I WILL TRY MY BEST TO HEAL YOU
DR VIVEK GUPTA
Senior Consultant: Medanta, Lucknow
Ex Addl Professor: KGMU, Lucknow
Liver Transplant: Baylor University, USA
लिवर ट्रांसप्लांट /मेदांता, लखनऊ /डॉ विवेक गुप्ता
लिवर ट्रांसप्लांट को तकनीकी रूप से कठिन सर्जरी माना जाता है। लिवर सर्जनों को विशेष तकनीकों में प्रशिक्षित किया जाना चाहिए। लिवर ट्रांसप्लांट से पहले मरीज के कई तरह के टेस्ट किए जाते हैं, जिनमें ऑपरेशन के लिए फिटनेस का टेस्ट भी होता है। लिवर ट्रांसप्लांट ऑपरेशन में मरीज के क्षतिग्रस्त लिवर को निकालकर नया लिवर प्रत्यारोपित किया जाता है।
मेदांता हॉस्पिटल, लखनऊ में नियमित रूप से किया जा रहा है लीवर ट्रांसप्लांट। मेदांता में लीवर ट्रांसप्लांट टीम अत्यधिक अनुभवी है। मेदांता टीम में 100 से अधिक डॉक्टर शामिल हैं। कुल मिलाकर मेदांता टीम को 4000 से अधिक ट्रांसप्लांट का अनुभव है।
नया लिवर डोनर से प्राप्त होता है I अधिकतर रूप से यह मरीज के निकटतम संबंधियों द्वारा ही दिया जाता है जैसे कि पति पत्नी भाई बहन या बच्चों या माता-पिता I ज्यादातर इसमें मैं नजदीकी रिश्तेदारों द्वारा ही लिवर डोनेशन लिया जाता हैI लिवर डोनेशन सर्जरी में लिवर का करीब 50 to 60% परसेंट हिस्सा निकाल दिया जाता है I डोनर का लीवर करीब 3 महीने में वापस बढ़ जाता है I
डोनेशन से पहले डोनर के कई तरह के टेस्ट होते हैं जिसमें कि डोनर की जनरल ब्लड टेस्ट जनरल फिजिकल टेस्ट तथा लीवर की अंदरूनी संरचना की जानकारी ली जाती है I इसमें सीटी स्कैन करा जाता है ताकि यह देखा जा सके कि लिवर को सही तरीके से विभाजित किया जा सकता है कि नहीं I डोनर का ब्लड ग्रुप मरीज के लीवर से मैचिंग होना चाहिए या फिर O ब्लड ग्रुप होना चाहिए का होना चाहिए I डोनेशन के लिए कमेटी द्वारा डोनेशन के लिए डोनर को सरकार या अस्पताल द्वारा बनाई हुई कमेटी से अप्रूव किया जाता है I ऑपरेशन करीब 8 घंटे का होता है तथा डोनर को अस्पताल में करीब 5 दिन पड़ता है रहना पड़ता है I डोनेशन की प्रक्रिया में जोखिम 1% से भी कम है तथा कुछ कॉम्प्लिकेशन होने का चांस भी बहुत कम रहता है I कुछ दिनों तक मामूली तकलीफ रह सकती है I करीब 3 महीने में डोनर का लिवर वापस बड़ा हो जाता हैI लिवर डोनेशन के बाद करीब 1 से 3 महीने में मरीज पूरी तरह से स्वस्थ महसूस करता है तथा डोनर को कोई लंबे समय तक दवाई नहीं चलती है I
लिवर ट्रांसप्लांट ऑपरेशन करीब 12 घंटे चलता है I इसमें मरीज का खराब लिवर पूरी तरह से निकाल दिया जाता है तथा नए लीवर को उसके स्थान पर लगा दिया जाता है I इसमें लिवर में आने वाली खून की सप्लाई की नालियों को जोड़ा जाता है पित्त की नली को जोड़ा जाता है एवं लीवर से खून की सप्लाई वापस ले जाने वाली धमनियों को हॉट से जोड़ा जाता है I लिवर ट्रांसप्लांट एक बहुत बड़ा ऑपरेशन है इसका सक्सेस रेट करीब 90-95% है I लिवर ट्रांसप्लांट के बाद कॉन्प्लिकेशन हो सकते हैं जैसे कि रिजेक्शन, इंफेक्शन, ब्लीडिंग, पित्त का