situation was really bad. Today, what we thought was impossible has been made possible,” Mr. Kiran said.

Liver resection is more risky, especially with liver cirrhosis

Dr. Mohamed Rela,

Gleneagles Global Health City

Article From THE HINDU 14-May-2017

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Reducing the need for liver transplant: Dr.Mohamed Rela

Prof. Dr. Mohamed Rela, Director – Institute of Liver Disease & Transplantation, Global Hospitals Group, has been recognized by ‘Top Masters in Healthcare Administration’ as one of the 20 Most Innovative Pediatric Surgeons Alive Today in the world.

A fellow of the Royal College of Surgeons, Prof. Rela is also the Chair of the Pediatric Committee for the International Liver Transplantation Society. He has performed more than liver 3,000 transplants, including one on a five-day-old baby, earning him an entry into the Guinness Book of Records. He is known in India and around the world for successfully performing highly complex surgeries to save the lives of very young children.

Prof Dr. Mohamed Rela talks to ETHealthworld about the liver transplant scenario in India and the challenges associated with it. Edited excerpts:

How has liver transplantation evolved over years?

India has a large burden of liver diseases. It is one among the countries where there is high proportion of liver disease particularly related to hepatitis B and hepatitis C viruses. India has also got a large burden of fatty liver diseases but in terms of treatment in the form of liver transplantation, India has taken a long time for it to be successful.

In the last ten years liver transplantation has become a reality and now large number of liver transplants in the form of living donor transplantation is taking place in India.
How do you compare liver transplants in India and those in the West?

In terms of the requirement for liver transplantation, we are still behind. We do around 1400 liver transplants in India. The requirement for liver transplantation is probably in the range of 10 – 15 per million populations. We need to do 10 times more liver transplantation if you look at the necessity for the population. We are far behind in terms of living donor transplantation, deceased donor or cadaver liver transplantation. If you look at the number of transplants done in this country, more than a 1000 of these are living donor transplantation.

In the whole of the United States there are probably only around 250 living donor liver transplants. We probably do four times more than United States, ten times more than what is done in Europe and we are doing as much living donor transplantation as in the eastern countries like Korea and Japan.

We are really racing ahead in the competition for the technicalities of living donor liver transplant. We are better than the Western countries and hopefully we will overtake everybody else other than China who might overtake us.

Tell us about the latest technical advances in liver transplantation.

The latest technical advance in liver transplantation comes from living donor liver transplant. In the Western world most of the advancements are in terms of split liver transplants, sharing organs, preserving organs, use of marginal organs and increasing access for the population for liver transplant. All of that is disease donor liver transplant – whereas in the East all the high-tech developments have come from living donor liver transplants and India is in the forefront for those developments.

What are the common challenges faced by people needing a liver transplantation?

The challenges are about access for the population. Large proportion of the population can’t afford this treatment. The cost of liver transplantation is well over 20 lakhs and unless the government undertakes to fund, it will not be accessible to all sections of society.

I would like to say that a large proportion of Tamil Nadu is actually funded by the government for liver transplants and that needs to take place throughout the country. If all people who require liver transplant have to be funded, it is going to be a very expensive affair for the governments.

Another challenge is that everybody who needs a liver transplant is not getting it even after funding. Part of the reason is that we rely completely on living donor and we have actually ignored or not done much effort for deceased donors, other than the southern states Tamil Nadu, Kerala and Maharashtra.

Andhra Pradesh has some deceased donor donations and there have been progresses made whereas in the northern or eastern part of India, there are absolutely no cadaver donations. Unless cadaver donations improve, all patients will not have access to liver transplantation.

How do you see the future of liver transplantation in India?

The future of living donor or liver transplantation is going to having a combination of both deceased donor and living donor liver transplant. The numbers in our country are going to increase.

In the next five to ten years the numbers are going to increase fivefold – tenfold and that means we need to train large number of surgeons and many hospitals have to come up offering liver transplantation in a cost effective manner.

The long term future of liver transplantation is when I have to say that we have to manage these patients without the need for liver for liver transplant. There have been several breakthroughs in the treatment of patients with liver disease. Now there are drugs available for hepatitis C.

In most countries hepatitis C liver diseases or hepatitis C cirrhosis forms almost 30 percent for patients who need liver transplant. Now we have got a drug to abolish this hepatitis C completely and cure this disease. Meaning 30 percent of the indications for liver transplants is going to disappear and the necessity for liver transplantation is going to come down.

Now there is also a lot of research on gene therapy which means all metabolic liver diseases which require liver transplant now won’t be needed. Then there are other treatments, artificial liver and liver dialysis work that is being carried out. This hasn’t been so successful till now, but if it does, most of the acute liver failure patients won’t need liver transplants. So that means we are slowly conquering medical treatment of many of the liver diseases and as we conquer medical treatment the requirement for liver transplantation will hopefully come down. Only a small proportion of patients will require transplant and that is the future. So the future is not about developing liver transplant but rather it is about reducing the need for liver transplant.


credit: ETHWORLD

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Celebration of life

A team of globally renowned Liver transplant surgeons comprising Prof. Dr. Mohamed Rela, a globally renowned liver transplant surgeon, Dr. Gomathy Narasimhan, Sr. Consultant – Liver transplant surgeon, Dr. Naresh Shanmugam, Sr. Consultant – Paediatric Hepatology from Global Health City, presided over the re-union of the Sri Lankan patients who have undergone liver transplants at Global Health City, who came together on a single platform to share their experiences. Namal Udugama an iconic singer, composer and songwriter of the island nation who had also undergone transplant surgery, performed a live concert to enhance the joy amongst patients through his music.

