New hope lies in living donor liver transplant

Parkway Group Healthcare Pte. Ltd. of Singapore sponsored a two-day seminar on aging last week. It was organized by Gleneagles Hospital Singapore, one of the group's hospitals in the region. The following are two reports by The Jakarta Post's Stevie Emilia, who was invited to the annual event.

Varikottil Kammu now sees each day with fresh hope, just like his newly found life. Six months back, he had no hope, and was waiting to die.

"Look at me, I feel much better now. I still need time to completely recover, but I'm getting my life back," said the 52- year-old Indian businessman, while sitting comfortably in his hospital bed, eating a sandwich for breakfast.

It was two weeks after the father of five had a liver transplant from a living donor, his 22-year-old nephew Ismail.

Kammu, who was to leave the hospital in another week while his nephew had already been discharged, was the first patient in the Gleneagles Hospital Singapore's new Living Donor Liver Transplant (LDLT) Programme, the first such program in Southeast Asia.

With the increasing incidence of liver diseases and a critical shortage of cadaveric donor livers (those from brain-dead individuals) for transplant, the procedure -- which was initially performed on children with terminal liver diseases with the parents as the living donors, but now has been expanded to include adult recipients -- brings new hope for those with end- stage liver diseases.

Until recently, more than 75 percent of patients on the waiting list in Singapore would die before a suitable cadaveric donor liver was found. In developing countries like Indonesia, the figure is probably higher.

"This program is introduced to prolong life, to help those with acute liver problems, while there is a lack of cadaveric donor livers. This procedure helps to improve and prolong their lives," said Dr. Lim Cheok Peng, managing director of Parkway Group Healthcare, which owns the Gleneagles Hospital Singapore.

The program, which took the hospital seven years to prepare and around US$1.5 million in investment, is expected to handle 50 such procedures a year. The costs are currently estimated at between S$200,000 and S$300,000.

To date, two successful transplants -- performed by experienced doctors led by the reputable specialist in LDLT procedure, Dr. Tan Kai-Chah -- have been performed at the hospital.

"At the moment, we are evaluating the third case," Lim said.

So, how is it done?

The human liver comprises eight segments, each with its individual blood supply and bile drainage. Individual segments or a combination of segments (the right or left robe) are retrieved from the living donor and transplanted to the recipient. The remaining liver in the donor will regenerate and replace its size and function within four to six weeks. Similarly, the transplanted liver segments in the patient will regenerate rapidly.

In the procedure, two teams of doctors will perform the donor and recipient operations almost simultaneously, where about half the donor liver will be removed. Once the diseased liver is removed from the recipient, the liver graft that had been retrieved earlier from the donor is implanted. Both halves of the liver will regenerate and grow to full size in four to six weeks. The donor operation usually takes six to eight hours and the recipient operation eight to 10 hours.

Patients considered for living donor liver transplants are usually those with end-stage liver disease who would be listed for a cadaveric donor liver. They usually suffer from, among others, jaundice, recurrent encephalopathy, intractable ascites, or certain unresectable cancers of the liver.

On the other hand, the donor should be a close relative or emotionally related to the recipient, must be older than 18 years and in good mental and physical health. In addition, the donor must be of the same or compatible blood group to the recipient and free from HIV, chronic viral hepatitis B and C, any significant medical illness, active alcoholism and pregnancy.

For 42-year-old Shua Hing Lian, it was love that made her give parts of her liver to her husband, 52-year-old Ang Kok Meng, who suffered from acute liver disease. Her case, the second for the hospital, was unique as the donor was not a relative of the recipient.

"She was willing to do it because of the emotional relationship between them. After going through some tests, it was discovered it could be done," Lim said, insisting the tests were essential to ensure a successful transplant.

He said that a "perfect match" was important to prevent other complications because, "once the liver fails, the kidney and the heart can also fail".

In Ang Kok Meng's case, he was diagnosed with minor liver problems last year, but ignored it and continued drinking and working.

"But after attending a Christmas party, he didn't feel good. Instead of consulting a doctor, he called his relatives back in China and asked for herbs. He even went to China to seek treatment, but after two to three months he returned, his condition had deteriorated. His entire body turned yellowish and blackish," his wife, who is also the mother of a boy, said, as translated by her sister, Shua Hing Jong.

Eight days after the transplant, Shua Hing Lian was allowed to leave the hospital, while her husband was still kept in intensive care.

After the transplant, the donor is usually nursed in the intensive care unit for 24 hours, hospitalized for six to eight days and should be able to resume most light home and work activities within a month -- depending on their individual rate of recovery. The donor is closely monitored by the surgeons over the next several weeks and then as required. There are no dietary restrictions, but the donor will be prescribed vitamins for the next few months.

The recipient is expected to stay in hospital for a longer period (usually three to four weeks), initially in the intensive care unit and later in the surgical ward. During this period, the recipient will be closely monitored for infection, rejection and regeneration of the transplanted liver.

"The first recipient will be released three weeks after the transplant, so it's very individual. One transplant applied to one patient does not necessarily apply to other patients," Lim said.

More information on Parkway Group Health Care can be found at pgh.parkway.com.sg; 24-hour Medical Referral Center: imrc.com.sg, e-mail: mrc@parkway.com.sg, or call (65) 67355000.