LIVER TRANSPLANT IN INDIA IS CHEAP AND SAFER NOW

Liver transplants expensive but 95% life-saving " LUCKNOW: Three years ago, 48-year-old Rajesh Puri underwent a liver transplant after he was detected with chronic hepatitis C with cirrhosis of liver. He was diagnosed with the disease in 2004 and was on medication for the next five years. When his condition deteriorated in 2009, doctors advised a liver transplant. "There was no other way to save my life,'' said Rajesh who is now living a healthy life after his wife Rita donated part of her liver to save him. The liver transplant cost them Rs 25 lakh. Rajesh is not the only one to have faced extreme situation due to ill health. There are thousands others forced to undergo a liver transplant. The challenge with 90% of the liver diseases, say doctors, is that patients don't realise they have it until it's late. What's worse is that cost of treatment for liver ailments especially in later stages is exorbitant." SOURCE::::http://articles.timesofindia.indiatimes.com/2012-12-17/lucknow/35867741_1_liver-transplant-liver-diseases-s-soin

LIVER TRANSPLANT CO-ORDINATOR INDIA

Liver Transplant proves to be a BOON OF LIFE if it is done for the right reasons, at the right time, by the right people and of the eligible patient. But most of the patients are unprepared for this major operation. They get misguided by inadequate, unsubstantiated and sometimes misleading information. Such information is available through the internet and propaganda done on behalf of Liver Transplant Centers. To get the best result out of this life-saving procedure of Liver Transplant, it is advised to have complete information related to this field. The patient, his family members, caretakers and well-wishers must be fully aware about various Liver Transplant Hospitals, Surgeons, Doctors, Success-rates, Cost, Post Liver Transplant Life, Medicines and their side effects etc. etc. The author of this website Jyotsna Verma(Chief Liver Transplant Coordinator) worked as a Senior Transplant Coordinator in renowned centers of Liver Transplant in India with reputed surgeons (Dr.A.S.Soin, Dr. Subash Gupta etc.). She has an experience of dealing with about 11000 liver disease patients and has personally coordinating more than 700 liver transplants in India. Through her Liver Transplant Consultation Services, she wants to provide the benefits of her experience to all the patients in need for Liver Transplant. She has not not restricted herself to a single Liver Transplant Team, Center or Area. In past Decade, India has become an attraction for Medical Tourism specially because of 'Low Cost and High Success Rate Liver Transplant'. The cost of Liver Transplant Surgery in India varies between 10 to 30 Lacs Rupees (INR) which is about 1/6th of the cost of Liver Transplant Surgery abroad. A new Liver gives a new life and a well informed decision gives a successful Liver Transplant and complete satisfaction to the patient. The Patient and his family need to have proper Guidance and Education regarding Liver Disease and Liver Transplant procedure before going for this major undertaking. The author wants to help, guide and educate such patients through her experience as a Liver Transplant Coordinator and to share the moments faced by the patients in their Pre, Peri and Post transplant Period. Many times during her services she came across the end-stage liver disease patients and the families of Fulminant Liver Failure patients. They were not understanding the need of Liver Transplant and were running away from life thinking that liver disease was the END. There are many queries and misconceptions in their minds which need to be addressed by a person with authentic knowledge of the liver transplant scenario in India and abroad. The author provides detailed counseling and education regarding Medical, Legal and Financial issues related to Liver Transplant procedure and life after Liver Transplant. Coming out of the operation theatre or the hospital after liver transplant operation is not the end of the story. Post Transplant Period is extremely important and requires education about post-transplant lifestyle and care. Many precautions have to be followed for a healthy, normal lifestyle afterwards. The patient with a transplanted liver can expect a normal life in terms of health, activity and vigor BUT some basic precautions, anti-rejection drugs and periodic follow-up with Liver Transplant Team will continue for life SOURCE::::http://www.livertransplantconsultant.com/

