Fifty liver transplants: a single centre experience of haemodynamic management in liver  transplantation for cirrhosis [part 1]

Gunetilleke, Bhagya; Ranamuni, Roshangani; Jayaweera, Dushyantha; Welikala, N.; Kerner, V.; Munasinghe, Nihal; Withanage, R.; Wickremasinghe, N.; Hewage, S.; Fernando, Meranthi; Hettiarachchi, Dineshani; Niriella, Madunil Anuk; Dassanayake, Anuradha S; Thilakaratne, S.; Wijesuriya, Ruwan; Liyanage, C.A.H.; Siriwardana, R. C.; Dissanayake, Janaki; Wijesuriya, N.; Rodrigo, U.; Mudalige, A.; Silva, J. De

doi:10.4038/sljs.v39i2.8865

Cited by 4 publications

(9 citation statements)

References 23 publications

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“…Sri Lanka carried out its first successful cadaveric LT in 2010, followed by the first live-donor transplant in 2012, the first transplant for acute liver failure in 2018 and the first successful paediatric transplant in 2020 [20,21]. As of 2021, 22 liver transplantations have been conducted in the country [12].…”

Section: Liver Transplantation In Sri Lankamentioning

confidence: 99%

Challenges of liver transplantation programs in low‐ and middle‐income countries: An experience from Sri Lanka

Jayarathna,

Dassanayake,

Dorji

et al. 2024

Public Health Challenges

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Liver diseases lead to 1.3 million deaths per year around the world, the majority of which are secondary to cirrhosis. In the management of liver diseases in chronic and acute conditions, liver transplant (LT) plays a major role in improving the survival and quality of life of patients. LT programmes require the technical capabilities in performing the pre‐transplant evaluation, transplant surgery and post‐transplant care supported by adequate infrastructure and a set of trained teams. Globally, there were 28,000 deceased donor LTs, and 14,000 living donor LTs were performed in 2021. In the South Asia region, India, Pakistan and Sri Lanka conducted 2998 LTs in 2021. Many countries report sociocultural, religious and legislative barriers to acquiring adequate donor livers. We describe the challenges in LT programmes in low‐ and middle‐income countries and experiences from Sri Lanka. Sri Lanka carried out its first LT in 2010, and the service is provided free of charge in the state health sector. In Sri Lanka, the common indications for LT in adults are non‐alcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma and alcoholic liver disease. In children, the indications are biliary atresia, hepatocellular carcinoma and Wilson disease. The common challenges include a lack of an adequate number of doctors and post‐transplant team members, a low number of organ donors and a long waiting list, all of which can be disadvantageous for transplant programmes. To continue providing LT services, there is a need to adopt multimodal strategies in the areas of providing additional skills training to the operating team and promoting organ donation culture in the background of supportive organ donation legislation. With the adoption of the national strategic plan for organ, tissue and cell transplantation, the country hopes to strengthen its capacity of providing transplant services to its people.

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Section: Liver Transplantation In Sri Lankamentioning

confidence: 99%

Challenges of liver transplantation programs in low‐ and middle‐income countries: An experience from Sri Lanka

Jayarathna,

Dassanayake,

Dorji

et al. 2024

Public Health Challenges

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“…Although there are evident defects in the synthesis of vitamin K-dependent coagulation factors and fibrinogen, the synthesis-derived anticoagulant factors, especially protein C, are also reduced. Elevated endothelial-derived FVIII coupled with low protein C contributes to a hypercoagulable state [ 20 , 21 , 22 ]. In this setting, PT and APTT suggest defective coagulation.…”

Section: Coagulopathy In Liver Diseasementioning

confidence: 99%

Patient Blood Management in Liver Transplant—A Concise Review

et al. 2023

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Transfusion of blood products in orthotopic liver transplantation (OLT) significantly increases post-transplant morbidity and mortality and is associated with reduced graft survival. Based on these results, an active effort to prevent and minimize blood transfusion is required. Patient blood management is a revolutionary approach defined as a patient-centered, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient’s own blood while promoting patient safety and empowerment. This approach is based on three pillars of treatment: (1) detecting and correcting anemia and thrombocytopenia, (2) minimizing iatrogenic blood loss, detecting, and correcting coagulopathy, and (3) harnessing and increasing anemia tolerance. This review emphasizes the importance of the three-pillar nine-field matrix of patient blood management to improve patient outcomes in liver transplant recipients.

