Consultancy Corner: Healthy growth of paediatric liver transplantation in India

The need for PLT is estimated to be 1-2 per million populations as per the data from the West; extrapolating this to India, there is a need for 2500 PLT per year. As many as 30% of children with liver diseases seen at referral centres in India are reported to be candidates for LT. 

Since the first paediatric transplant in November 1998, performed on an 18-month-old child with biliary atresia, acceptance in India has been slow, due to considerations of cost, infections, inability to support long-term care, and non-availability of expertise; even the need for developing a PLT program in India has been debated for long. 

While the first successful PLT provided the impetus to establish transplantation in India, the first few years posed several challenges. Many children who needed a transplant were often referred late, as there were very few guidelines on when to refer a patient to a specialised centre. The vast majority of children who needed a transplant came from a low socioeconomic status with resource constraints. In addition, a bias against the girl child and lack of cadaveric donor livers also limited the number of transplants performed. 

Since the turn of the decade there has been a dramatic growth of PLT in India. There are now six well-established PLT programmes in the country. The total number of PLT performed in our centre has now exceeded 200 and the number of PLT done in India in 2014 was around 65 with our programme contributing to 42 of those. Paediatric patients now constitute 30% of our annual volume. India is soon expected to be one of the largest paediatric transplant centres in the world. 

The success of the liver transplant programmes in the country can be attributed to various factors. Our surgeons, after having trained in various centres in the West, have replicated and improved upon the surgical techniques that they learnt there. With time, the quality of the intensive care has improved tremendously. With increasing experience, the quality of post-transplant care has also become standardised. The armamentarium of drugs and the improved understanding of their pharmacodynamics have improved, leading to a better management of immunosuppression and thus improved survival. 

The lack of facilities for LT in several regions of the world has prompted many foreign nationals to come to India for liver transplants. India has now become a major centre for LT for international patients because of the high quality – low cost value proposition. Children from over 20 countries have now received a LT in India. 

With increasing number of children crossing the five and seven-year post LT landmarks, ten-year survival data should become available in the next couple of years. With increasing experience, LT is now offered for complicated cases, for metabolic diseases and other rare disorders. Technical innovations to perfect complex procedures like AuxiliaryLT(APOLT) have further led to a development of maturePLT units.