News
Age boundary in liver transplants pushed back by Kings Hospital
View(s):By Kumudini Hettiarachchi
Currently the only hospital in the private sector in Sri Lanka undertaking liver transplant surgery is Kings Hospital, while in the state sector three centres do so – the National Hospital of Sri Lanka (NHSL), the Colombo North Centre for Liver Diseases (CNCLD) of the Colombo North Teaching Hospital and the Peradeniya Teaching Hospital.
Prof. Thamara Perera
Six people, five males and one female, the youngest patient being 42 years and the oldest 67 years, have benefited from the fully-fledged Liver Transplant Programme at the Kings Hospital launched on March 29, this year.
The patients have been from Colombo as well as Jaffna and Kurunegala, having suffered severe liver damage (cirrhosis) due to various causes.
Reiterating the challenges of liver transplantation surgery, the Kings Hospitals’ Transplant Team Leader and Consultant Transplant Surgeon, Prof. Thamara Perera says that it is not “just an operation”. It is in contrast to other surgeries because the liver has an impact on all other systems of the body. “This is why it is complex surgery.”
He says that liver transplantation is the only long-term survival option for those in chronic liver failure. Being a complex operation, liver transplantation also carries a real risk of operative mortality (death). For straightforward transplants, the 3-month and 1- and 5-year survival rates of 95%, 90% and 80%, are the currently acceptable targets.
The core team also includes Consultant Hepatobiliary & Liver Transplant Surgeon, Dr. Prabath Kumarasinghe; Consultant General & Hepatobiliary Transplant Surgeon, Dr. Buddhika Dassanayake; Consultant Transplant Anaesthetist, Dr. Anjali de Silva; Consultant Anaesthetist, Dr. Thusitha Jayathilake; and Consultant Gastroenterologist, Dr. Ranjith Peiris.
Prof. Perera says that the patient’s physiology before and after liver dysfunction and failure has to be taken into consideration. This is why liver transplantation is not just medical science but also an art.
A liver transplant operation in progress on a Sunday
The very first state-of-the-art ‘Liver Intensive Care Unit’ (ICU) in the private sector has been established at Kings Hospital, he says, going onto explain that minute details have been considered to ensure the safety of patients. This ICU is powered with positive pressure to minimize infections, as in liver transplants, infection is the killer and this is where a lot of institutions fail the patient in short and long-term care.
Prof. Perera says that he believes that the 67-year-old from Jaffna is the oldest liver transplant patient in Sri Lanka and they have pushed the age-boundary for these surgeries in the country. The same patient had undergone a heart bypass operation 11 years ago. The 42-year-old, meanwhile, a lawyer in Colombo had returned to work 10 weeks after the transplant.
He talks of the importance of deep evaluation of every patient on a case-by-case basis. There was another 62-year-old patient with complications including severe encephalopathy (altered mental state), inadequate nutrition and sarcopenia (muscle loss). As nutrition is vital before undergoing a liver transplant, for it is essential to optimize muscle strength and the patient was severely ‘de-conditioned’, the team ‘re-conditioned’ him by keeping him in hospital under a robust nutritional and physiotherapy programme, enabling him to walk into the operating theatre.
The Liver Intensive Care Unit. Pix by M.A. Pushpa Kumara
All those who have undergone liver transplants have received a part of this organ from a live donor, with both donor and recipient keeping strictly to Sri Lanka’s legal framework. The donors, above 21 years, are usually blood or close relatives or emotionally-connected to the recipient. The hospital follows all procedures to the letter including a close ethics review of each case, according to Dr. Perera.
While the donors usually go home 4-6 days after they donate a section of their liver, the recipients spend about 6-8 days in hospital.
Prof. Perera comes armed with extensive experience, having worked in one of the busiest liver transplant programmes in Europe which performed 250 adult and paediatric transplants per year. He has handled an average of 100-120 liver transplants since becoming a specialist in 2010 and rising to the rank of honorary Professor.
Having performed more than 1,300 liver transplants, no mean achievement for a surgeon of his age, Prof. Perera’s skill covers “all” forms of liver transplants – cadaveric, live donor, split-liver and multi-visceral transplants in both adults and children. While his focus is delivering technically complex transplants through surgical technique innovation, he has performed the world’s first machine revived liver transplants.
He has also conducted research and been part of trailblazer trials that have reshaped transplant practice in the west, it is learnt. He has over 250 articles in prestigious journals such as the ‘New England Journal of Medicine’; ‘Lancet Gastroenterology and Hepatology’; ‘American Journal of Transplantation’; and ‘British Journal of Surgery’, with more than 6,000 citations.
Now giving of his expertise in Sri Lanka, Prof. Perera is building a sustainable liver transplant programme in the private sector, earlier mooted by Prof. Kemal Deen and Prof. Janaka de Silva.
He and his team are also sharing their knowledge and expertise with two Consultant Hepatobiliary and Transplant Surgeons, Dr. Vinojan Satchithanantham and Dr. Sreekanthan Gobishangar based in the north.
Prof. Perera and his team have a simple motto: To see a transformation of life for all those living on the brink with liver failure, whose only option is a transplant.
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