CHEAPER AND SAFE LIVER TRANSPLANT IN INDIA

KOLKATA: Liver transplants could get easier and cheaper in the next 5-7 years and help to save at least 5000 patients in West Bengal annually. Diseases like cirrhosis of liver in adults and biliary atresia in children account for around 2500 deaths every year. Once patients are made aware of transplant and its benefits, it can be treated more effectively and help curb mortality rate to a great extent, says Anupam Sibal, Delhi-based paediatric gastro-eneterologist. A member of the medical team that conducted the first liver transplant in India thirteen years ago, Sibal visited Kolkata on behalf of the Children's Liver Disease Awareness and Support Programme ( CLASP). "While in USA a transplant costs around Rs 1.2 crore, it is only around Rs 20 lakh for an adult and Rs 12 lakh for a child in India. With more and more clinical instruments being manufactured in India, the costs are coming down further. What we now need is a greater awareness. We need to tell people how liver diseases could be prevented. Then, they should be told how transplants make it possible for patients to lead a normal and healthy life," said Sibal. The first transplant had been done on an 18-month-old child in Kancheepuram way back in 1998. The child Sanjay Kandaswamy is now a 13-year-old boy. "Sanjay is the ambassador of liver transplantation and his story has inspired hundreds of patients with liver failure to opt for a transplant," added Sibal, who had conducted the transplant along with five others. While just 80 transpalnts were done over the next seven years, scores are happening every week now. "Organ transplant is yet to take off in a big way in India, but liver transplants are being done at a fair rate. There is scope for more. The liver has eight parts, of which 2-4 parts could be replaced with that of a blood relative. While it takes 10 days for the donor to regain fitness, the patient is usually released in three weeks," explained Sibal. About 50% of the transplants in children are needed due to biliary atresia - a condition in which there is no connection between the liver and the intestine. Hepatitis B, C, alcohol and liver cancer are the common causes of liver failure in adults. "If a baby has jaundice within two weeks of birth, a liver failure can't be ruled out. But low awareness, even among the medical community, often results in neglect. I have come across hundreds of cases where the liver could have been saved with proper treatment. In adults, there is a fear associated with transplant. arranging for a donor is a big problem. Since cadaver transplantations are not yet frequent in India, blood relatives are the only option. Often, they are not ready to undergo the surgery. We have to convince them that they are not giving away the entire organ," said Sibal. SOURCE:---http://articles.timesofindia.indiatimes.com/2012-01-12/kolkata/30619451_1_liver-transplant-transplant-costs-organ-transplant

COMPETITION EFFETS MOS COMPLEX LIVER SURGERY

More competition between medical centers that perform liver transplants may mean sicker patients get lower-quality donor organs, according to a U.S. study. When more than one center has patients on the same donor list, the centers have an incentive to get organs for as many of their own patients as possible, wrote researchers, whose report appeared in Liver Transplantation. So doctors are more likely to take the first available organ when their patient is at the top of the transplant list, whether or not that pairing has the best chance to succeed, rather than risk the organ will go to another center. "There is the question whether competition decreases the ability of a center to better match donor and recipient characteristics," wrote John Paul Roberts, from the University of California, San Francisco, and colleagues. They analyzed data on more than 38,000 liver recipients who had transplants from non-living donors between 2003 and 2009. The transplants were done at 112 medical centers in 47 so-called distribution areas - some covered by only one center and some that relayed organs to multiple transport centers. Roberts and his colleagues found "clinically important differences" showing patients who received organs were initially worse off, with a higher risk of dying or having their transplant fail, in areas that had more medical centers in competition for the same organs. For example, 10 percent of patients who received organs at centers with no competition had the worst scores for liver disease severity pre-transplant, compared to more than 28 percent of those in the high-competition distribution areas. FOR MORE...SEE BELOW LINK... SOURCE:---http://www.indianexpress.com/news/competition-affects-who-gets-a-liver-transplant-study/1055604

MEDANTA MEDICITY--LIVER TRANSPLANT UNIT

The Medanta Institute of Liver Transplantation and Regenerative Medicine is Asia's first of its kind, dedicated Institute offering liver transplantation and all other levels of treatment for liver and biliary diseases including cancer, both in adults and children. The goal is to follow global norms for evidence-based best practice, at the same time striving for innovation of safer and more effective treatments. Patient cure with a human touch is the principal goal of the Institute. The team with an experience of more than 700 liver transplants in India runs the country's largest and the world's second largest (live donor) liver transplant program. The Institute of Liver Transplantation boasts of one of the world's highest success rates (95%) and lowest infection rates in liver transplantation, with a unique 21-point liver donor safety protocol. In addition, ccomplex non-transplant liver and bile duct surgery is done for hepatobiliary disease in both adults and children. It is also a high volume referral centre for all types of liver lumps, bile duct cancer, cysts and blocks. The Institute is committed to a scientific, compassionate & a patient-friendly approach. The ethos is one of an undying quest to innovate safer and more effective treatments for our patients, and to serve as a teaching and mentoring Institute. SOURCE::---http://www.medanta.org/liver_transplantation.aspx

