News
NHSL’s trailblazing liver transplants
View(s):- Many smiling men, women and children have walked out with a fresh lease of life
By Kumudini Hettiarachchi
Dr. Ruwan Dissanayake
Slowly and surely without much fanfare, the premier National Hospital of Sri Lanka (NHSL) has been performing liver transplants including many ‘firsts’ in this field in the country.
The firsts of the NHSL’s Liver Transplant Programme include paediatric liver transplant; split-liver transplant; liver transplant for Budd-Chiari Syndrome; redo liver transplant; dual organ transplant; and ABOi transplant, in addition to the usual transplants. (See box)
As this edition of the Sunday Timeswent to press, a 28-year-old from Matale, was recovering on the 7th Floor of the Epilepsy Building in the sprawling NHSL complex, after a transplant pulled him from the brink of death due to acute liver failure.
Dr. Prabath Kumarasinghe
The patient who was in the 12-bed general Intensive Care Unit (ICU) shared with the neurosurgical unit, is now in the state-of-the-art Ward 86 in an individual room with an attached toilet to prevent any infection post-transplant. This was the first successful transplant performed for acute liver failure (loss of liver function speedily, usually in a person who has had no pre-existing liver disease) at the NHSL.
When the Sunday Timesvisited the ward recently, there was a 58-year-old from Marawila who had undergone a liver transplant. In isolation, in the room was also his wife.
Dr. Anjali De Silva
Referred from Marawila to the NHSL on suspicion of the patient having liver trouble, a multidisciplinary team had evaluated him, checking out his heart, lungs, gastrointestinal system, kidneys etc., coming to the conclusion that he needed a liver transplant.
Having been included in the National Donor Programme, a deceased donor liver had been available and it was on September 6 that the scrubbed up Transplant Team entered the Duplex Operating Theatre (OT), to harvest the liver in one OT and transplant it in the patient in the other OT. Now, this patient is back home attending to his daily routine.
The very first patient to undergo a liver transplant had been a man performing the heavy labour of pol parala rahina weda. He had come by bus from Kalutara and had not even had the wherewithal including the fare to return home and the staff had done a hat collection for him.
Dr. Gayan Bandara
Launched in 2017, the numbers of the Liver Transplant Programme speak for themselves – with the latest patient from Matale, there have been 65 transplants including five children, with an 80% success rate.
Pointing out that liver transplants are the most technically demanding surgical procedures in the medical field, Consultant Transplant Surgeon Dr. Ruwan Dissanayake says that sometimes it takes six, sometimes 12 and at others even 20 hours for this surgery, depending on its complexity.
The peri-operative mortality (a death, regardless of cause, occurring within 30 days after surgery in or out of the hospital) of liver transplants even in the best centres around the world is 10% (1 in 10), he says, indicating the skill and knowledge and the meticulous post-operative care required.
Sr. Pradeepa Priyadarshani
Even though the first liver transplant in a state hospital in Sri Lanka was performed back in July 2010 at the NHSL, the programme had been discontinued due to numerous challenges, it is learnt.
Later, Dr. Dissanayake was performing kidney transplants at NHSL and helping out with liver transplants at the Colombo North Liver Centre, when on December 31, 2016, he got an “accidental” call, with a person offering support for the development of a cadaveric donor programme.
From one deceased patient at the North Colombo Teaching Hospital, Ragama, there were three organ harvests – and the positive outcome gave courage and the new Liver Transplant Unit of NHSL was launched in 2017 with a team of energetic young blood.
The current team comprises Dr. Dissanayake; Consultant Hepato-Pancreato-Biliary & Liver Transplant Surgeon, Dr. Prabath Kumarasinghe; Consultant Vascular Surgeon, Dr. Gayan Bandara; Consultant Transplant Anaesthetist, Dr. Anjali De Silva (who had taken the place of Consultant Anaesthetists Dr. M. Sugunadevan & Dr. Oliver Pathmaperuma); and Consultant Anaesthetist Dr. Rachini Vithanage.
The Marawila patient in his room in Ward 86. Pix by M.A. Pushpa Kumara
All team members appreciate the wholehearted support extended by NHSL Deputy Director Dr. Pradeep Ratnasekera as well as other Anaesthetists, Intensivists and Transfusion Physicians and the microbiology, gastroenterology, nephrology, haematology and nutrition teams of the NHSL.
Paying tribute to the efforts of colleagues, the team says that the humble young man with acute liver failure was diagnosed by Matale’s Consultant Hepatologist Dr. Eranda Luxman, who then referred him to the NHSL.
The power of the state health system in saving lives is apparent – the unconscious patient while awaiting a donor liver, had been carefully tended for two weeks by the NHSL’s Medical ICU Consultant Intensivists, Dr. Dilshan Priyankara and Dr. A. Mendis along with their teams. It had been the Neuro-ICU’s Consultant Intensivists, Dr. Eranga Sanjeewa and Dr. Nalika Karunaratne, meanwhile, who prepared the deceased donor for the organ donation.
While those undergoing liver transplants are referred from distant areas across the country including Jaffna, Anuradhapura, Polonnaruwa, Batticaloa, Hambantota and Matara, the organs needed for the transplants come from within the NHSL as well as hospitals across the country.
A liver transplant at the NHSL
The team recalls that the first paediatric liver transplant was on an eight-year-old girl from Kalutara, with the healthy liver being harvested from a deceased donor at the Ratnapura Hospital and airlifted by helicopter in the dead of night.
The first split-liver (divided into two sections) transplant saved the life of one child, they say, talking of the “complications” of the transplant for Budd-Chiari Syndrome where they had to transfuse 58 pints of blood to the patient.
The Operating Theatre
The Sister-in-Charge of Ward 86 and the OT, Sr. Pradeepa Priyadarshani explains how they advise patients not to get food from outside as they could get an infection and encourage the carers to use the in-ward facilities available for cooking the patients’ meals.
With the Annual Health Bulletin recording that at least 2,000 people die of chronic liver disease and the only option for many of them is a transplant, the team is urging the strengthening of the donor programme.
The patient from Marawila, along with other men, women and children who have left the Liver Transplant Unit with smiles, new livers and a fresh lease of life, says with emotion: “This team is a blessing for Sri Lanka.”
Ward 86 with all facilities
| Firsts by the NHSL Unit Liver transplant entails surgery to remove a liver that no longer functions properly (with the person going into liver failure) and replace it with a healthy liver or part of a liver from a deceased donor or a live donor respectively. In addition to the usual transplants, here are the firsts performed by the NHSL Liver Transplant Unit:
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