Liver Transplant M & M, from a Non Transplant Universi ty Hospital = Liver Transplant M & M, from a Non Transplant Universi ty Hospital

다국어 초록 (Multilingual Abstract)

Aims: Liver transplant is the only curative therapy for decompensated cirrhosis, but there remained several regions throughout the globe where this important and lifesaving modality is non-existent or in the phase of early development. Pakistan ranks third among countries with highest burden of chronic hepatitis C, with a prevalence of >4.8%. For decompensated cirrhotics, only one liver transplant center is available. Post-transplant care remains a challenging domain for the hepatologists in the country
Methods: This cross-sectional analysis was done for the post-transplant care and follow up of liver transplant patients in a facility devoid of transplantation. Apart from demographic information, data were collected for indications of liver transplant, post-transplant complications- immediate or within 4 weeks, delayed within one year and then during follow up periods, along with therapeutic modality for treatment of complication. Adverse effect, rejection episodes, their cause and management were recorded.
Results: 41 transplant recipients were enrolled between 2016 and 2017. 80% were male. 39 were living donor liver transplant. Most common indication of transplant was HCV in 25 (61%), 13 were PCR positive and given directly acting antivirals (DAAs) with 100% eradication. 2 patients developed diabetes after 6 months of transplant, both were on tacrolimus. Thirteen patients developed biliary anastomotic strictures and went through successful therapeutic ERCP. 21 patients extensively worked up for deranged liver function test and there biopsy showed chronic rejection. Hepatoma recurrence was not seen.
Conclusions: Pakistan is in a desperate need of liver transplant facilities and transplant hepatologists. Collaborative work is needed with expert centers.