You deserve the best treatment for
- Acute Liver Failure
- Hepatitis C
- Liver Cancer
Not all patients with Cirrhosis need a liver Transplant. Not all Patients with Hepatitis C deserve to be treated with Interferon injections. Not all patients with Acute Liver Failure need an Emergency Liver Transplant!
CLBS delivers holistic care to patients with Liver / Gastrointestinal diseases. We focus on individualizing the patient's treatment according to the nature of his disease, the stage of his disease and the functional status of his other organ systems - his heart, his lungs, coexisting diabetes or any other health problems that he may have.
We at CLBS believe that one treatment DOES NOT suit all.
Cirrhosis: Treatment needs to be individualized
Only a subset of patients with Liver disease/Cirrhosis needs liver transplant. Most others are not candidates for transplant many will do well without a transplant for many years. Some may never need a Transplant at all!!
At Center for Liver and Biliary Sciences, Liver transplant is only one part of the gamut of Treatment options available to patients with different types of Cirrhosis. A patient with autoimmune hepatitis cannot be treated in the same way as a patient with end stage. Liver disease due to long lasting Hepatitis C infection.
A patient with Hepatitis B flare also has to be dealt with differently. A diagnosis of Wilson's, disease does not mean the patient has to be rushed in for a transplant. A strong hepatology wing headed by Dr.Manav Wadhawan ensures that only patients fulfilling the most stringent clinical criteria are taken up for the Transplant.
However after the transplant most of these patients will grow the virus in their bloodstream quite soon. This will start damaging the liver with time! This cycle must be broken.
At CLBS all patients who undergo liver transplant for hepatitis C are evaluated for this routinely 6 months after the transplant. After checking the Hepatitis C virus levels in the blood and evaluating the new liver, most patients are now started on Interferon injections. With a new liver, these patients tolerate the interferon injections surprisingly well! This targets the virus and stops it from damaging the new transplanted liver.
Further, there is not just one kind of hepatitis C virus. There are different genotypes of the same virus. These different genotypes behave quite differently from each other. Genotype 1 is common in the west and in countries like Japan. Genotype 3 is much more common in India, Pakistan and other countries in this subcontinent. The behavior of Genotype 1 and 3 are so widely different that it may so happen in the future that they are renamed as entirely different viruses rather than labelling them too simply as different subtypes of the same 'Hepatitis C virus'.
Much of our research focuses on this difference between these genotypes. Because differential behavior also means differences in response to treatment!
Liver cancer : HCC
Unfortunately many patients with longstanding liver disease have a Hepatocellular cancer (HCC) hidden within the liver. Hence all patients with Hepatitis B or C or other causes of Cirrhosis need to be checked regularly to find any such hidden tumor's when they are still quite small. When detected early the results of treatment are quite good!
For patients with small HCC's surgery is the treatment of choice. If the rest of the Liver is healthy, the tumor bearing segment of the liver is removed at surgery (liver resection).If the rest of the Liver also has cirrhosis, then these patients will do well with liver transplant chances of the tumor growing back are really low when transplant is offered to patients whose tumors are within certain internationally accepted criteria (Milan or UCSF criteria)
Acute Liver Failure
At CLBS we have one of the largest series of patients who had presented with Acute Liver Failure (Sudden jaundice with rapid deterioration in level of consciousness with progression to pre-coma / coma) and were successfully treated with Emergency Liver Transplant performed as a lifesaving measure.
But more importantly, we have a larger series of patients of Acute Liver Failure (ALF) who were salvaged without transplant. There are many centres across the world who perform Liver Transplant for patients with ALF when they meet certain set of criteria. However it has been repeatedly seen that some of the patients of ALF who meet these criteria have actually recovered without a transplant! This set us thinking.
The result of our clinical research is that we do not follow these fixed criteria. Instead we follow dynamic criteria which depend on serial observation of the patient's status and blood reports in response to medical management.
Only those patients who do not show a favorable response to aggressive medical treatment are taken up for Urgent Liver Transplant. We believe careful patient selection based on very close monitoring is the key to choosing which patients of ALF are best treated with a transplant, and who would do well without.
Interferon injections are the only effective treatment that targets the Hepatitis C virus. But when the hepatitis C virus has already begun its damage on the liver, these patients tolerate Interferon injections poorly. Hence most patients with Hepatitis C related Cirrhosis will need a transplant, not interferon therapy.