GANGA RAM HOSPITAL OFFER FREE INTESTINAL TRANSPANT

As the young student battles for life bravely five days after the brutal gang-rape, a leading private hospital in New Delhi on Friday offered free intestinal transplantation and subsequent treatment to her. Sir Ganga Ram Hospital has communicated this offer to Dr B.D. Nathani, Medical Superintendent of Safdurjung Hospital where the victim is being treated currently, Dr R.S. Rana, Chairman, Board of Management SGRH, said. The 23-year-old student has undergone a surgery to remove her gangrenous intestine. The doctors treating her had said that she is “stable, alert and conscious” but she remained on ventilator support. “Intestinal failure occurs when most of the intestine has to be removed surgically as in this case. Intestinal transplant is the only chance of survival with a normal functioning intestine for the victim,” Dr Samiran Nundy Chairman, Department of Surgical Gastroenterology and Organ Transplantation said. The private hospital has performed India’s first and only living donor intestinal transplant which has been reported in peer reviewed journal this year, Dr. Rana said. According to Dr Naimish Mehta Transplant Surgeon SGRH, who was involved in India’s first Living Donor Intestinal Transplant Surgery, “there are two ways by which intestinal graft can be obtained, either from a brain dead donor or from a living related donor. Both these options could be available for the victim once her condition stabilises.” SOURCE:::::http://www.thehindu.com/news/national/hospital-offers-free-intestinal-transplant-to-rape-victim/article4225857.ece

APOLLO LIVER SURGERY UNIT

Apollo Liver Surgery Unit at Indraprastha Apollo Hospital is one of the best pediatric and adult gastroenterology programs in India.

The statistics, at Indraprastha Apollo Hospital, over the past twenty three years are not just about sheer rise in the number of patients visiting us but about unparalled trust.

• 50000 admissions every year up from 10,000 in 1980

• Bed strength of more than 650

• Occupancy shooting up from 80 to 100 % in the last 20 years

• Average hospital stay reduced from about 7 days (1980) to about 3 days in 2003

• From about 1500 major and 2000 minor operations in 1980 to more than 16000 major and
2000 minor operations today.



Meet The Team of Physicians with International Reputation

Dr.Subash Gupta
Senior Consultant Liver Transplant Surgeon
Indraprastha Apollo Hospitals

Dr.Manav Wadhawan
Transplant Hepatologist

Dr. Vivek Viz
Associate Consultant
Department Of Liver Surgery

Dr. Ajitabh Srivastav
Junior Consultant




SOURCE ::http://www.transplantliverindia.com , http://www.transplantliverindia.com/about-doctor-1.asp

PLEASE SAVE A YOUNG LIFE

Someone mailed the story of Rahul to my email

I request you Please Donate for a noble cause!

Hi my dear friends....Today I'm here to convey a message for a noble cause.I am going to share some news about a young boy named Rahul, suffering from a rare liver problem "Budd Chairi Syndrome "a liver disease.His is a very rare disease and can be cured by the surgery

The Budd chiari is treated by surgical shunts to divert the flow of blood around the obstruction or the liver itself.In Rahul's case, there is an urgent need of transigular intraheptic portosystemic surgery(TIPS). his disease is being diagnosed at the "Medanta Hospital, Gurgaon".However, the expenses of his treatment is beyond his family's reach as he doesn't have father to support him. He is having only his brother and mother in family.The cost of his treatment is estimated to be around Rs. 6 lakh.Only 20 days left for his operation and if he didn't get the money, might be he will be no more

So buddies and dear friends, please come forward and donate money for a noble cause.

You can Contact his brother Ravi Gupta @ +91 9827294545
or

mail me : syal.nitin@yahoo.com


IF YOU WANT TO DONATE SOME AMOUNT OF MONEY THEN PLEASE CONTACT ON GIVEN NO.


we really need your help,your small amount of money will create a big difference.

Come forward and join the hand for Humanity.



