Successful Liver Transplantation in India: A Case Study (Azhar Iqbal from Pakistan)

Successful Liver Transplantation in India: A Case Study (Azhar Iqbal from Pakistan)
  • Patient Name : Azhar Iqbal
  • From Country : Pakistan
  • Destination Country : India
  • Procedure : Liver Transplant
  • Hospital : Max Super Speciality Hospital

A liver transplantation is a major surgery that involves the removal of the diseased liver from the patient’s body. In its place, whole or partial liver taken from deceased or a living donor.

A liver transplantation is a major surgery that involves the removal of the diseased liver from the patient’s body. In its place, whole or partial liver taken from a deceased or a living donor.

It is a common surgery conducted on patients suffering from chronic liver disease, including liver cirrhosis, hepatitis C and B, primary liver cancer, Wilson’s disease, polycystic disease, and alpha 1 antitrypsin deficiency.

Getting liver transplantation done is a big decision to take, especially considering the fact that a close family member will have to give a majority of their liver to the patient. Such was the case of Mr. Azhar Iqbal from Pakistan, a classic case of hepatocellular carcinoma and liver cirrhosis, who was advised a liver transplantation surgery.

Introduction

Mr. Iqbal, aged 54, is a resident of Lahore, Pakistan. He had a history of hepatitis-C related liver cirrhosis and was diagnosed with hepatocellular carcinoma in July 2018. Patient’s son, Bilal Ahmed, sent an inquiry to MediGence to seek an opinion for his father as the doctors in Pakistan had refused to conduct any treatment.

With so many local references and companies available to provide guidance to them, Bilal was confused about where and whom to trust. Some of the agents even provided false information to them on the pretext of getting an opinion from the concerned hospital or doctor.

However, Bilal decided to trust MediGence and discussed his father’s case with the team in detail. He shared all the medical reports with the team when they contacted him and asked to get an opinion from Dr. Subhash Gupta at Max Hospital, who is quite popular in Pakistan for liver transplantation surgery.

About Patient’s Medical Condition (Pre-treatment)

Mr. Azhar had a history of hepatitis C. Pain in the abdomen, history of HCV, and appetite loss was some of the chief complaints that led him to undergo an ultrasound of the pelvis and the abdomen.

The scan suggested the presence of hepatocellular carcinoma (HCC) with partial thrombosis of the left branch of the portal vein. Following the ultrasound, a multiphasic CT scan was conducted, which confirmed the presence of HCC.

The scans confirmed the presence of two large mass of tumors in the left lobe, that has infiltrated into the main portal vein. The right lobe of the liver was normal.

Treatment Decision

Because the local doctors denied conducting any treatment, Mr. Azhar was put on palliative therapy and was asked to take Sorafenib over a period of time to restrict the tumor growth. The family decided to stick to the local treatment and see if the treatment is working. They kept in touch with the team at MediGence to resolve their queries.

However, his health started to deteriorate over a period of time due to the side effects of the medicine. Weight loss continued abdominal pain, and loss of appetite triggered them to go for a repeat CT scan, which confirmed that the tumor had spread.

It was at this stage that they finally decided to go ahead with the treatment in India. The team kept in touch with Bilal throughout and guided them with what should they do at every step. Bilal shared the latest CT scan with the team to take an opinion from Dr. Subhash Gupta so that they can plan their travel accordingly.

Knowing that his father may require chemoembolization, however, there is still a possibility of a liver transplant, it was decided that Mr. Azhar would travel with his wife (attendant), youngest daughter (donor), and elder brother (attendant).

The team at MediGence assisted them with visa application and coordination with the Indian Consulate in Islamabad to make sure that the visa is granted on an immediate basis. The family got their visa within two weeks and decided to book their flight tickets.

Travel Period

Mr. Azhar Iqbal took a flight from Lahore to reach Delhi on September 21st, 2018 along with his wife, daughter, and brother. The donor and the patient’s brother returned to Pakistan on October 31st, while the patient is staying in Delhi for further follow-ups. He and his wife are planning to return to Lahore, Pakistan, by mid-November.

Treatment Details

Pathogenesis-of-Hepatocellular-Carcinoma-Chronic-exposure-of-the-liver-to-injury-from

The first appointment of the patient with the liver specialists took place on the very next day of their arrival. Their case was thoroughly discussed and medical history was noted. They were again asked to come back and meet Dr. Subhash Gupta on the coming Monday.

The patient met Dr. Gupta and spoke to them about their medical history, chief complaints, and the existing scans that they have. The doctor suspected that the tumor may have spread to the gallbladder, for which he ordered a fresh MRCP scan.

The reports of the scan were discussed with Dr. Gupta on the next day. Thankfully, there was no invasion into the gallbladder. However, the tumor had spread to the main portal vein and its branches, and also to the right lobe of the liver. Looking at the reports, Dr. Gupta recommended that he should get at least one session of transarterial chemoembolization (TACE) done to reduce the size of the tumor because, in the absence of it, it is too risky to conduct the transplant surgery.

Mr. Azhar had a discussion with his family and agreed to get TACE done as soon as possible without delaying any further. He got admitted to the hospital on the same day and TACE was done on the following day on September 26th. He was discharged from the hospital on September 28th.

A week after the discharge, all the tests pertaining to the liver functioning and the presence of tumor were repeated. There was a marked reduction in the tumor in the portal vein as well as the left lobe of the liver. It was decided that it is now safe to consider transplant surgery. The patient and the donor were thoroughly guided about the risks of the surgery and that there is still an 80:20 success to failure risk.

Seeing that both the patient and the donor are ready to make an informed decision, the donor workup was initiated. The tests results were analyzed and submitted to the liver transplant committee for approval on the case.

The committee concluded that it is safe to proceed with the liver transplantation surgery for Mr. Azhar. Both the patient and the donor were admitted to the hospital on the next day and the liver transplant surgery at Max Hospital was conducted on October 10th, 2018.

Following the surgery, both the donor and the recipient were transferred to the ICU. The donor remained in the ICU for 5 days, while the recipient stayed there for 11 days. The donor was discharged on October 19th, while the patient’s discharge took place on October 26th.

The biopsy conducted on the samples recovered from the liver confirmed Stage 2 carcinoma. The doctors are now planning to continue a few chemotherapy medications to further zero down the chances of return of the carcinoma.

Patient’s Medical Condition (Post-treatment)

Thankfully, the surgery and recovery inside the hospital were without any complications. The donor recovered really well after the surgery and so did the patient. The donor’s parameters were all normal by the time she was discharged from the hospital.

The patient was stable and physically active when he was discharged from the hospital. Currently, he is recovering at the guest house and waiting to attend his follow-up sessions with Dr. Gupta. He is taking his diet properly and also indulges in morning walk every day to keep himself up and running.

Everybody, including the team of doctors at Max Hospital headed by Dr. Gupta, is happy to see the donor and the recipient so well. Team MediGence wishes Mr. Azhar and his daughter, Noor, a happy and a healthy life ahead.

Last modified on at Sep 10, 2019

(Brig) Dr. Anupam

Brig (Dr) Anupam Saha has been the foremost Gastro-Intestinal and Hepato-Pancreato-Biliary Surgeon of the Indian Armed Forces with more than 20 yrs of experience in performing complex operations for cancer and other diseases involving the Liver, Pancreas, Gall Bladder as well as other Gastro Intestinal surgeries involving the Colon, Rectum and the Gastro-Intestinal System. He is currently the HOD & Sr. Consultant of Dept of Liver Biliary Sciences at Venkateshwara Hospital

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