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“…14 The Colombo North Centre for Liver Diseases (CNCLD) is a prominent adult liver transplant center in Sri Lanka that has played a pivotal role in the national liver transplant history. [15][16][17] By 2020, CNCLD had successfully performed 50 liver transplants in adults, including many other milestones in adult LT history in SL. [15][16][17] As an advancement of the existing LT service, CNCLD marked its first successful PLT, which was the first successful PLT in SL as well.…”

Section: Introduction/backg Roundmentioning

confidence: 99%

“…[15][16][17] By 2020, CNCLD had successfully performed 50 liver transplants in adults, including many other milestones in adult LT history in SL. [15][16][17] As an advancement of the existing LT service, CNCLD marked its first successful PLT, which was the first successful PLT in SL as well. 18 Establishment of a demanding specialty like pediatric liver transplantation, in a free healthcare system with limited high-end infrastructure and a unique socioeconomic structure, presents numerous challenges.…”

Section: Introduction/backg Roundmentioning

confidence: 99%

“…In 2010, Sri Lanka achieved its first successful adult liver transplantation (LT), which paved the way for the establishment of similar services in multiple centers across the country 14 . The Colombo North Centre for Liver Diseases (CNCLD) is a prominent adult liver transplant center in Sri Lanka that has played a pivotal role in the national liver transplant history 15–17 . By 2020, CNCLD had successfully performed 50 liver transplants in adults, including many other milestones in adult LT history in SL 15–17 .…”

Section: Introduction/backgroundmentioning

confidence: 99%

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Challenges faced in establishing a pediatric liver transplant program in a lower‐middle‐income country with free healthcare service

Fernando,

Tillakaratne,

Gunetilleke

et al. 2024

Pediatric Transplantation

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BackgroundLiver transplant is the cure for children with liver failure. Sri Lanka is a lower‐middle‐income country with a predominant free, state health system. Pediatric liver transplant program in Sri Lanka is still in the budding state where the initial experience of the program is yet to be documented.MethodsA retrospective review was performed including the clinical characteristics of all pediatric liver transplant recipients of Colombo North Centre for Liver Diseases since the inception of the program from June 2020 to May 2023.ResultsThere were 14 PLT performed in 3 years. The median recipient age and weight were 8 years (6 months–15 years) and 23.3 kg (6.4–49.2), respectively. The majority were boys (64%). All were from low‐income backgrounds. Indications for LT were acute liver failure (5/14), decompensated chronic liver disease (5/14), and acute on chronic liver failure (4/14). Underlying liver diseases were Wilson disease (6/14), autoimmune liver disease (3/14), biliary atresia (2/14) and progressive familial intrahepatic cholestasis type 3 (1/14), and unknown etiology (2/14). The majority were living donor liver transplants (86%). Of the living donors, 42% (5/12) were Buddhist priests. There were three immediate deaths and two late deaths. The 3‐month survival was 78%, and overall survival was 64%. Living donor transplants carried a higher success rate (92%) compared to diseased donor transplants (0%; 2/2).ConclusionsInitial experience of pediatric liver transplant program of Sri Lanka is promising despite being established in a free healthcare system amidst the crisis circumstances.

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Fifty liver transplants: a single centre experience of haemodynamic management in liver transplantation for cirrhosis [part 1]

Cited by 4 publications

References 23 publications

Challenges of liver transplantation programs in low‐ and middle‐income countries: An experience from Sri Lanka

Challenges of liver transplantation programs in low‐ and middle‐income countries: An experience from Sri Lanka

Patient Blood Management in Liver Transplant—A Concise Review

Challenges faced in establishing a pediatric liver transplant program in a lower‐middle‐income country with free healthcare service

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