HINDUSTAN TIMES NEWS REPORED THIS

SEE THE CERTIFICATES FROM MEDANTA MEDICITY

SWAP LIVER TRANSPLANTS

NEW DELHI: They were strangers living in different parts of the world till about three months ago, when terminal liver failure brought them together Eighteen-month-old Dike Ezeanya of Nigeria is the toast of doctors, his mother (L) and the Ahuja couple (R) at Ganga Ram Hospital in Delhi. (TOI Photo)
More Pictures
in Delhi.

Now, 18-month-old Nigerian boy Dike and 44-year-old Mumbai resident Priya have become India's first patients to successfully undergo a swap liver transplant surgery. Unable to find suitable donors with a matching blood group for either Dike or Priya, doctors from Sir Ganga Ram Hospital decided to try out a liver swap, much on the lines of a swap kidney transplant, which has now become common.

Five months after his birth, doctors diagnosed Dike with Billiary Atresia -- a rare condition of newborn infants in which the common bile duct between the liver and the small intestine is blocked or absent. If unrecognised, the condition leads to liver failure. And this is exactly what happened to Dike. On the other hand, Priya's state was also critical. Already suffering from advanced liver failure due to Hepatitis C infection, she was later diagnosed with tuberculosis.

With transplantation being their only hope, doctors hit a dead end --unavailability of compatible cadaver donors. But by a stroke of luck, Dr A K Soin (chief of liver transplant unit), Dr Neelam Mohan (paediatric hepatologist) and Dr Sanjiv Saigal (transplant hepatologist) found that the blood group of Dike's mother Chinwe was A which matched with Priya. On the other hand, Priya's husband Haresh belonged to the blood group B which was the same as Dike.

A 35-member surgical team then took 50% of Chinwe's right liver and transplanted it into Priya while Harish gave 20% of his left liver to save Dike. Almost two months after the surgery, both Dike and Priya are normal.

"While both donors' blood groups did not match their own recipients', they were suitable for the other recipient. Dike's father had the same blood group as the kid but he had very fatty liver and so wasn't a suitable donor. When we suggested the idea of a donor exchange, which is also called paired donation, both families jumped at the opportunity," Dr Mohan said.

Dr Soin added, "The biggest challenge in paired donation transplants is that both transplants must take place simultaneously, otherwise the donor for the second transplant (first recipient's relative) may refuse to undergo surgery once his own loved one has been transplanted."

"While donor swaps are common in kidney transplantation which takes two hours, they have not been previously attempted in liver transplantation as conducting two simultaneous living donor liver transplants (four operations) is a daunting task taking 10-12 hours each. The swap transplant took 16 hours in four different operating theatres and took place on June 25," Dr Soin said.

Dr BK Rao, chairman of Ganga Ram Hospital said, "This swap transplantation will come as a blessing at the time of acute organ donor shortage. Around 30% of rejected donors can become suitable swap donors, increasing transplant rates by 30%."

India at present requires 30,000 liver transplants a year. Unfortunately due to the country's abysmally low cadaver donation, doctors end up doing just 400-odd transplants a year.

Dr Saigal said, "Encouraged by this case, we have instituted registration of patients with medically suitable family donors who do not match their own recipients due to inappropriate blood group or liver size. This opens up unique opportunities for matchmaking between donors and recipients from different families, thus helping save more lives with liver transplants."

SOURCE: http://timesofindia.indiatimes.com/news/india/Nigerian-infant-Indian-in-swap-liver-transplants/articleshow/4913040.cms

SWAP LIVER TRANSPLANT IN INDIA

The surgery saved the lives of 18-month-old Nigerian baby Dike and 44-year-old Mumbai resident Priya Ahuja who were suffering from terminal liver failuressss

Until three months ago, oblivious of each other’s existence, 18-month-old Nigerian baby Dike and 44-year-old Mumbai resident Priya Ahuja were both struggling for their life because of terminal liver failure.

Their families had lost all hope of life-saving liver transplants as the only available liver donors for each case were of incompatible blood groups.

Little did they realise that their destinies would be so closely intertwined that they would have successful liver transplants by exchanging their donors and become linked forever.

These unique donor-swapping liver transplants were successfully performed recently by the liver transplant team at Delhi’s Sir Ganga Ram Hospital.

