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Abstract Ref Number = APCP90
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Lessons from 20 years of liver transplantation
Anupam Sibal
Group Medical Director, Apollo Hospitals Group
Senior Consultant Pediatric Gastroenterologist and Hepatologist, Indraprastha Apollo Hospitals
Liver transplantation is now well-established therapy in the developing world for children with acute liver failure, end stage liver disease and a variety of metabolic disorders. The first successful liver transplant in India was performed in an 18-month-old child suffering from biliary atresia in November 1998 at Apollo Hospitals, New Delhi. He remains well 20 years post transplantation.Thereafter, children from different parts of India and more than 20 countries have been transplanted. 1 year and 5 year post-transplant survival rates are above 90 % and 85 % respectively. Pre-operative nutrition/therapy, better surgical expertise, improvements in intensive careand standardized post transplant care with potent immunosuppressants have contributed to success. Success rate in children <1 year of age and those weighing <10 kgs have improved. Age and size are no longer barriers as babies as young as 4 months and as small as 4 kgs have been transplanted. Excellent survival figures have been reported in children weighing less than 7.5 kg. BA and ALF are the most common indications for pediatric LT.Expanding indications for LT include metabolic disorders and non-resectable tumors.ABO incompatible transplants are being increasingly performed. The average cost of 27000- 35000 USD for a pediatric transplant in India is about 1/5th to 1/10th the cost in the West, making it a major center for LT for international patients as well. With social and institutional support economic constraints are being overcome. Major challenges still include lack of cadaveric donors, late referral, bias against the girl child, low socioeconomic status and fear of donation. Nevertheless, with increasing acceptance of LT amongst the medical community and the public at large, there is now potential for the number of liver transplants to increase significantly so as to offer hope to the thousands of children who suffer from liver failure.
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