Liver Transplant

Introduction:

Liver transplant is a surgical procedure to remove a diseased liver and replace it with a healthy liver (whole or part) from a donor. Liver transplant operations use livers from deceased donors (Brain death) or from living donors. Liver transplant done as last treatment option for people who have end-stage liver failure that can’t be controlled by other treatments. 

Two specialized team of liver transplant surgeons work simultaneously in two equipped operation theatres. In case of living donor liver transplant, one team for donor operation for retrieval of part of donor liver and another team for removal of damaged (cirrhotic/cancer liver) and finally implantation of donated liver (Liver graft) to the recipient.

In case of deceased donor liver transplant the retrieval of liver (Liver graft) may be done in the same or other center and the liver is passed as quickly as possible to the recipient surgery theater. 

Liver transplant surgery carries a risk of complications, including bleeding, bile leaks, failure of donated liver (Graft), infection, sepsis and rejections of donated liver. Liver graft usually grows & regain its function within six to eight weeks after the transplant.

Recipient must have to take a number of medications after the liver transplant, may be for the rest of life. Drugs called immunosuppressants help keep the immune system from attacking new liver. Immunosuppressants also have side effects. Other drugs help reduce the risk of other complications after transplant Six months to one year of recovery period is needed for full recovery after a liver transplant.

However, normal activities may be resumed after a few months of transplant. In general, about 75% of people who undergo liver transplant live for at least five years. People who receive a liver from a living donor often have better survival rates than those who receive a deceased-donor liver. Ccomparing long-term results is difficult because people who have a living donor usually have a shorter wait for a transplant and aren't as sick as those who receive a deceased-donor liver.

Liver transplant in Bangladesh

Starting of Liver transplant in Bangladesh was a long time due. BIRDEM General Hospital took the initiative for starting liver transplant in Bangladesh. The fundamental of Liver transplant programme is the fully functioning Hepato -Biliary Surgery. Diabetic Association of Bangladesh (BADAS) invited Prof. Mohammad Ali to join the institute after his return from abroad, who received fellowship training on Hepato-Biliary-Pancreatic Surgery & Liver transplant at the Queensland Liver transplant Services, Queensland, Australia.

The first department of Hepato-Biliary-Pancreatic Surgery of Bangladesh started by Prof. Mohammad Ali on July 26,1999 at BIREDEM General Hospital. The complex surgeries of liver, biliary system, pancreas, which include various forms of liver resections, pancreatic
resections, biliary reconstructions and other surgeries of these vital organs.

The department of Hepato-Biliary-Pancreatic Surgery played the key role for initiating Liver transplant in Bangladesh. Prof. Mohammad Ali, as head of the Dept Hepato-Biliary-Pancreatic Surgery & chief Liver transplant surgeon organized multidisciplinary liver transplant team. Members of the team received training in New Delhi, India & Kyoto, Japan. Technical expertise of vascular & biliary anastomosis was practiced at Cow & sheep liver. Pork to Pork (Porcine model) liver transplant also carried out to practice more accurate vascular & biliary anastomotic techniques.

Operation theaters of Ibrahim Cardiac Hospital & Research Institute (ICHRI) was prepared for starting the first liver transplant of Bangladesh. There was shortage of equipment for the transplant. Some essential equipment & services were borrowed from other friendly institutes like National Heart Foundation of Bangladesh, Combined Military Hospital (CMH), Dhaka, Popular Medical College Hospital & Gastro liver Hospital & Research Institute, Dhaka.

Recipient & donor was selected but there was difficulty in convincing them to be the first candidate of liver transplant of Bangladesh. However, finally they were convinced & agreed for the transplant.

The first successful liver transplants in Bangladesh done on June 03, 2010. It acted as mile stone of initiation of Liver transplant in Bangladesh. Received appreciation from home & abroad. Ministry of Health acknowledged it with great appreciation. Members of the Bangladesh National Parliament (Jatiya Sangsad) congratulated it at its session.

Th second successful liver transplant of BIREDM done on August 06, 2011.It was done at the same operation theater of ICHRI and also borrowing equipment from other institutes. Diabetic Association of Bangladesh (BADAS) & Government of Bangladesh jointly made a liver transplant project. The third Successful Liver transplant done in the new complex on February 13.2020. Liver transplant team of BIRDEM General Hospital & Ibrahim Cardiac Hospital & Research Institute (ICHRI) was helped by Prof. Subhash Gupta & his team from New Delhi, India.

Three more liver transplant done in Bangladesh. Two at Lab Aid Specialized Hospital, Dhaka and another one at Bangabandhu Sheikh Mujib Medical University (BSMMU). Liver transplant team of BIREDM General Hospital is working hard to continue liver transplant services in Bangladesh so that the patients suffering with end stage liver diseases can continuously get liver transplant services at their own country.