Announcing the achievement, the hospital Board of Management chairman Dr. B. K. Rao said: “A team of 35 doctors worked for 16 hours at four operating theatres to complete the two liver transplants. This swap operation comes as a blessing at the time of organ donor shortage.’’

The chief liver transplant surgeon at the hospital, Dr. A. S. Soin, said: “Dike and his mother Chinwe’s blood groups were B and A and those of Priya and her husband Haresh’s A and B respectively. While both donors’ blood did not match their own recipients, they were suitable for the other recipient. When we suggested a donor exchange which is also called paired donation, both families jumped at the opportunity.’’

“The biggest challenge in paired donation transplants is that both transplants must take place simultaneously, otherwise the donor for the second transplant (first recipient’s relatives) may refuse to undergo surgery once his own loved one has been transplanted,’’ added Dr. Soin.

“It proved very tough to maintain Dike in his state of advance liver failure with deep jaundice and bleeding for two months.

We often felt we may lose him before transplant. However, since there was no other donor option apart from the exchange, the doctors and the parents had to wait,’’ said Dr. Neelam Mohan, paediatric specialist in charge of the case at the hospital.

Priya’s case was complicated as well. In addition to advanced liver failure, she was also suffering from tuberculosis.

“Encouraged by this case now, we have instituted registration of patients with medically suitable family donors who do not match their own recipients due to inappropriate blood group or liver size. This opens up unique opportunities for match-making between donors and recipient from different families, thus helping save more lives with liver transplants,’’ said Dr. Sanjiv Saigal, who was in charge of Priya’s case at the hospital.



SOURCE: http://beta.thehindu.com/news/cities/Delhi/article6178.ece

NEW TREATMENT FOR SHORT BOWEL SYNDROME

In a first of its kind study, scientists have found that an extract from green algae Chlorella may turn out to be an effective treatment for short bowel syndrome (SBS).

SBS is a clinical condition characterized by diarrhea, dehydration, electrolyte imbalance, malabsorption, and progressive malnutrition related to a wide resection of the small intestine.

One of the most important therapeutic objectives in the management of SBS is to maintain the patient's calorie intake and nutritional status.

But, some enteral nutrition (EN) products use for energy supports in order to reduce total parenteral nutrition (TPN) demand. .

Chlorella is a species of green algae that grows in fresh water. It has been consumed as a food source for centuries in mainly Japan and other Far East countries, besides, it's healing properties has enhanced it's consumption too. Several EN products have been used for SBS.

Led by Mustafa Kerem from Gazi University Experimental Surgery Center, the study showed that there's a positive effect of chlorella crude extract (CCE) on intestinal adaptation of rats which had undergone short bowel syndrome.

The researchers saw that administration of CCE led to significant increase in intestinal villi height and villi width, intestinal protein and DNA amount, and serum citruline levels, which is a sign of improved intestinal absorption.

Utilising this information, one can say that algs which are easily found widely in salt and fresh waters and can be generated easily, can be used in clinical settings.

CCE has beneficial role in intestinal adaptation. It seems that it can be an alternative to the other commercial enteral and parenteral products.

The study was published in the World Journal of Gastroenterology. (ANI)

source:

http://www.khabarexpress.com/12/10/2008/Green-algae-extract-may-offer-short-bowel-syndrome-treatment-news_47868.html

HEPATOADRENAL SYNDROME

Adrenal failure is common in critically ill patients, particularly those with sepsis. As liver failure and sepsis are both associated with increased circulating levels of endotoxin and proinflammatory mediators and reduced levels of apoprotein-1/high-density lipoprotein, it is not surprising that adrenal failure is common in patients with liver disease also. Liver failure is well recognized to cause renal (hepatorenal syndrome) and pulmonary syndrome (hepatopulmonary syndrome). However, the association between liver failure and adrenal insufficiency is less well studied. In septic patients, a blunted response to adrenal stimulation identifies patients with a poorer prognosis who may benefit from corticosteroid supplementation. This condition has been termed relative adrenal insufficiency (RAI). Given the similarities between septic shock and liver failure, a number of groups have now studied the incidence of RAI in various forms of liver disease. Recently at least 5 studies have shown that adrenal insufficiency is common in critically ill patients with liver disease even in the absence of clinical sepsis. Although different definitions of RAI exist, the current literature suggests that RAI is common, being seen in 33% of acute liver failure patients and up to 65% of patients with chronic liver disease and sepsis. The finding that RAI can exist in the absence of sepsis and may be as high as 92% of patients undergoing liver transplantation using a steroid free protocol has led one group to propose the term hepatoadrenal syndrome.

