Liver transplant done with HOPE in Chennai hospital


A corporate hospital here said on Friday that it has successfully performed what it claimed to be the countrys first liver transplant with a hypothermic oxygenated perfusion (HOPE) pump on an end-stage liver disease patient.

COVID-19 has impacted organ transplantation in the country causing an acute shortage of cadaver organs.

As a result, a large number of patients were waitlisted for a long interval, said Dr Karthik Mathivanan, Associate Director of institute of liver diseases and transplantation, MGM Healthcare.

Elective surgeries and transplants were stopped in many hospitals from March last year when the pandemic struck.

Patients waiting for organ transplants in Chennai hospitals had to wait longer as transplants could not be resumed amid the high-viral atmosphere due to COVID-19.

Factors like determining the COVID status of donors, the risk of recipients getting infected during or after the transplant and ensuring a safe atmosphere for the surgery, also played a crucial role.

Organ transplants have been affected due to the pandemic. The demand has gone up and donors have become harder to come by, said Dr Mathivanan.

On an average about 400 people wait for cadaver liver in a year in the State.

Hundreds of patients wait for donors and finally lose their lives due to inability to procure the organ, he said.

The condition of other patients waiting for kidneys, heart and lung is also precarious, he added.

In the case of a 44-year-old man with end-stage liver disease, he had waited for two-and-a-half years for the organ.

This patient has a rare AB blood group which also added to the difficultly of getting the liver, Dr Thiagarajan Srinivasan, Director, institute of liver diseases and transplantation at MGM Healthcare, said.

Given that the patient had a rare blood group and slim chances of finding a cadaveric donor liver, his situation was getting a little complicated, Dr Thiagarajan said.

The patient did not have a matched compatible live liver donor and had a history of two unsuccessful previous near- miss attempts in the waiting period to get the donor liver.

However, about three months ago, a cadaveric liver was available but the brain-dead donor was administered high dose of blood pressure- support drugs and was unstable, Dr Thiagarajan said at a virtual press conference.

It was then the team of doctors led by Dr Thiagarajan decided to use the HOPE pump owing to the complexity of the case and the condition of the donor liver.

The recipients family was informed that the donor liver was pale and on biopsy had a high fat content of 40 per cent.

We used the machine pump on the donor liver to make the liver transplantable into the patient. We took the organ, did a biopsy and kept it in dynamic cold perfusion for six hours, he said.

Normally, a liver after retrieval from a brain-dead donor is perfused by static ice-cold preservative solution.

But the HOPE machine pump helped the doctors in repairing and improving the quality of the liver by pumping preservative fluid into the organ at a temperature of 4-6 degrees and oxygen was further added to the fluid through a membrane oxygenator.

The liver discard rate commonly is 15-20 per cent, and with the use of this innovative technology it would help in reducing the discard rate and give a new lease of life to a lot of end-stage liver disease patients, he said.

He said MGM Healthcare successfully conducted the cadaveric liver transplantation on the patient using the innovative HOPE on March 25 by a 50-member team that he headed.

This HOPE procedure is low cost, innovative and revolutionary, Dr. Thiagarajan said and called upon the State government and industry to establish dedicated organ perfusion centres for marginal cadaveric livers to help expand liver donor pool and to reduce organ shortage and cost.

The patients condition remained stable throughout the transplant and in the post-operation period. He is now leading an active, normal life with perfectly functioning new liver, said Dr Mathivanan.

Incorporation of innovative machine pump technology can save many lives, he said and added: We hope to bring all the latest technology to the country at an affordable cost.

Dr. Arulprakash S, senior consultant & clinical lead- gastroenterology & hepatology, MGM Healthcare, said this technology provided a chance of using marginal livers with good outcome and thereby reducing waiting time for patients awaiting liver transplant.

Harish Manian, CEO, MGM Healthcare, said this rare cadaveric liver transplant with HOPE machine is a testament that the hospital would continue to bring in the best of technology for the patients.

Sharing his experience, the liver recipient Ramprabhu thanked the clinical team led by Dr Thiagarajan Srinivasan for giving him a new lease of life.

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