स्राव हर्निया आदि, जो की ज्यादतर केस में डॉक्टर कंट्रोल कर लेते हैं I ट्रांसप्लांट के बाद करीब 5 दिन आईसीयू में रखा जाता है तथा करीब 12 से 15 दिन के अस्पताल में रखा जाता है Iमरीज को ऑपरेशन के बाद कई तरह की सावधानियां बरतनी होती है जैसे कि खानपान का विशेष ध्यान रखना तथा भीड़ से बचना इसके अलावा मरीज के रेगुलर बेस पर टेस्ट कराए जाते हैं जाते हैं मरीज को रिजेक्शन व इंफेक्शन से बचाने के लिए दवाइयां दी जाती हैं I यह दवाइयां शुरुआत में ज्यादा होती है धीरे-धीरे कम की जाती है पर कुछ ताउम्र चलती हैI दवाइयों के अलावा मरीज की जनरल सेहत का भी ध्यान रखना पड़ता है जैसे कि ब्लड प्रेशर एवं शुगर को कंट्रोल रखना तथा नियमित व्यायाम करनाI मरीज को एक नई जिंदगी मिल सकती है तथा उसका लीवर नया लेकर कई सालों तक बढ़िया काम कर सकता है मरीज अपनी पूरी जिंदगी जी सकता है I
Scientific Papers and Publications by Dr Vivek GUPTA
Published Papers
1) Gupta V*, Mishra S, Choudhary A, Jain V. Bilateral intraperitoneal drain with bi daily lavage as an effective means to manage pyoperitoneum. Indian Journal of Biomedical Research 2005 Jan-June;63(1):16-21
2) Gupta V*, Kumar S, Shukla A, Kumar S, Kumar S. End-of-life care of terminally ill geriatric cancer patients in northern India. Natl Med J India 2007 Mar-Apr; 20(2): 74-77
3) Subramanian A, Shankar Joshi B, Roy AD, Roy R, Gupta V*, Dang RS. NMR spectroscopic identification of fingerprint markers of human intracranial tuberculomas. NMR Biomed 2008 Apr;21(3):272-88
4) Mishra D, Gupta V*, Sonkar AA, Bajpai U, Roy R. Proton HR-MAS NMR spectroscopic characterization of metabolites in various human organ tissues: pancreas, brain and liver from trauma cases. Physiol Chem Phys Med NMR. 2008;40:67-88
5) Shatakshi Srivastava, Raja Roy, Vivek Gupta*, Ashish Tiwari, Anand N. Srivastava and Abhinav A. Sonkar. Proton HR-MAS Spectroscopy of squamous cell carcinoma tissues: An ex-vivo study to Identify Malignancy Induced Metabolic Fingerprints. Metabolomics 2011; (2)7, 278-288
6) Gupta V*, A Chandra, M Singh, PK Shrivastava, A Singhai, BK Ojha. Establishing a deceased donor program in north Indian region: lessons learnt. Clinical transplantation 2016 May;30(5):633-40.
7) Gupta V*, Kumar S, Rahul, Chandra A. Predictors of long term survival after surgical resection in carcinoma gallbladder. Int J Med Res Rev. 2016; 4(11):2046-2053
8) Chandra A, Kumar S, Maurya AP, Gupta V, Gupta V*, Rahul. Laparoscopic ventral mesh rectopexy for complete rectal prolapse: A retrospective study evaluating outcomes in North Indian population. World J Gastrointest Surg.2016 Apr 27;8(4):321-5.
