Global Hospitals, Chennai has successfully performed the first split liver transplantation in India. This novel method is known as the Auxilary Liver Transplant (ALT). The procedure is economical and patient does not have to take long term immuno-suppressive drugs which are known to cause serious side effects. The technique was used to save two patients who are recovering well and have been already discharged.
In the wake of an acute shortage of cadaver donors globally, a technique of splitting the liver for two recipients was developed in Europe. Split liver transplants involve dividing a cadaver donor liver into two halves for transplantation into two patients as life saving procedures. ALT is a complex procedure and is performed only at a few centres globally.
Dr Mohamed Rela, a liver transplant surgeon who has performed over 1200 liver transplants at leading hospitals globally, pioneered this technique at King's College Hospital London. He is currently part of the transplant team at Global Hospital Chennai, Bangalore and Hyderabad who performed the operation.
The liver donor was a young accident victim and the procedure took over 20 hours. A team of four surgeons, two anaesthetists, and other ancillary staffs were part of the transplant team. Of the two patients, one was a young girl suffering from Crigler Najjar Syndrome and the other an old woman suffering from an end-stage liver disease.
Patients undergoing any transplant operation have to remain lifelong on immuno-suppressive drugs. The advantage of ALT is that intake of immuno-suppressive drugs by the patient can be discontinued at an early stage. While in standard liver transplant operation, entire diseased liver is replaced by a new liver. In ALT, most of the recipient liver is retained and only part of it is replaced with a new graft. This procedure can be used in cases of acute liver failure and metabolic liver disorders. In the former, patient's own liver has the potential to recover and regenerate over 6-12 months after which immuno-suppressive drugs can be stopped, Dr. Rela told Pharmabiz in an email interaction.
In metabolic liver disease, gene therapy techniques are being developed as a cure instead of liver transplantation. In ALT, the retained liver can be the target for future gene therapy as it spares patients from the cost and drug side effects.
The challenges before surgeons are co-ordination of organ retrieval and the ability to perform operation swiftly with minimal blood loss. "In this case we were successful because of technical expertise, teamwork, advanced infrastructure," he added.
The cost for a liver transplant is Rs 2 lakh. Other cities carrying out liver transplant are Delhi (Gangaram Hospital, Apollo), Chennai( Apollo) and Cochin.
There are a number of trained surgeons but not all have been successful due to lack of facilities. In the last two years, liver transplant success rates are comparable with international centres. India will be a major player in liver transplantation but cadaver organ donation should improve to make this a reality, said Dr Rela.