The Hindu Business Line : Promoting live liver transplant

Impressed by Indian medical expertise and struck by the gravity of liver diseases, Prof Koichi Tanaka is convinced that a programme to promote `live liver donor transplant (LLDT)' is an absolute necessity. "I am willing to spend time and effort to work with Indian experts to push this," he says.

The diminutive and soft-spoken Prof Tanaka is a pioneer in LLDT surgery, which promises a safe, less-expensive and less-painful option for people suffering from acute liver diseases. He has an enviable track record of 1,500 operations. .

Worldwide, about 8,000 living donor liver transplants have been done and Japan alone accounts for more than 50 per cent. In cadaver liver transplantation, a complete liver — extracted from a `brain dead' person — is grafted into the patient in a long-drawn and complicated surgery. The surgery is extremely expensive and extremely difficult to get a donor organ.

In the case of LLDT, only a slice of the liver of a living person, either a relative or a willing donor, is transplanted. The challenge is to ensure that post-surgery, the donor gets back to normal life quickly and the recipient is brought to good health at the earliest.

Prof Tanaka and his team from the Kyoto University's Department of Transplantation did the first successful surgery on a child in November 1989. In 1992, they repeated the success in an adult. In 1998, they successfully transplanted the right lobe graft (which constitutes 60 per cent of the liver), triggering a major growth in adult-to-adult liver transplant cases.

Prof Tanaka went to Pittsburgh in the US to learn cadaver organ transplant. But what moved him to try live donor transplantation was the fact that in Japan there was a tremendous shortage of cadaver organs, and at least 45,000 people died of liver diseases annually. Of these, at least 10 per cent had a chance of survival through transplant.

Organ donation is very low in Japan owing to cultural reasons. Since going to the US or Europe for a liver transplant was expensive and donor organs too not easily available, alternative techniques were critical. Prof Tanaka is credited with establishing LLDT as a standard procedure in Japan. He has also made a mark in its worldwide dissemination.

In India too, though thousands need liver transplant, just a hundred or less are able to get donor organs that too with great difficulty, says Dr K. Ravindranath, Managing Director of Global Hospitals in Hyderabad. The hospital specialises in transplant surgery and has brought Prof Tanaka and several other liver specialists like Dr Mohammed Rela to Hyderabad and are actively collaborating with their teams.

Prof Tanaka also heads a large research corporation called The Institute of Biomedical Research and Innovation in the city of Kobe. With a budget of around $300 million, the Institute is focussed on developing medical devices, stem cell therapy and improving the quality of lives of patients who undergo transplant surgery.

Increasingly corporates in Japan are accepting that the donor and recipient of liver can discharge normal duties. Prof Tanaka said that while the donor returns home after two weeks in hospital and returns to routine work within two months, the recipient takes 3-6 months to return to normalcy and needs regular monitoring up to a year.

"While transplantation without immunosuppressants is the ideal goal, we are happy to be at the forefront of gradually reducing the need, especially in children who have received an organ. At present 30 per cent of paediatric recipients are free from immunosuppressants," he says.

Immunosuppressants help to ensure that the body does not reject the transplanted organ and remains healthy. But these drugs are expensive and have side effects too. Therefore, research efforts have been directed at reducing their use.

Interestingly, Prof Tanaka has been involved in the transplantation of islets of Langerhans in the pancreas from a living donor along with Dr James Shapiro.

Dr Shapiro first suggested the idea of a living donor islet transplant programme in Kyoto while lecturing there three years ago.

"Living donor islet transplants could allow many more desperate patients with Type 1 diabetes to get successful islet transplants," says Dr Shapiro.

"The donor operation is relatively safe, but is not entirely devoid of serious potential risk," he added. But the shortage of donor islet cells is a bigobstacle, he added.

Dr Tanaka sees good scope for collaboration with India in transplant surgery and stem cell therapy. Though not very optimistic about stem cells making a big mark in liver transplant in the near future, Prof Tanaka says stem cells for growing islets in pancreas (diabetes cure) and small intestine should be effective. Similarly, harvesting stem cells from bone marrow, and utilising them for regeneration of tissue, are expected to become effective routes of treatment soon.

Prof Tanaka is also involved in the creation of an International Institute for Organ Transplant in Kobe, which is being funded by the Japanese Government and corporates. It is expected to be operational in 3-4 years. This organisation will be connected to global hospitals, including those in India, and conduct research, education and training.

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