10) Chandra A, Gupta V*, Rahul, Kumar M, Kumar A. Intraoperative ultrasound of complex biliary strictures: Use of a novel contrast agent: Can J Surg 2017;60:316-22
11) Chopra N, Gupta V*(Corresponding author), Gupta V, Kumar S, Joshi P, Chandra A. Liver Hydatid Cyst with Cystobiliary Communication: Laparoscopic Surgery Remains an Effective Option. J Minim Access Surg 2018 Jul-Sep; 14(3): 230-235
12) Chandra A, Singh P, Maurya A, Gupta V, Gupta V* et al. Laparoscopic ventral rectopexy: A viable option in procidentia with redundant sigmoid – An Indian perspective. J Minim Access Surg 2018 Oct-Dec; 14(4): 304-310
13) Chandra A, Mishra B, Kumar S, Chopra N, Gupta V* et al. Composite Antropyloric Valve and Gluteus Maximus Muscle Wrap for Neoanal Reconstruction: Initial Results. Contributing Author. Dis Colon Rectum. 2019 Jan;62(1):104-111
14) Gupta V, Gupta V*, Joshi P et al. Management of post cholecystectomy vascular injuries. Surgeon 2018 Nov; 2 (18)30120-3
15) Gupta V, Kumar S, Gupta V* et al. Blumgart’s technique of pancreatojejunostomy: Analysis of safety and outcomes. Hepatobiliary Pancreat Dis Int. 2019 Apr; 18(2) 181-187
16) Joshi P, Yadav R, Dangi A, Kumar P, Kumar S, Gupta V* et al. Corrosive Esophageal Strictures: From Dilatation to Replacement: A Retrospective Cohort Study. Dysphagia. 2019 Sep 4. doi: 10.1007/s00455-019-10058-1
17) Gupta V, Dangi, A, Gupta V*. et al. Validation of the Fistula Risk Score for Post-operative Pancreatic Fistula After Pancreatoduodenectomy. Indian J Surg (2020). Doi: 10.1007/s12262-020-02616-x
18) Chandra A, Kumar S, Singh P, Gupta V* et al. Endoscopic Ultrasound-Guided Anal Sphincteroplasty for Fecal Incontinence in Women: A Pilot Study. Indian J Gastroenterol. 2019 Dec;38(6):534-541
19) Chandra A, Rajan P, Dangi A, Gupta V* et al. Natural Orifice Transanal Endoscopic Rectopexy: A Novel Option for Rectal Prolapse. Dis Colon Rectum. 2020 Oct;63(10):e523-e528
20) Gupta V*, A Chandra, Gupta V et al. Gall bladder perforation: a single centre experience in north India and a step up approach for management. Hepato Biliary and Pancreatic Disease International. 24.8.2021.
21) Gupta V*, Sodha VS, Kumar N et al. Missed Pancreatic Injury in Patients Undergoing Conservative Management of Blunt Abdominal Trauma: Causes, Sequelae and Management. Turk J Surg 2021; 37 (3): 286-293
22) Chandra A. Rajan P, Gupta V* et al. Natural Orifice Endosonographic Colposuspension with Rectopexy for Combined Pelvic Organ Prolapse –A Feasibility Study. Accepted in Dis Colon Rectum. 2021
23) Srivastava M, Chandra A, Rahul R, Gupta V* et al Expression of Human Omentum Following Abdominal Surgery Cureus. 2021 Aug; 13(8): e17477.