Singh and colleagues reported a single case of adrenal insufficiency following liver transplantation. Harry and coworkers demonstrated an abnormal high dose cosyntropin stimulation test in 28 of 45 (62%) patients with acute liver failure. In a cohort of 38 “nonstressed” patients with end-stage liver disease, McDonald et al reported a 64% reduction in peak plasma cortisol following insulin-induced hypoglycemia and a 39% reduction following a high-dose cosyntropin test when compared with healthy controls. In patients with adrenal insufficiency, the mortality rate was lower in those patients treated with glucocorticoids. Hence, untreated patients with adrenal insufficiency (low cortisol levels) and patients with a very high cortisol level may have a high mortality rate. The association between low serum HDL levels and adrenal insufficiency observed in many studies supports the notion that liver disease may lead to impaired cortisol synthesis. The adrenal gland does not store cortisol; increased secretion arises due to increased synthesis under the control of adrenocorticotropin. Cholesterol is the principal precursor for steroid biosynthesis in steroidogenic tissue. Experimental studies suggest that HDL is the preferred lipoprotein source of steroidogenic substrate in the adrenal gland. Recently, mouse SR-B1 (scavenger receptor) and its human homologue (CLA-1) have been identified as the high-affinity HDL receptors mediating selective cholesterol uptake. These receptors are expressed at high levels in the parenchymal cells of the liver and the steroidogenic cells of the adrenal glands, ovary, and testis. CLA-1 m-RNA is highly expressed in human adrenals, and the accumulation of CLA-1 m-RNA is regulated by adrenocorticotropin. Apolipoprotein (apo) A-1, the major protein component of HDL, is synthesized principally by the liver and to a lesser degree in the intestine. Cicognani and coauthors demonstrated a striking decrease in the level of serum HDL in patients with cirrhosis that was related to severity of liver disease. Thus low levels of HDL in patients with liver disease may be pathogenetically related to the high incidence of adrenal insufficiency. Van der Voort and colleagues demonstrated that in critically ill patients, low HDL levels were associated with an attenuated response to cosyntropin. Apart from low HDL levels and the reduced delivery of substrate for cortisol synthesis, other mechanisms may contribute to the pathophysiology of the hepatoadrenal syndrome. Patients with acute and chronic liver disease have increased levels of circulating endotoxin (lipopolysaccharide) and proinflammatory mediators such as tumor necrosis factor (TNF)-alpha. It is postulated that intestinal bacterial overgrowth with increased bacterial translocation together with reduced Kupffer cell activity and porto-systemic shunting results in systemic endotoxemia with increased transcription of proinflammatory mediators. Endotoxin has been shown to bind with high affinity to the HDL receptor (CLA-1) with subsequent internalization of the receptor. Lipopolysaccharide may therefore limit the delivery of HDL cholesterol to the adrenal gland. Furthermore, TNF-alpha as well as interleukin- 1 and interleukin-6 has been demonstrated to decrease hepatocyte synthesis and secretion of apoA-1. In addition to its effects on apoA-1, TNF-alpha has been demonstrated to directly inhibit cortisol synthesis in a dose-dependent manner as well as to cause tissue resistance to cortisol by decreasing the number of glucocorticoid receptors or by up-regulating binding proteins. Tsai et al studied adrenal function using short corticotropin stimulation test (SST) in 101 critically ill patients with cirrhosis and severe sepsis. Adrenal insufficiency occurred in 51.48% of patients. The patients with adrenal insufficiency had a higher hospital mortality rate when compared with those with normal adrenal function (80.76% vs. 36.7%, P < .001). The cumulative rates of survival at 90 days were 15.3% and 63.2% for the adrenal insufficiency and normal adrenal function groups, respectively (P < .0001). The hospital survivors had a higher cortisol response to corticotropin (P < .001) and the cortisol response to corticotropin was inversely correlated with MELD score, and Child-Pugh scores. Mean arterial pressure on the day of SST was lower in patients with adrenal insufficiency (P < .001), and a higher proportion of these patients required vasopressors (P < .001). Mean arterial pressure, serum bilirubin, vasopressor dependency, and bacteremia were independent factors that predicted adrenal insufficiency. In another study 25 cirrhotics with septic shock were studied and RAI was found in 68%. Quicker resolution of shock and apparent survival benefit was seen with low dose hydrocortisone.

