Expert says success rates in country at a par with the best in the world

The liver transplantation scene in India that started with low success rates a few decades ago has evolved into a specialty that boasts success and survival rates comparable with the best centres in the world, liver transplantation pioneer Mohamed Rela said on Sunday.

Addressing a press conference, Dr. Rela, who heads the liver transplant programme of Global Hospitals and Health City here, said good liver transplants were able to provide a one-year survival in 90 per cent of cases (75 per cent of cases with acute liver failure), a five-year survival rate for 85 per cent of patients and a 10-year survival rate in about 70 per cent of cases.

Apart from medical expertise and technological advances, the enormous changes in the transplantation scenario were also due to the raised awareness leading to more cadaver and living donor transplants, Dr. Rela said. Tamil Nadu, especially Chennai, was the forerunner for altruistic cadaver liver donation, and the mobilisation of the organised sector of the government was now a model for other States, he said.

“In terms of long-term survival of ten years or longer, results with liver transplantation are better than that with renal transplants,” Dr. Rela said.

While liver transplants now cost about Rs.22 lakh for adults and half that amount for children, the usage of immuno-suppresants could be tapered down, leading to lesser post-transplant costs, he said.

Pointing to liver cancers as among the most common causes of liver disease, Dr. Rela said the lack of screening was leading to patients presenting with fairly advanced cancers.

Later, addressing a scientific session, Dr. Rela said transplants could be offered for benign liver tumours, which if left unattended could be lethal through “mass effect than metastasis.”

In a condition like hepatoblastoma — an important liver tumour in children — the worldwide experience has been that any tumour that does well with chemotherapy did well with resection. However, pre-operative chemotherapy is an important intervention prior to resection procedure.

On hepatocellular carcinoma, which was one of the most common cancers, Dr. Rela said it was important to appreciate the condition as two diseases rolled into one with both having different prognosis.

While resection, chemo-embolisation, radio frequency ablation and liver transplantation were among the available options to treat liver cancers, one of the problems in India was that each centre offered the treatment modality that they had, Dr. Rela said.

He suggested that it was best for patients to report to a centre that had all these facilities and could thus provide multi-disciplinary treatment.

“Though in many cases, liver transplant could be a better option than resection, liver resection will remain a major modality in India because of the lesser costs involved,” Dr. Rela said.

Global Hospitals Chairman K. Ravindranath said the group would soon be opening centres in Delhi, Mumbai and Kolkata in the next couple of years when it would have the largest number of liver intensive care beds.