Published Abstracts:-
24) Graft to Recipient Weight Ratio Analysis of 414 Consecutive Living Donor Liver Transplants: How Much Can the Bar Be Lowered? B Palat, V Gupta, NN Mehta, V Kumaran, R Mohanka, AN Rastogi. Liver Transplantation. 2011 (16), S117-S118
25) Factors Affecting Graft Survival after Living Donor Liver Transplantation. M Govindasamy, S Chattopadhyay, P Singla, T Srinivasan, V Gupta et al. Liver Transplantation. 2011 (6), S227-S227, 2011
26) Non Invasive Assessment of Donor Liver Steatosis and Its Relevance in the Post Transplant Recovery of Recipient in Living Donor Liver Transplantation. V Gupta, T Srinivasan, M Govindasamy et al. Liver Transplantation. 2011 17 (6), S212-S213
27) Infectious Complications in Living Donor Liver Transplantation (LDLT)-Patterns and Factors Influencing Outcome. T Srinivasan, S Chattopadhyay, M Govindasamy, V Gupta et al. Liver Transplantation.2011 17 (6), S109-S109
28) The Financial Cost of Mandatory Data Reporting: A Non-reimbursable Burden for Transplant Centers. M Asolati, G Testa, N Johnson, F Paterno, M Saeed, V Gupta et al. American Journal of Transplantation. 2012, 12, 525, 2012
29) Factors Affecting Return To Work after Liver Transplantation. M Asolati, M Levy, L Jennings, F Paterno, M Saeed, V Gupta, G Klintmalm. American Journal of Transplantation. 2012, 12, 525, 2012
30) Renal Outcomes after Liver Transplantation for Acute Liver Failure. F Paterno, J Trotter, M Asolati, N Onaca, R Ruiz, G Mckenna, I Saeed, V Gupta et al. American Journal of Transplantation. 2012, 12, 509
31) Survival after Late Hepatic Artery Thrombosis. M Saeed, G Testa, R Ruiz, N Onaca, A Dabous, V Gupta et al. American Journal of Transplantation. 2013, 13, 220, 2013
32) Hepatic Artery Thrombosis: Overall Incidence and Variables Affecting Outcome.MI Saeed, G Testa, R Ruiz, P Kim, V Gupta et al. Liver Transplantation. 2013, 19, S246-S246
33) Late Versus Early Biliary Complications after Liver Transplantation. V Gupta, N Onaca, M Saeed, A Dabous, M Asolati, R Ruiz et al. American Journal of Transplantation. 2013, 13, 169, 2013
34) Gupta V, Chandra A, Singh M, Gupta V, Kumar S, Joshi P, Sharma P, Hasan H, Srivastava P, Khan M, Arshad Z, Kant R. Using Scheduled Commercial Flights for Transport of Liver for Transplant. Am J Transplant. 2017;17 (suppl 3).
35) Effect of cholangitis on predictors of lymphadenopathy in gallbladder cancer. Abstract in HPB 20:S706 · September 2018
36) Effect of cholangitis on pre-operative evaluation of regional lymphadenopathy by CT in pancreato-biliary malignancies. Abhijit Chandra, Vivek Gupta, Saket Kumar, Pradeep Joshi, Vishal Gupta, Pavan Kumar Gorla, and Akshay Anand Agarwal Journal of Clinical Oncology 2019 37:15_suppl, e15651-e1565
Communicated:-
37) Severe COVID-19 infection in post liver transplant patient with signs of acute graft rejection: A case report from Northern India. Submission in Indian Journal of Surgery.
Scientific Presentations
1) Geriatric oncology, a look ahead – an Indian perspective. Paper presentation at Indian Association of Surgical Oncology annual conference at Kodaikanal, India. 2005. Gupta V, Kumar S, Shukla A, Kumar S, Kumar S.
2) HR-MAS Spectroscopy of oral cancer tissues and their assessment with histopathological examination. Paper presentation by Dr A.A.Sonkar at National Magnetic Resonance Society meeting at NCL, Pune, India. February 2007. Gupta V, Sonkar A.A, Srivastava A.N, Roy R
3) HR-MAS Spectroscopy of oral cancer tissues and their assessment with histopathological examination. Poster presentation at the 15thmeet of International Society of Magnetic Resonance in Medicine. Berlin, Germany. May 2007. Sonkar A.A, Gupta V, Srivastava A.N, Roy R
4) Graft to recipient weight ratio analysis of 414 consecutive living donor liver transplants; how much the bar can be lowered. Paper presentation at the 16th congress of ILTS, Hong Kong, China. June, 2010. Balachandran P, Gupta V, Mehta N, Kumaran V, Mohanka R, Rastogi A N, Saigal S, Saraf N, Mohan N, Nundy S. Soin A S