In conclusion, relative adrenal insufficiency (RAI) is common in critically ill patients with cirrhosis with or without sepsis. It is related to functional liver reserve and disease severity and is associated with hemodynamic instability, renal dysfunction, and increased mortality. Low dose hydrocortisone may be beneficial in this condition. However, current data doesn’t suffice to recommend steroids in liver disease. Furthermore, assays for free cortisol will be more realistic in this setting as both cortisol binding globulin & S. albumin decrease in this setting and total cortisol level may be misleading. Occult infection must be ruled out in culture negative patients & dose of ACTH for SST should be standardized. Hence, more studies are required in this field, especially from Indian subcontinent.


source:
http://hepatologyindia.org/hepatoadrenalsyndrome.php

SMALL INTESTINE TRANSPLANTATION IN INDIA

Intestine is a segment of the digestive tract extends from stomach to the anus. It has two parts small intestine and large intestine which has further sub-divided parts. In the whole body anatomy intestine is one of the most important parts. Intestine transplant means replacement of a diseased intestine with a healthy one donated from another person.

Who needs an intestine transplant ?
Children or adults with intestinal failure require an intestine transplant surgery. Children may require intestinal transplant for several reasons like :

Short Bowel Syndromes like :

Gastroschisis
Necrotizing Enterocolitis (NEC)
Volvulus
Aganglionosis/ Hirschsprung’s Disease
Intestinal Atresia
Other conditions like :

Pseudo-Obstruction
Microvillus Inclusion
Malabsorption
Tumor
An intestinal transplant is also done to children or adults who suffer from intestinal failure from total parenteral nutrition (TPN), an intravenous nutrition supply system through a catheter or needle inserted into a vein in the arm, groin, neck or chest. Long-term TPN can also result in complications like bone disorders, catheter-related infections and liver failure.

Tests of the Patient :
Before intestinal transplant, the medical teams examine the physical health of the patient which is called evaluation process. A person has to do a thorough medical examination like Upper gastrointestinal and small bowel X-ray series, Barium enema, Endoscopy, Abdominal CT scan, Motility studies, EKG and echocardiography, Ultrasound of the circulatory system, Blood tests for liver function, electrolytes, kidney function and antibodies to certain viruses, etc.

Evaluation of the Transplant :
Intestine transplant is a complex medical procedure done by expert transplant specialists. The surgery of intestine transplant takes 12 hours. It may be three types such as- single intestinal transplant, combined liver intestine transplant, multi-visceral transplant. However the type of intestine transplant depends on the cause of the intestinal failure and results of the medical examination.

In intestine transplant, the blood vessels of the patient are connected to the donor's blood vessels to establish a blood supply to the transplanted intestine. Then to the gastrointestinal tract the donor's intestine is connected.

Recovery from the Surgery :
Unlike the transplant, the recovery also differs to each patient which overall depends on the medical history, type of transplant and medical condition at the time of their transplant. The recovery may take several weeks or months. Immediately after the transplant, the patient is monitored in an intensive care unit (ICU). During the post surgery period, the patient is constantly monitored through frequent blood draws, biopsies of the transplanted intestine through the ileostomy and radiologic testing. Post surgery monitoring is important like in any other organ transplant surgery. One can withdraw the total parenteral nutrition (TPN) and slowly can start the oral diet.

Organ transplantation surgery in India is updated now with all modern infrastructure and transplant specialist. One can take intestine transplant surgery in India with the help of our medical team. Our team offers this surgery at an affordable price along with free consultation by the experts as well as treatments with no waiting periods. Medical treatments in India is now easily accessible.

SOURCE:

http://www.indian-medical-center.com/intestine-transplant.html

HE LIVES WITHOUT SMALL INTESTINE

Laying down in his hospital bed and watching each drop of protein supplement entering his body, 17-year-old Ramesh Babu dreams of becoming an IAS officer one day.

Ramesh, who hails from Tamil Nadu is currently undergoing a treatment at Church of South India (CSI) hospital in Bangalore for a rare disease, short bowel syndrome. He does not have the small intestine which absorbs and digests food. It was surgically removed.