First Successful Liver Transplant of Bangladesh at BIRDEM,hospital, Dhaka

The first liver transplantation in Bangladesh was successfully done on 3rd June 2010 . Dept. of Hepato-Biliary-Pancreatic Surgery, BIRDEM Hospital organized the transplant with the leadership of Chief liver transplant surgeon, Professor Mohammad Ali . His team included Prof. S.M. Abu Zafar, Dr. Md Mamunur Rashid, Dr.Md Mustaque Hossain, Dr. Hashim Rabbi, Dr. A H M Tanvir Ahmed, Dr. Kazi Mahbuba Akhtar & Dr. Hasina Alam., The members of the Anesthetic team were Dr. Col (Rtd.) Hamidur Rahman, Prof. Nur Nabi Chowdhury, Dr Mahbub Hasan & Dr. Kawsar Shardar. Prof. Md. Omar Faruq and Dr. A H M Areef Ahsan offered the intensive care support. Team of Gastroenterology-Hepatobiliary-Pancreatic Disorders (GHPD) department included Prof. M. Anisur Rahman , Dr. Mohsin Kabir and Dr. Golam Azam . Dr. Haider Ali performed the doppler study of the transplanted liver.

The liver transplant team of Indraprastha Apollo Hospital, New Delhi, India headed by the chief liver transplant surgeon, Dr. Subash Gupta helped in the transplant.

The first liver Transplant was performed in the operation theatre of Ibrahim Cardiac Hospital and Research Institute (ICHRI). The procedure started on 3rd June 2010 at 7.30am and ended at 12.30 am on 4th June (17 hours), in two adjoining operation theaters. The recipient was Mr. Kazi Ershad Ahmed (42), from Comilla who had been suffering from liver disease for a long time and received treatment at home & abroad. Despite all treatment he ended up in end stage liver disease (cirrhosis) for which liver transplant is the only treatment. His maternal uncle Mr. Khaled Abdullah (29) donated his right lobe of liver as the last resort to save his life. After the transplant both the recipient and donor are doing well.Successful completion of the first liver transplantation at BIRDEM hospital received special thanks and appreciation from both the government and non government organizations. It was well publicized in the electronic and print media of both home and abroad.
On behalf of the Ministry of Health and Family Welfare, the honorable minister, Prof.A.F.M Ruhul Haque MP, sent a letter of appreciation and congratulated Prof. Mohammad Ali and his team for achieving such a long cherished goal and making a mile stone in the medical history of Bangladesh. He applauded the overall development of skill and expertise in this field at BIRDEM hospital. He hopes that this land mark of professionalism in medical sector will inspire medical professionals and also contribute in building trust on our skill and expertise within the country and abroad. He also informed this great historical news to members of the parliament in the session of national assembly of Bangladesh.

It may be mentioned here that, Professor Mohammad Ali returned to Bangladesh in 1999 after getting training in various liver transplant centers in abroad with the dream to achieve this goal in his own country and started the first Department of Hepato-Biliary-Pancreatic Surgery Bangladesh at BIRDEM. He made arrangement of many patients for liver transplant done in abroad and tirelessly organized the liver transplant team for starting liver transplant in Bangladesh.

To make this first liver transplantation successful, active participation and cooperation of many departments and institutions were involved .Ibrahim Cardiac Hospital and Research Institute (ICHRI), Organ transplant unit of BADAS, Dept. of Anesthesiology, Dept. of Critical Care Medicine, Gastroenterology-Hepatobiliary-Pancreatic Disorders (GHPD), Dept of Surgery, Laboratory services, Radiology and Imaging Services, Transfusion Medicine, Dept of Immunology, Hospital Administration, Logistic Dept and Dept. of Nursing. Different government and private institutions also offered their help in the transplantation programme with their services and equipments. Specially , Ibrahim Cardiac Hospital & Research Institute (ICHRI), Armed Forces Institute of Pathology, National Heart Foundation of Bangladesh, Gastro liver Hospital and Research Institute and Popular Diagnostic Centre.

A farewell seminar and press conference was arranged at BIRDEM auditorium on July 6, 2010. Mr. Ershad was greeted with flowers and standing ovation by everybody. The message of honorable National Professor Dr. Mohammad Ibrahim, founder of BADAS is written as ‘‘Grateful for giving the opportunity to serve you.” With this historical event Bangladesh entered in a new era of transplant surgery and Prof. Mohammad Ali and his team are looking forward to do more liver transplants regularly and the patient of end stage liver disease will get the service in their own country.

