Zydus Hospital, Ahmedabad crosses 300 Liver Transplants - Highest in Gujarat

PRNewswire
Ahmedabad (Gujarat) [India], September 1: The rise of sedentary jobs, lack of exercise and increased intake of processed foods have slowly driven one of the fastest-growing liver conditions, non-alcoholic fatty liver disease (NAFLD), which now affects 1 in 4 adults [1],[2].
Left untreated, it can progress through inflammation (NASH), scarring, and eventually cirrhosis or liver cancer [3]. This rising disease burden runs headlong into a stark shortage. Zydus Hospital, Ahmedabad, continues to push against this gap, and has recently crossed 300 liver transplants, marking a major liver transplant milestone for Zydus Hospital Ahmedabad.
Liver Transplant surgeries are multidisciplinary endeavours, complex and demanding. Zydus Hospital, through its liver transplant programme in Ahmedabad, challenges the existing limits of surgical capabilities and focuses on a collaborative, multi-disciplinary approach that sees a close coordination of experts across liver transplant surgeon, liver critical care specialist, anaesthesia, hepatologist, gastroenterologist, and nephrology (in case of simultaneous liver-kidney transplantation, or SLKT), who work in tandem to expand horizons for patient benefit.
The team has successfully performed living donor and deceased donor liver transplants, ABO-incompatible liver transplants, paediatric liver transplants, planned transplants for chronic liver disease (CLD), and emergency cases of acute liver failure. "Almost 40% of our patients arrive with acute-on-chronic liver failure (ACLF), and need a transplant within 24 to 36 hours of arriving" says Dr. Anand Khakhar, liver transplant and HPB surgeon in Ahmedabad, who has more than two and half decades of experience and is a recipient of the Dr. B.C. Roy Award. He recalls a 12-year-old boy who was rushed from Junagadh with ALF. "He was comatose, on ventilator support and dialysis. The one thing we could not afford in his case was sepsis or hypotension." A drop in blood pressure could cause blood vessels to dilate further and rapidly worsen the his condition. "The child's mother came forward as a donor, and while her evaluations were underway, he developed hypotension and sepsis was suspected," said Dr. Anand. On closer assessment, the team determined it was necrotic tissue that was producing those symptoms. "We removed the necrotic liver, and stabilised him long enough that we could safely proceed with the transplant," added Dr. Anand. The boy responded well during post-op and soon returned home. Performing such complex and challenging liver transplant cases need advanced infrastructure. As Dr. Yash Patel, Liver Transplant Surgeon, adds, "At Zydus, we have access to modular advanced OTs, dedicated liver ICUs, advanced MRI facilities, FibroScan imaging along with multidisciplinary support under one roof."
Younger adults arrive in the same critical state, sometimes with added complications. A 22-year-old architecture student came to Zydus with ALF and was in a similar state. "In his case, in addition to dialysis, we also had to add toxin filters and he only had one suitable donor, his sister, but their blood group did not match," says Dr. Anand. "We usually need to disable pre-existing antibodies with rituximab as part of a larger protocol that includes plasma exchange but as he was not in a condition to tolerate the rituximab, we ran a continuous plasma exchange until his antibody level came down to a level where his body could tolerate the transplant. We then proceeded with removing his spleen, and then transplanted his liver. The surgery went well and he recovered well" said Dr. Anand. Careful immunosuppression post-op balances the risk of organ rejection against infection risk and supports wound healing. "We have always prioritised the need and safety of our patients. If there are hurdles in the way, we try our best to overcome them," added Dr. Khakhar.
"We, in India, have a huge burden related to chronic liver disease and its complications. Years back, in our early gastroenterology practice, there was no treatment for patients with advanced liver disease. We are fortunate to have a complete liver unit with an excellent transplant team at Zydus Hospital under one roof. Not only it has given a new hope but also a new life to these patients, who otherwise would have had a very poor quality of life and lifespan," adds Dr. Nilay Mehta, Sr. Gastroenterologist and Endoscopist.
