Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Paediatric liver transplantation in Sri Lanka; From an impossible dream to a lifesaving reality(The Sri Lanka Collage of Paediatricians, 2024) Fernando, M.; Siriwardana, R.No abstract availableItem Knowledge, attitudes, and beliefs about liver transplantation among caregivers of children with liver diseases; a single centre experience from Sri Lanka(Sri Lanka Medical Association, 2023) Gunaratne, A.L.S.N.; Gunarathna, P.G.P.D.; Gunawardana, A.D.J.N.; Hansamali, U.V.S.; Heenkenda, H.M.A.N.; Ekanayaka, J.; Fernando, C.M.P.INTRODUCTION: Paediatric Liver transplantation (PLT) is evolving in Sri Lanka. There is no data documented related to caregivers' knowledge of PLT. OBJECTIVES: To determine the knowledge, attitudes, and beliefs about liver transplantation (LT) among caregivers of children with liver diseases. METHODS: A descriptive cross-sectional study was conducted among the caregivers attending the paediatric liver clinic at Ragama. The calculated sample size was 186. Data were collected using an interviewer-administered questionnaire. Descriptive statistics with SPSS 27.0 were used for analysis. Ethical approval was obtained from the Faculty of Medicine, Ragama. Since there were no previous similar studies, as the tool, we used a newly designed, pre-tested questionnaire which included the basic facts about the knowledge of LT. RESULTS: Of 186 caregivers, the majority were mothers (n=107, 57%). A mixed religious background was noted with Buddhists, Catholics, Islam and Hindus being 80%, 11%, 7% and 2% respectively. Most were educated up to or above the GCE ordinary level (n=180, 97%). The majority (n=124, 68%) were from low-income families with a monthly income of less than 50,000 LKR. Almost half of the participants, 89 (47.8%) knew someone who had undergone an LT. Knowledge of having PLT within the country, living donation, diseased donation, blood group matching and life-long medications were accurate in 171 (91.9%), 170 (91%, 75 (40%), 172 (92%), 116 (62%) respectively. Regarding the beliefs and attitudes towards LT, 170 (91%) were willing to donate and 144 (77%) indicated to support LT. There were 32 (17%) who believed that liver diseases can be cured with alternative medicine and 103 (55%) believed being religious would result in better outcomes. CONCLUSION: Knowledge of LT among caregivers is promising with a positive attitude. Some of their beliefs seem to be non-scientific.Item Fifty liver transplants: a single centre experience of haemodynamic management in liver transplantation for cirrhosis [part 2](The College of Surgeons of Sri Lanka, 2021) Gunetilleke, B.; Ranamuni, R.; Jayaweera, D.; Welikala, N.; Kerner, V.; Hettiarachchi, D.; Munasinghe, N.; Withanage, R.; Wickremasinghe, N.; Hewage, S.; Fernando, M.; Hettiarachchi, D.; Niriella, M.; Dassanayake, A.; Thilakaratne, S.; Wijesuriya, R.; Liyanage, C.; Siriwardana, R.; Dissanayake, J.; Wijesuriya, N.; Rodrigo, U.; Rodrigo, U.; Mudalige, A.; de Silva, J.Globally, an estimated one million deaths occur annually due to complications of cirrhosis. Cirrhosis with end stage liver disease [ESLD] is a leading cause death due to non- communicable diseases in Sri Lanka. Non-alcoholic fatty liver disease [NAFLD] and alcohol related liver disease [ARLD] are the principal causes of ESLD due to cirrhosis in Sri Lanka. Liver transplantation remains the only curative treatment for such patients. Multiorgan dysfunction and hemodynamic instability characteristic of ESLD adds to the complexity of perioperative care in liver transplantation. Maintenance of stable hemodynamics including optimal hemostasis forms the core of the anaesthetic strategy in liver transplantation.Item First paediatric live donor liver transplant in Sri Lanka with 1 year outcome : challenges for the future(The College of Surgeons of Sri Lanka, 2021) Siriwardana, R.; Thilakarathne, S.; Fernando, M.; Gunetilleke, M.B.; Weerasooriya, A.; Appuhamy, C.INTRODUCTION: Liver transplantation in the paediatric age group is demanding due to smaller body proportions and physiology. This paper describes the first successful paediatric liver transplant in Sri Lanka along with its one-year outcome. Describing the challenges faced during the process, we highlight the factors that need to be considered for a sustainable programme in the future. METHODOLOGY: A 9-year-old girl who had progressive familial intra hepatic cholestasis type 3 was referred to us with features of end stage liver disease. She was identified as a suitable candidate for liver transplantation. Her 38-year-old mother was selected as the donor, who was evaluated for suitability of a left lateral segment donation. RESULTS: The first paediatric liver transplantation was performed in July 2020. The child's mother donated the left lateral segment weighing 325g. During the postoperative period the child developed outflow tract obstruction at the hepatic venous anastomosis. This