First Liver Transplant of Bangladesh went home

Mr. Ershad Ahmed (42yr.) recipient of 1st liver transplant in Bangladesh left BIRDEM on July 6, 2010.Mr. Khaled Abdullah (29 yr.) left hospital on June 22, 2010.

Mr. Ershad has uncomplicated recovery. He left ICU on 16th post transplant day and was shifted to hospital cabin. He is on normal diet and immunosuppressive drugs according to set protocol.

Second successful liver transplantation of Bangladesh at BIRDEM Hospital,Dhaka

The second successful liver transplant of Bangladesh was done on August 06, 2011 at BIRDEM hospital, Dhaka.

The recipient Mr. Reazul Islam (35 yrs.), diabetic, College teacher, Golachipa, Potuakhali. He had been suffering from Hepatitis B virus infection since 2002 and developed Cirrhosis of liver. He developed end stage liver disease with repeated episodes of encephalopathy and refractory ascites and hyperspleenism since 2008. He received treatment in different centers, home and abroad. During this period he was treated at BIRDEM Hospital on several occasions and finally was advised liver transplant as the last hope of survival. The donor, Mr. Kium Azad (38 yrs), a maternal uncle of the recipient came forward to donate part of his liver as a life saving measure.

The transplant was organized by the Dept. of Hepato-Biliary-Pancreatic Surgery, BIRDEM. The Liver transplant team was headed by the chief Liver transplant Surgeon, Prof. Mohammad Ali. The liver transplant team of Prof. Subash Gupta of Indraprastha Apollo Hospital, New Delhi, India helped in the transplant.

The department of Gastro Intestinal Hepato-Biliary- Pancreatic Disorder (GHPD), Surgery, Anesthesiology, Critical Care Medicine, Transfusion Medicine, Radiology & Imaging Services, Laboratory & Immunology Services, Nursing Services of BIRDEM & ICHRI ,Organ transplant Unit & Administration of BADAS took active part in the transplant. The operation theatre facilities, Dept. of Anesthesiology, Laboratory services & Administration of Ibrahim Cardiac Hospital & Research Institute (ICHRI) actively participated and extended all cooperation.

The transplant done at two well equipped operation theaters of ICHRI. Two teams of twenty five members performed the operation, starting from 9 AM till 01:30 AM, next day (about 16 hours). Right lobe of the donor liver (weighing 735 gram) was retrieved. The cirrhotic liver of the recipient was totally removed and the donated right lobe (Graft) was implanted to the recipient at the same site. The recipient and donor left hospital without any problem and passing normal life.

Dutch Bangla Bank Foundation made generous contribution to the liver transplant facilities. ICHRI provided their operation theater complexes and other facilities for the transplant. Armed Forces Institute of Pathology, Gastro liver Hospital & Research Institute & Popular Diagnostic Centre extended their support in the transplant.

It may be mentioned here that, the first ever liver transplant of Bangladesh was successfully performed at BIRDEM on June 03, 2010. Both the recipient and the donor are doing well. They are back to their normal life and activities. The first successful Liver transplant at BIRDEM received wide spread national and international appreciation. Bangladesh has been enrolled as one of the liver transplant country in the world since 2010.We believe that the 2nd successful liver transplant at BIRDEM will reinforce the dimension of advancement of medical science and technology of Bangladesh.

The liver transplant team : Surgical : Prof.Mohammad Ali, Prof. S M Abu Zafar, Dr. Md. Mamunur Rashid, Dr. Muhd. Mustaque Husain, Dr. Hashim Rabbi, Dr. Kazi Mahabuba Akhter, Dr.A.H.M. Tanvir Ahmed, Dr. Hasina Alam and Dr. Ashim Kumar Dutta, Anaesthesia : Prof. A K M Nur Nabi Choudhury, Dr. Col (Rtd) Hamidur Rahman, Prof. M A Salam Khan, Dr. Mahbubul Hasan , Dr. Kawsar Sardar, Dr. Basudeb Saha, Dr. Md. Nazmul Hakim, Dr. Md Mushfiqur Rahman and Dr.Md. Hamidur Rahman, Critical Care : Prof. Mohammad Omar Faruque, Dr. A S M Arif Ahsan, Dr. Kaniz Fatema and Dr. Fatema Ahmed, GHPD : Prof. M Anisur Rahman, Dr. Mohsin Kabir, Dr. Golam Azam and Dr. Arif Mahmud, Organ Transplant :- Prof. Md. Abul Mansur and Dr. Polash , Radiology and Imaging: Prof. A S Mohiuddin, Prof. Raihan Hussain, Dr. Nasreen Sultana and Dr. Muhitul Alam, Laboratory and Transfusion medicine: Prof. Shubagato Choudhury, Prof. M Sirajul Islam and Dr. Tashmim Farhana Dipta, Team from abroad: Prof. Subash Gupta, Dr. Neerav Goyal, Dr. Sanjeev Aneja, Dr. K V Ramarswamy and Dr. Ramdip Roy. Nursing team , headed by chief nurse of Operation theatre, Josefphin Rozario..

