Fifty liver transplants: a single centre experience of haemodynamic management in liver  transplantation for cirrhosis [part 2]

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

doi:10.4038/sljs.v39i3.8894

Cited by 5 publications

(7 citation statements)

References 15 publications

(17 reference statements)

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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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“…Chu et al (2006) show in their population-based national study in the USA for endemic mycosis that 14% of histoplasmosis patients had an immunocompromising condition including solid organ transplantation. Like other countries, an increasing number of solid organ and bone marrow transplants are being done in Sri Lanka resulting in growth of the at-risk population (Abeysinghe et al 2018, Vadysinghe et al 2018, Gunetilleke et al 2021. For example, four hundred kidney transplants were conducted in Sri Lanka in 2017 (Vadysinghe et al 2018).…”

Section: Evaluation For Immunodeficiencymentioning

confidence: 99%

Histoplasmosis in Sri Lanka – barely recognized, yet present

Sigera¹,

Jayasekera²,

Denning³

2023

MycoAsia

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Histoplasmosis has been reported in Sri Lanka for decades; however, clinical recognition and diagnosis of the disease are rare. We conducted a comprehensive search of English-language medical literature from 1969 to February 2022. Our analysis found one population survey of histoplasmin skin sensitivity testing in 1969 (5.7% positive incidence) and ten cases of histoplasmosis across Sri Lanka. The highest number of cases were reported from the Central province, where the positive histoplasmin tests were observed previously. None of the patients were positive for HIV, and both diabetes and betel chewing seem linked with oral histoplasmosis. Out of the reported cases, 50% were diagnosed with disseminated histoplasmosis; asymptomatic, acute pulmonary, and chronic pulmonary histoplasmosis were not observed. The clinical presentation varied from oral lesions (the most common presentation), skin lesions, and fever of unknown origin to adrenal crisis. Fungal culture and histopathology were used for diagnosis, with no use of antigen and antibody testing. Amphotericin B and itraconazole were used as treatment options. The rising at-risk population mandates enhancing laboratory diagnostic facilities and increasing the awareness of medical professionals in Sri Lanka on histoplasmosis.

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“…A restrictive transfusion strategy linked to VHA based protocols are integrated in ERAS protocols in liver transplantation. (38,39) CONCLUSION End stage liver disease secondary to cirrhosis is a leading cause of death due to non-communicable disease in Sri Lanka. Cryptogenic cirrhosis and alcoholic cirrhosis are the principal aetiologies in patients presenting for liver transplant at CNCLD.…”

Section: (Ii)mentioning

confidence: 99%

Optimizing Intraoperative Haemodynamics and Haemostasis to Enhance Recovery After Liver Transplantation for Cirrhosis in Adults

Gunetilleke

Welikala

Ranamuni

et al. 2022

Sri Lankan J Anaesthesiol

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Cirrhosis with end stage liver disease is a leading cause of non-communicable disease related deaths in Sri Lanka. Liver transplantation remains the only curative treatment for such patients. Multi-organ dysfunction characteristic of end stage liver disease, surgical and anaesthetic factors, quality of the graft, coagulopathy and haemodynamic instability, all lead to the complexity of the perioperative care for liver transplant. Aggressive management focused particularly on maintaining intra-operative haemodynamic stability and optimising haemostasis, directly impacts successful patient outcomes and forms the core of the anaesthetic strategy.

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Fifty liver transplants: a single centre experience of haemodynamic management in liver transplantation for cirrhosis [part 2]

Cited by 5 publications

References 15 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

Histoplasmosis in Sri Lanka – barely recognized, yet present

Optimizing Intraoperative Haemodynamics and Haemostasis to Enhance Recovery After Liver Transplantation for Cirrhosis in Adults

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