BGS Global Hospitals performs Posted on- 13th April 2010
BGS Global Hospitals performs

Liver transplant surgery for massive metastatic liver disease, the first in India

BGS Global Hospitals has successfully performed cadaver liver transplant surgery for massive metastatic liver disease for the first time in India. Metastatic disease with only the liver being involved is a very rare disease in the world.

Apple Computers’ CEO Steve Jobs had undergone a similar liver transplant surgery for metastatic liver disease a year ago. Metastatic liver cancer is a cancer that is found in the liver but which originated elsewhere in the body.

A team of surgeons headed by Professor Mohamed Rela undertook the complicated and challenging surgery lasting more than 10 hours and rescued the patient Mr. C V Ramachandran virtually from the jaws of death by removing his diseased liver weighing 6.5 kg and transplanting a cadaver liver from a brain dead person. Mr. Ramachandran, who underwent the surgery two weeks ago is cheerful, can walk and is on normal diet.

The latest surgery is a feather in the cap of Global Hospital’s liver transplant program. The group has had the distinction of having undertaken the largest number of cadaver liver transplants in the country with a success rate on par with that of the best centres in the world.

Mr. Ramachandran was diagnosed with metastatic neuroendocrine tumour of the liver with the whole of the liver being involved. He had been bedridden and unable to eat for over eight months. On intravenous fluids, he had lost about 20 kgs in eight months.

The patient had undergone surgery for a carcinoid tumour in the rectum in 2007. He was well for a few months but soon started showing signs of metastatic liver disease with declining liver function, rapid loss of weight and finally leading to complete liver failure. He experienced breathlessness, his liver was enlarged and his legs were swollen. His upper abdomen was filled with fluid, a condition known as ascitis, leading to compression of the main vein, the inferior vena cava. He was treated with chemotherapy but did not respond well. He had no healthy liver tissue.

Professor Mohamed Rela, Chief Transplant Surgeon, Global Hospitals Group, said, “After thorough investigations it was decided that a liver transplant was the only treatment option. Otherwise, he would not live for more than a couple of months. The high-risk surgery was very challenging and lasted well over ten hours. The removal of the diseased liver was extremely difficult because of its huge size and the way it was wedged between the ribcage and the posterior abdominal wall and stuck to diaphragm. The liver was plastered to the intestines as well as the inferior vena cava, one of the main veins. We had to be extremely cautious in separating the liver with almost no working space so as not to damage the inferior vena cava, the intestines, and other neighbouring organs. The inferior vena cava is the large vein that carries de-oxygenated blood from the lower half of the body into the right atrium of the heart and any damage to it could be life threatening. Cancerous liver tissue, which weighed 6.5 kg, ten percent of his body weight, was removed and a cadaver liver successfully transplanted. He was administered a total of 10 litres of blood.”

Dr. Rela added, “This liver transplant surgery for the massive metastatic liver disease is the first of its kind in the country and one among the very few cases in the world. Metastatic disease with only the liver being involved is a very rare disease. The cadaver liver transplant surgery has good results in the long term and is totally symptom free.”

A 15-member team comprising five surgeons, five anesthetists and five nurses headed by Prof. Rela performed the surgery at BGS Global Hospitals. Five others -- a hepatologist, a sonologist and three technicians assisted the team.

Post surgery, the patient was monitored continuously and stringently by transplant critical care specialists, transplant hepatologists and many paramedical staff in the well-equipped, state-of-the art transplant ICU where he made quick progress. Blood tests were done twice daily. Arterial blood oxygen and carbon dioxide level test, liver function test, Doppler test to check arterial flow to liver, and chest X Ray to check for post-operative pneumonia, etc were periodically performed.

The patient started taking oral feed on the third day of the surgery itself. His clinical condition in all parameters improved. Mr. Ramachandran, the patient, said, “I was in a very difficult situation. I feel comfortable now and can be back to normal life with my family.”

Dr. K. Ravindranath, Chairman and Managing Director, Global Hospitals Group said, “Global’s liver transplant program is the largest in the country and the only one providing complete range of liver transplantation. Our success rate is close to 90% on par with that of the best centers in the world. The Group has the distinction of having undertaken the largest number of cadaver liver transplants in the country. We have a team of ten transplant surgeons supported by several hepatologists, critical care specialists and a host of support specialties. Our world-class services at affordable cost have drawn patients from India and abroad.”

Dr. N. K. Venkataramana, Vice-Chairman, BGS Global Hospitals, said, “ BGS Global Hospitals has the largest number of dedicated Liver Transplant and Liver ICU beds with all facilities. The transplant team comprises highly skilled and trained professionals from various disciplines. This is the first cadaver liver transplant surgery performed at our hospital. With growing awareness about cadaver organ donation and our state-of-the-art facilities, we will be able to offer excellent treatment and care for those requiring liver transplantation.”

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