New hope lies in living donor liver transplant

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.