5) Non Invasive Assessment of Donor Liver Steatosis and its Relevance in the Post Transplant Recovery of Recipient in Living Donor Liver Transplantation. Gupta V, Thiagarajan S, Mahendran G, Chattopadhyay S, Balachandran P, Kumaran V, Mehta N, Varma V, Nundy S, Soin A S. Paper presentation at the Indian chapter of IHPBA, New Delhi. Nov 2010
6) Accuracy of T-2 Weighted Magnetic Resonance Cholangiopancreatography in Evaluation of Biliary Anatomy in Living Liver Donors. Chattopadhyay S, Govindasamy M, Singla P, Rastogi A, Gupta V, Srinivasan T, Varma V, Mehta M, Buxi T S, Nundy S, Soin A S. Paper presentation at ILTS, Valencia, Spain. June 2011
7) Infectious Complications in Living Donor Liver Transplantation (LDLT)- Pattern and Factors Influencing Outcome. Srinivasan T, Chattopadhyay S, Govindasamy M, Gupta V, Varma V, Mehta N, Nundy S, Kumaran V, Soin A S. Paper presentation at ILTS, Valencia, Spain. June 2011
8) Non Invasive Assessment of Donor Liver Steatosis and its Relevance in the Post Transplant Recovery of Recipient in Living Donor Liver Transplantation. Gupta V, Thiagarajan A, Mahendran G Chattopadhyay S, Balachandran P, Kumaran V, Mehta N, Varma V, Nundy S, Soin A S. Poster presentation at ILTS, Valencia, Spain. June 2011
9) Factors Affecting Graft Survival after Living Donor Liver Transplantation. Mahendran G, Chattopadhyay S, Singla P, Thiagarajan T, Gupta V, Varma V, Mehta N, Kumaran V, Nundy S, Soin A S. Poster presentation at ILTS, Valencia, Spain. June 2011
10) Factors predicting return to work after liver transplantation. Asolati M, Levy M, Jennings L, Paterno F, Saeed M I, Gupta V, Klintmalm G B. Poster presentation at American Transplant Congress, Boston. June 2012
11) The financial cost of mandatory data reporting, a non-reimbursable burden for transplant centers. Asolati M, Testa G, Johnson N, Paterno F, Saeed M I, Gupta V, Goldstein R, Klintmalm G B. Poster presentation at American Transplant Congress, Boston. June 2012
12) Renal outcomes after liver transplantation for acute liver failure. Paterno F, Asolati M, Onaca N, Ruiz R, Saeed M I, Gupta V, Jennings L, Testa G, Klintmalm G B. Poster presentation at American Transplant Congress, Boston. June 2012
13) Marginal liver grafts: Who are the best recipients? Oral presentation at Controversies in Transplantation meeting. Gupta V, Ruiz R. Colorado. Feb 2013
14) Late vs early biliary complications after liver transplantation. V. Gupta, N. Onaca, M. Saeed, A. Dabous, M. Asolati, R. Ruiz, P. Kim, G. Testa, R. Goldstein, G. Klintmalm. Oral presentation at ATC, Seattle. May 2013
15) Deceased donor liver transplantation: Experience of emerging centers in organ donation: National Summit on best practices in Organ & Tissue donations. Fortis Memorial Institute, Gurgaon(India). 3rd September 2016
16) Laparoscopic surgery for Hydatid cyst with cystobiliary communication:V. Gupta, N. Chopra, V Gupta, A Chandra. Presented at Indian Chapter of International Hepatobiliary Pancreatic Association, Bangalore (Jan 2017)
17) Long term outcome for chronic pancreatitis with associated pseudocysts: P Swamy, A Dangi, V Gupta, A Chandra. Presented at Indian Chapter of International Hepatobiliary Pancreatic Association, Bangalore (Jan 2017)
18) Using Scheduled Commercial Flights for Transport of Liver for Transplant. V Gupta, A Chandra, M Singh, V Gupta, S Kumar, P Joshi, R Kant. Presentation at American Transplant Congress. Chicago (USA) 29.4.2017
19) Endoscopic Management of BronchoBiliary Fistula. R K Yadav, S Kumar, P Singh, V Gupta, P Joshi, V Gupta, A Chandra. Poster presentation at annual conference of Indian Association of Surgical Gastroenterology. Puducherry. 5.10.2017