Future perspective:

Prof. Mohammad Ali is continuously working to establish an equipped, state of the art liver transplant centre at BIRDEM hospital, Dhaka, Bangladesh. It’s our great pleasure to inform that all the necessary instruments have been purchased. All the arrangements will be made soon. We believe that our people will get continuous liver transplant services at own country.

Newspaper Publication
Acknowledgment
The third successful Liver transplant of Organ Transplant Unit of BADAS, Bangladesh

The third successful Liver transplant of Organ Transplant Unit of BADAS (Bangladesh Diabetic Samity) was done on February 13,2020. The Transplant performed by a joint team of Ibrahim cardiac Hospital & Research Institute (ICHRI)& BIRDEM General Hospital. Transplant done at the newly equipped liver transplant facility of Organ Trans plant unit. Thirty-member team, headed by Prof. Mohammad Ali, chief liver transplant Surgeon performed the transplant in 11 hours.

Mrs. Jahan Ara Begum (52) from Comilla was the recipient. She had been suffering from Liver cirrhosis due to Non-Alcoholic Steato Hepatitis (NASH). Received treatment in different hospitals & ultimately reached end stage liver disease. Liver transplant was the last hope for her survival. Her beloved youngest son, advocate Mr. Shoriful Islam (29) donated right half of his liver and created a history in Bangladesh offering new life to a mother by a son. Mr. Shoriful Islam (Donor)has uneventful recovery & left Hospital on February 27,2020. Mrs. Jahan Ara Begum (Recipient) also recovered well and left the hospital on March 18,2020. Her hepatic functional profile and other parameters are well maintained. Mr. Shoriful Islam is also going to join his usual judiciary profession. Both the recipient, donor and their family members expressed gratitude to Liver transplant team members, authority of BADAS, ICHRI & BIRDEM General Hospital for the successful liver transplantation.

Dept. of Hepato-Biliary- Pancreatic Surgery, BIRDEM General Hospital played the key role to organize the multidisciplinary liver transplant team. Dept. of Anesthesiology, Critical care Medicine, Transfusion medicine, Imaging, GHPD BIRDEM Hospital, Dept. of Anesthesiology & Imaging of ICHRI participated. Doctors from Max super specialty Hospital, New Delhi, India headed by Prof Subash Gupta helped in the transplant. A team of doctors from Dhaka Medical College Hospital & Sheikh Russell Gastro liver institute also participated.

A press conference was held at BIRDEM Auditorium on February 20, 2020. Professor Dr. AK Azad Khan, President of Diabetic Association of Bangladesh (BADAS) presided. Md. Sayef Uddin. Secretary General, BADAS, Prof Zafar A Latif, DG, BIRDEM General Hospital & Prof. M. A. Rashid, CEO(ICHRI) also attended the press conference. Honorable Attorney General of Bangladesh Mr. Mahbubey Alam, was the chief guest. He congratulated BADAS for the third successful liver transplant in Bangladesh. In his remarkable speech, he highlighted on the organ donation and urged people to come forward like his colleague advocate Shoriful Islam to donate part of liver to their relatives as lifesaving gesture. It may me mentioned that the first successful Liver transplant of Bangladesh done at BIRDEM General Hospital on June 3,2010 & the 2nd Liver transplant on August 6,2011 in the same institute. Equipped liver transplant facility of Organ Transplant Unit of BADAS established jointly by Government of the people’s Republic of Bangladesh & BADAS. This highly specialized center will continue the liver transplant program with minimum cost, so that our people can get the service at their own soil.

Established Liver Transplant Center in Bangladesh

Liver Transplantation In Bangladesh

As chief Liver Transplant Surgeon, organized the first two successful Liver transplants of Bangladesh at BIRDEM. Hospital. Dhaka. Manpower developed, arranged equipments and organized facilities for liver transplant. The first successful liver transplant performed on June 3, 2010 and second transplant on August 6, 2011. Both the donors and recipients are back to their normal life. Working hard to establish a well equipped liver transplant centre in Bangladesh. A liver transplant is a surgical procedure to remove a diseased liver and replace it with a healthy liver (whole or part) from a donor.

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