Dr. Himanshu Sharma, Liver Critical Care Specialist adds, "There is a common misconception that NAFLD which includes NASH is exclusive to individuals who are obese or overweight." Despite a normal weight, affected individuals can still store harmful visceral fat around the liver. Recently, 37-year-old patient was airlifted from Chandigarh in a dire state. He was diagnosed with lean NASH related CLD. "His pre-op issues were significant and he had lost significant muscle mass. He was 6ft tall and weighed only 43kgs. He came with lower abdominal wall infection and a bad case of cellulitis. We needed to stabilise him before going ahead with the transplant. Our ICU team along with physiotherapy and rehab, put in tremendous work and helped him rebuild his strength over the month he spent with us. He recovered slowly and was discharged. It's been two years now and he's doing well and gone back to practicing law," Dr. Himanshu added. The Liver Critical Care team and the transplant rehab specialist, Dr. Himani Goswami along with Shruti Bhardwaj, Nutritionist, played a tremendous role in his journey to recovery and normalcy.
At the core, Zydus understands the importance of multidisciplinary work across different fields and creates an environment where teams can collaborate and work on demanding cases comprehensively. A 50-year-old man from Raipur, suffering from Autosomal Dominant Polycystic Kidney Disease (ADPKD), was admitted to Zydus Hospital. ADPKD is the most commonly inherited cause of end-stage kidney disease, which sees the development of several large cysts in both kidneys. "This patient needed simultaneous liver and kidney transplantation. Further, his large native left kidney was full of cysts and had to be removed to make space for the transplanted kidney. One large liver cyst contained a large amount of pus, making its removal additionally difficult," said the team. Several factors complicated his case and transplanting both his organs successfully was indeed a 'Herculean task'.

Navigating such dual transplants involve several intricacies due to the stark differences in anaesthesia, critical care goals and pre- and post-op goals of both liver and kidney transplant teams. These and many such diabolically opposite requisites are usually resolved through superior clinical acumen and a higher-order cognitive collaboration between the stalwarts in the field. The team at Zydus includes top Gastroenterologists and Hepatologists in Gujarat including Dr. Nilay Mehta, Dr. Ajay Choksey, Dr. Hardik Kotecha, and Dr. Tejas Modi, renowned Nephrologists, Dr. Himanshu Patel, Dr. Prakash Darji, Dr. Devang Patwari and Dr. Kamal Goplani, Anaesthetists, Dr. Meeta Agarwala, Dr. Kairav Shah, Dr. Vikram Patel, Dr. Paragsinh Gohil and Dr. Nimesh Prajapati, and Radiologist, Dr. Bhavik Shah and team. This cross-discipline integration of such kind ensures excellent patient care and a holistic approach to patient management.
In South-east Asia, almost 80% patients are living donors. In this scenario, donor safety in living donor liver transplantation is of the utmost importance. "To operate on them safely, send them home in good health, and make sure their recovery is unhindered -- that's our goal," says Dr. Yash. "These donor surgeries are major in their own right, and the focus we put into them is what sets us apart, I feel. Donor safety is very close to my heart" he adds. There is also an urgent need for living donors who can come forward and help create organ donation awareness amongst the community, as liver is a regenerative organ, and a part of it can be donated without disturbing the quality of life. To know more, visit https://zydushospitals.com
Innovations in medical science are reflected in the evolution of newer, safer and more sophisticated techniques that have significantly enhanced the quality and viability of liver transplants. At Zydus Hospital, Ahmedabad, such advances are translated into clinical excellence and have brought renewed hope to thousands of patients and their families.
References:
1. Nd AM. Non-Alcoholic Fatty Liver Disease, an Overview. Integr Med (Encinitas). 2019;18(2):42-49.
2. Hallsworth K, Adams LA. Lifestyle modification in NAFLD/NASH: Facts and figures. JHEP Rep. 2019;1(6):468-479.
3. Bertot LC, Jeffrey GP, Wallace M, et al. Nonalcoholic fatty liver disease-related cirrhosis is commonly unrecognized and associated with hepatocellular carcinoma. Hepatol Commun. 2017;1(1):53-60.
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