was managed with a percutaneously placed stent. Six months after transplant, she developed an acute rejection that required steroids. Treatment of rejection was complicated with multiple liver abscesses caused byAspergillus. The infection was treated with systemic antifungals and drainage. At one-year post transplant, the recipient had recovered from the trauma of surgery and had normal liver biochemistry, a patent hepatic venous stented anastomosis and complete resolution of the abscesses. We faced dual challenges in dealing with a live liver transplant donor and a young child who was the recipient. Our success, on this occasion, was underscored by the multidisciplinary contribution from specialists scattered across the island combined with state-public partnership. CONCLUSION: To offer a sustainable live donor liver transplant service for the future, many other aspects, beyond surgery itself, need to be addressed.Item Internal biliary diversion to avoid liver transplantation in an adult with intractable pruritus due to idiopathic intrahepatic cholestasis(Springer Nature, 2020) Siriwardana, R.C.; Jayatunge, D.S.P.; Ekanayake, C.S.; Tilakaratne, S.; Niriella, M.A.; Gunetilleke, B.; Dassanayake, A.S.BACKGROUND: Cholestasis is due to the obstruction at any level of the excretory pathway of bile. One particularly troublesome symptom of cholestasis is pruritus which leads to a profound effect on a patient’s quality of life. In children with progressive familial intrahepatic cholestasis (PFIC), medical treatment often fails. An alternative surgical procedure using biliary diversion offers significant relief for intractable pruritus in non-responders. CASE PRESENTATION: A 43-year-old male presented with a history of persistent jaundice and intractable pruritus for a 2-month duration. His liver enzymes were markedly elevated. However, his liver synthetic function was preserved. After extensive evaluation, a cause for cholestasis was not identified. A multi-disciplinary decision was to consider liver transplantation, but as his liver synthetic functions were remarkably preserved and the intractable pruritus was the sole indication for a transplantation, it was finally decided that internal biliary diversion should be done for symptomatic relief. His pruritus dramatically improved at 6 weeks post-operative. His liver enzymes and bilirubin levels also decreased compared to his pre-operative status. Currently, his liver functions are being closely monitored. CONCLUSION: Though it is not used in adults, the experience of biliary diversion in children with PFIC shows that there is a considerable improvement of symptoms and postpone the need for a transplant. In our patient, liver function and bilirubin as expected did not show a major improvement. But the dramatic improvement of the symptoms gave us the time to postpone the liver transplantation. A biliary diversion is a reasonable option that needs to be considered even in adults with refectory pruritus due to cholestasis.Item Liver transplantation - initial experience at Colombo North Liver Transplantation Service(Sri Lanka Medical Assosiation, 2012) Bogamuwa, M.M.M.P.; Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Wijesuriya, S.R.E.; Liyanage, C.A.H.; Gunetilleke, M.B.; de Silva, H.J.INTRODUCTION: Liver transplantation (LT) is the treatment of choice for end stage liver diseases. LT is still in its infancy in Sri Lanka. AIMS: To describe the initial experience of the Colombo North Liver Transplantation Service (CNLTS) METHODS: The study population included all patients referred for LT to CNLTS. All cases were evaluated for the indication and medical, social and psychological suitability for LT. Decision to list patients for LT was reached by a multidisciplinary team consisting of surgeons, physicians and anaesthetists. All data were collected prospectively. RESULTS: 52 patients were referred for LT over a period of 7 months. 48/52[92.3%) were males. The median age at referral was 52(range 13-66) years. The median Child-Turcotte-Pugh(CTP) score at referral was 9/15(range 5-13/15). Median Model for End Stage Liver Disease (MELD) score at referral was 17(range 9-26). 3/52(5.8%) had hepatocellular carcinoma and 9/52(17.3%) had a low MELD score (<14) but with life threatening complications of cirrhosis as indication. 4/9(44.4%) of those being upper gastrointestinal bleeds from varices. 28/52(53.8%) of the referrals had cryptogenic cirrhosis (CC), 18/52(34.6%) had alcoholic cirrhosis, 2/52(3.8%) each had metabolic, congenital and other causes for cirrhosis. 7/52(13.5%) transplants were performed [3 Live Donor LTs(LDLT) and 4 Deceased Donor LTs(DDLT)]. 5/7(71.4%)[2 - LDLT, 3 -DDLT] had a successful LT outcome. 11/45(24.4%) patients died while on the LT waiting list. CONCLUSIONS: High MELD CC was the commonest reason for referral for LT in our group. There was a high waiting list mortality highlighting the need for an efficient DDLT service.