In December 2008, he complained about severe abdominal pain and the doctors at first thought it was Appendicitis. But while operating on him, they found gangrene in his small intestine and diagnosed that he was suffering from the Superior Mesenteric Artery (SMA) syndrome, a rare and life threatening gastrointestinal disorder caused by the compression of the third portion of the duodenum.

Speaking to DNA, Dr Sathyasheelan, assistant surgeon at the CSI hospital, said, "Patients with SMA syndrome had rarely come out of the operation theatre. But he survived for more than six months after the surgery.It is a miracle."

His father Naganathan, who is a weaver by profession and from the lower socio-economic stratum of the society find it difficult to meet his hospital expenses. "So far we had spent Rs3 lakh for his treatment. I haven't worked for last seven moths as I have been travelling all over Tamil Nadu for his treatment.We have taken loans to meet the expenses," said his father.

According to Dr Sathyasheelan, there is only one option left before Ramesh, the small bowel transplantation. "The surgery will cost around Rs8-10 lakh and it is difficult to get a living potential donor for the transplantation," he said, adding, "This will be the first small bowel transplant in India, if it happens."

Ramesh's family is planning to get him discharges as they cannot afford the hospital expenses. So far, the treatment was given free of cost from the Bible Society funds.

SOURCE:
http://www.dnaindia.com/bangalore/report_boy-lives-without-small-intestine_1273058

PANCREAS TRANSPLANTATION IN INDIA

Pancreas is a gland organ in human body responsible for the secretion of digestive juice and production of hormones like glycogen, insulin. It is a 6 inches long gland located between the stomach and spine. It is divided into three parts- head (widest part), body (middle) and thin end (tail). The hormones produced by pancreas help to regulate the blood sugar levels. Pancreas transplant means surgical replacement of diseased pancreas with a healthy one of a donor. A pancreas may fail to perform its function and then pancreas transplant surgery is recommended.

Causes behind Pancreas Transplantation :
Who requires a pancreas transplant? The doctors recommend pancreas transplantation surgery to those who suffer from complication of Type 1 diabetes like severe hyperglycemia, Hypoglycemia, etc. The islet cells in the pancreas could not produce insulin in patient with this type of diabetes.

Types of Pancreas Transplantation :
Though the main types are categorized as whole pancreas transplantation and partial pancreas transplantation, some medical groups divide it into three types. In the whole process, a complete pancreas is transplanted usually along with kidney transplantation but in some cases it is done after kidney transplantation as well. In the partial process, half pancreas of a donor person is transplanted into the patients’ body.

Simultaneous pancreas-kidney transplant (SPK) : It means simultaneaous transplant of both kidney and pancreas for diabetis patient suffer from end stage kidney failure.
Solitary pancreas transplant : It is done to prevent the onset of diabetic complications in the kidney, after kidney transplantation.
Islet transplant : It is a minor surgical procedure for pancreas transplant.
Risks of Pancreas Transplantation :
Unlike any organ transplantation surgery in India , pancreas transplantation has also some risks. Before transplantation the doctors test the patient and the donor’s type of Human leukocyte antigen (HLA) type. The matching of the HLA type helps into acceptance of the new pancreas. Rejection of pancreas may happen as a new organ is considered by the body as foreign. To fight the rejection of pancreas, drugs are given to the patients. Even the drugs may cause side effects.
People those of who has no heart or blood vessel disease, can take pancreas transplant safely. The side effects of surgery may be bleeding and infection.

Procedure of Surgery of Pancreas Transplant :
Usually the surgery of pancreas transplantation takes 12 to 15 hours. The new pancreas is attached to the blood vessels and to the bladder, intestine to drain digestive juice. New surgical methods are developed for pancreas transplant. Laparoscopic surgery is less painful as little incision is done in this surgery. After surgery, constant monitoring is done to study the function of the new pancreas as well the other side effects. A healthy lifestyle is urgently required for the patient after surgery for proper rehabilitation.

India is sought by the foreign travelers for its medical treatments including organ transplantation surgery in India. Our team will guide one to undergo pancreas transplant under the surgery specialists of Apollo Hospitals. One will avail treatments at an affordable price along with free consultation and no waiting periods. Medical treatments in India are now accessible and affordable.

SOURCE:

http://www.indian-medical-center.com/pancreas-transplant.html