20) Neo Anal Reconstruction using Antro Pyloric Valve and Gluteus Muscle Wrap for End Stage Fecal Incontinence. R K Yadav, N Chopra, P Kumar, A Chandra, V Gupta, S Kumar, P Joshi, V Gupta. Poster presentation at annual conference of Indian Association of Surgical Gastroenterology. Puducherry. 5.10.2017
21) Retrospective analysis of 70 cases of malignant masquerade: Xanthogranulomatous cholecystitis. R K Yadav, R Kulkarni, A Chandra, V Gupta, S Kumar, P Joshi, V Gupta. Oral presentation at annual conference of Indian Association of Surgical Gastroenterology. Puducherry. 5.10.2017
22) Effect of Cholangitis on Predictors of Lymphadenopathy in Gallbladder Cancer. R Kulkarni, V Gupta, P Joshi, S Kumar, V Gupta, A Chandra. Poster presentation at IHPBA meet, Pune, India. 13 January 2018
23) Composite Antropyloric Valve and Gluteus Maximus Muscle Wrap for Neoanal Reconstruction: Initial Results. N Chopra, P Kumar, A Dangi, RK Yadav, S Kumar, P Joshi, V Gupta, V Gupta, A Chandra. Award paper presentation at IASG, Chandigarh, 2018
24) Functional Outcome and Quality of Life After Surgery for Chronic Pancreatitis. V Gupta, P Singh, A Dangi, P Kumar, A Pai, P Joshi, S Kumar, V Gupta, A Chandra. Poster at IASG, Chandigarh, 2018
25) Blumagart’s Technique of Pancreatojejunostomy: Analysis of Safety and Outcomes. A Dangi, V Gupta, S Kumar, V Gupta, P Joshi, Rahul, P Kumar, R Yadav, A Chandra. Poster at IASG, Chandigarh, 2018
26) Validation and Clinical Utility of Fistula Risk Score for Pancreatoduodenectomy in Indian Population: A Retrospective Cohort Analysis. V Gupta, A Dangi, S Kumar, V Gupta, P Joshi, Rahul, Pavan G, R Yadav, A Chandra. Submitted for IASG 2018
27) Visceral Artery Aneurysm: Multimodal Management in Tertiary Care Centre. N Chopra, A Chandra, A Dangi, S Kumar, P Joshi, V Gupta, V Gupta. Submitted for IASG 2018
28) Delayed Manifestation of Pancreatic Injury following Blunt Trauma Abdomen and its Management: V Gupta, Pavan G, N Kumar, S Kumar, P Joshi, V Gupta, A Chandra. Submitted for IASG 2018
29) Effect of Cholangitis on Predictors of Lymphadenopathy in Gall Bladder Cancer. Poster for IHPBA World Congress. Geneva. September 2018
30) Effect of cholangitis on pre-operative evaluation of regional lymphadenopathy by CT in pancreato-biliary malignancies. Eposter at 2019, Annual ASCO meeting, Chicago, USA
31) Severe COVID in post liver transplant patient with signs for acute graft rejection. Presented at Liver Transplant Society of India, Annual meet(virtual) in Nov 2020
32) Bile duct exploration with primary closure of duct without T-tube should be preferred in patients with failed endoscopic clearance of choledocholithiasis." SAGES Annual Meeting. (virtual), August 31, 2021 - September 3, 2021, Las Vegas, NV, USA
33) 3d Generated Model For Intra-operative Planning Of Parenchymal Transection And Middle Hepatic Vein Reconstruction In Living Donor Liver Transplant Session: SF145 | Transplantation and Tissue Engineering. American College of Surgeons Annual Meeting, (virtual), Oct, 2021. USA
34) Prognostic Significance Of Inhibitor Of Apoptosis Proteins In Gallbladder Cancer. American College of Surgeons Annual Meeting, (virtual), Oct, 2021. USA
35) Missed Pancreatic Injury in Patients Undergoing Conservative Management of Blunt Abdominal Trauma. Oral Free Paper presentation at the 31st Annual IASGCON 2021. 9th & 10th October, AIIMS Bhubaneswar.
36) Gall bladder perforation: a single centre experience in north India and a step up approach for management. Oral Free Paper presentation at the 31st Annual IASGCON 2021. 9th & 10th October, AIIMS Bhubaneswar.
37) Gall bladder perforation: a single centre experience in north India and a step up approach for management. Poster presentation research showcase, KGMU, Lucknow (20.11.2021)
38) Gallbladder cancer surgery: Our experience. Presented at India Medical Association, Lakhimpur, Uttar Pradesh. (10.6.2023)