Global Health City the flagship facility of Global Hospitals Group, one of India’s fastest growing hospital chains, has performed Liver transplantation on over 60 patients from Sri Lanka apart from many complex Liver and Pancreatic surgeries.

“The people present have all undergone a transplant over the last six years. Their presence here is a testimony to the fact that organ transplant is a safe solution to address liver failure.

It might also be relevant to mention here that, we have performed a transplant on a child who was weighing less than five kilos who incidentally happens to be from Sri Lanka”, said Prof. Dr. Mohamed Rela speaking on the occasion.

“It is a great experience to see patients transplanted few years ago to a few months ago, both adults and children return back to normalcy and enjoying a good quality of life. Children are back at school and adult patients are back to full productivity and taking care of their families. Definitely, they seem a lot more cheerful”.”

M.F.A RIYAS – Chairman & CEO Forte International said “this is like a dream come true to see so many happy families getting back on track and sharing their experiences and happiness together.

This was the motto of joining hands with Global Hospitals and the local doctors together, in order to provide the best of medical care to my Sri Lankan Brothers & Sisters”.

The Organ transplant program of Global Health City is among the largest in South East Asia and caters to almost 20 countries in the SAARC, Middle East and African nations.

Unique features of the program

* Program performing large number of both Deceased donor and Living donor Liver transplant

* Largest number of procedures involving technical innovations like Split Liver Transplantation and Auxiliary Liver Transplantation

* Smallest child (less than 5 kgs.) to undergo Liver Transplant at Global health City was from Sri Lanka

* First Swap transplant at Global health city was between 2 Sri Lankan families for Sri Lankan Patients

* Pioneers in Adult & Paediatric Liver Transplants performed over 675 Liver transplants at Chennai 200 paediatric transplants making us the largest centre for Liver Transplant.

* Largest centre for combined Liver & Kidney Transplant.

* Performs complex liver & pancreas surgeries for tumour.


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Baby gets new liver

Andhra Pradesh health minister Kamineni Srinivas visited the family of an eight-month-old child who underwent a liver transplant in a city-based private hospital.

Gnana Sai from Chittoor district suffered from a serious liver ailment and was admitted to Global Health city. Her medical expenses were borne by the Andhra Pradesh government after her father filed a mercy-killing petition in the court as he was unable to afford the treatment costs.

Gnana’s father Ramanappa came forward to donate a part of his liver. “It has been ten days since the surgery now. Both the baby and the father are doing fine,” said Dr Mohamed Rela, director, Institute of Liver Disease and Transplantation, Global Hospitals. They would be discharged in a few days.

A 12-member team took seven hours to complete the procedure. “Though there is surgery to decrease the jaundice, 90% of them would require liver transplantation before they are 18 years old,” said Dr Naresh Shanmugam, pediatric hepatologist at Global Hospitals.

Credits: TOI

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Dr Mohamed Rela of Global Hospitals, have been identified as one among the most illustrious paediatric surgeons from across the world.

Doctors’ dilemma: To transplant or not to transplant

As transplant procedures gain momentum across the country, doctors are beginning to increasingly rely on donor organs to save lives. Not everyone needs the cut, or a new organ, said doctors, expressing concern over the rise in such surgeries.

Around 600 liver surgeons congregated in Chennai on Friday to discuss diagnosis and treatment of acute liver failure – a condition often treated with liver transplantation.

“Only 30% of these patients would really need a donor organ, the rest can be treated with proper medical intervention,” said Dr Mohamed Rela, director, Institute of Liver diseases and Transplantation, Global Hospitals.

Acute liver failure is caused by overdose of certain medication, Hepatitis and other viruses, herbal supplements, autoimmune and metabolic diseases.

Dr Rela observed that most doctors are in a dilemma whether to do a transplant or not. “Though we do have a set of guidelines to ascertain patients who need a donor organ, they are not strictly followed,” he said.

From 2008 to 2015, 573 livers were harvested in Tamil Nadu from cadaver donors, with 147 being donated in 2015 alone.

Julia Wendon, senior hepatologist and consultant Intensive Care at King’s College, London, said a needless transplant procedure could put an otherwise healthy person on lifelong immunosuppressants.

 “King’s College in the early 90s came out with a criterion to decide on when to do a transplant. In the UK, a patient is assessed by a group of specialists at multiple levels before the nod is given,” said Dr Wendon, who has been actively campaigning against unnecessary transplant procedures.

With close to 80% of the liver being donated by live donors, several ethical issues come to the fore as well. “There is a lot of psychological pressure on the donor. The recipient may be a close family member and they feel it’s their obligation to donate,” said Dr Rela.

 Dr Wendon felt a transplant procedure can be avoided if the liver disease is detected early. “The problem is, most patients here don’t immediately seek help in a tertiary care centre until it’s too late. An integrated approach to medical care is also needed,” she said.
Courtesy: TOI 
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