Liver transplantation—Economics in the less developed world

Saigal, Sanjiv; Shah, Sudeep R.

doi:10.1007/s12664-011-0159-8

Cited by 5 publications

(8 citation statements)

References 6 publications

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“…These multiple commercial support inputs eventually helped us overcome the challenges we faced after the transplant. A system that will utilize the goodwill of the general public and ensure continued support of the corporate sector will need to be fostered to fill the gap between demand and available free health care resources to make liver transplantation successful in selected public institutions for the benefit of the majority [8].…”

Section: Discussionmentioning

confidence: 99%

First paediatric live donor liver transplant in Sri Lanka with 1 year outcome : challenges for the future

et al. 2021

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IntroductionLiver transplantation in the paediatric age group is demanding due to smaller body proportions and physiology. This paper describes the first successful paediatric liver transplant in Sri Lanka along with its one-year outcome. Describing the challenges faced during the process, we highlight the factors that need to be considered for a sustainable programme in the future. MethodologyA 9-year-old girl who had progressive familial intra hepatic cholestasis type 3 was referred to us with features of end stage liver disease. She was identified as a suitable candidate for liver transplantation. Her 38-year-old mother was selected as the donor, who was evaluated for suitability of a left lateral segment donation. ResultsThe first paediatric liver transplantation was performed in July 2020. The child's mother donated the left lateral segment weighing 325g. During the postoperative period the child developed outflow tract obstruction at the hepatic venous anastomosis. This was managed with a percutaneously placed stent. Six months after transplant, she developed an acute rejection that required steroids. Treatment of rejection was complicated with multiple liver abscesses caused by Aspergillus. The infection was treated with systemic antifungals and drainage. At one-year post transplant, the recipient had recovered from the trauma of surgery and had normal liver biochemistry, a patent hepatic venous stented anastomosis and complete resolution of the abscesses. We faced dual challenges in dealing with a live liver transplant donor and a young child who was the recipient. Our success, on this occasion, was underscored by the multidisciplinary contribution from specialists scattered across the island combined with state-public partnership.

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Section: Discussionmentioning

confidence: 99%

First paediatric live donor liver transplant in Sri Lanka with 1 year outcome : challenges for the future

et al. 2021

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“…In addition, some centers accept lower levels of calcineurin inhibitors in living donor liver transplants. 4 Also acute cellular rejection episode does not affect liver graft survival. 5 The potential mechanisms for lesser rejection in liver includes production of soluble MHC1 by liver (blocks preformed antibodies and inhibits T cell activation) and good regeneration capacity of liver.…”

mentioning

confidence: 99%

Current Status of Immunosuppression in Liver Transplantation

Choudhary

Saigal

Shukla

et al. 2013

Journal of Clinical and Experimental Hepatology

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With advancements in immunosuppressive strategies and availability of better immunosuppressive agents, survival rate following liver transplantation has improved significantly in the recent times. Besides improvements in surgical techniques, the most important factor that has contributed to this better outcome is the progress made in the field of immunosuppression. Over the last several years, the trend has changed to tailored immunosuppression with the aim of achieving optimal graft function while avoiding its undesirable side effects. Induction agents are no longer used routinely and the aim is to provide minimal immunosuppression in the maintenance phase. The present review discusses the various types of immunosuppressive agents, their mechanism of action, clinical utility, advantages and disadvantages, and their side effects in short and long-term. It also discusses about tailoring immunosuppression in presence of various situations such as renal dysfunction, metabolic syndrome, hepatitis C recurrence, cytomegalovirus infections and so on. The issue of chronic kidney disease and the available renal sparing immunosuppressive strategies has been particularly stressed upon. Finally, it discusses about the practical aspects of various immunosuppression regimens including drug monitoring. ( J CLIN EXP HEPATOL 2013;3:150-158)

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“…90,91 Antibody induction therapy [ATG, basiliximab] may be used as a steroid-sparing or CNI sparing regimen. 92,93,94 Maintenance immunosuppression refers to an immunosuppressive regimen that is continued 30 days from transplantation and used indefinitely after that. 91 Personalizing immunosuppression is seen as tailoring immunosuppression protocols considering recipient characteristics (renal function, metabolic syndrome), etiology of liver disease and extent of alloimmune activation.…”

Section: Immunosuppressive Regimens In Liver Transplantationmentioning

confidence: 99%

“…LT recipients with autoimmune liver disease, IBD, or episodes of TCMR remain on low dose maintenance of prednisolone. 94 In patients with renal dysfunction, basiliximab 20 mg intravenous is administered on postoperative days 0 and 4; TAC is withheld until postoperative day 5. If there is no renal dysfunction, TAC 1 mg administered orally twice daily is started on postoperative day one, with further dose adjustments depending on a target trough level of 8-10 ng/mL for the first 3 months and 5-8 ng/mL after that.…”

Section: Immunosuppressive Regimens In Liver Transplantationmentioning

confidence: 99%