[Kabar-indonesia] Indonesia's first liver transplant a success

[Joyo at aol.com]

The Jakarta Post
Wednesday, November 1, 2006

Feature 

Indonesia's first liver transplant a success

Suherdjoko, The Jakarta Post, Semarang

Indonesia's liver transplant team, comprising doctors of the
Semarang's Kariadi Hospital and of the School of Medicine,
Diponegoro University, together with the liver transplant
team of National University Hospital of Singapore
successfully conducted a liver transplant on 15-month-old
Ulung Hara Hutama on October 1.

Ulung's liver, which could no longer function, was removed
and replaced by 25 percent of the liver of his mother, Lisa
Olivia, 28.

The operation, the first ever in Indonesia, was a success.

Ulung's condition is improving and he is now treated in an
Intensive Care Unit (ICU) at Kariadi Hospital. A balloon is
placed next to him while a nurse keeps monitoring his health
condition.

Lisa, Ulung's biological mother, who has donated 25 per cent
of her liver, looks healthy. She has been discharged from
the hospital. She has visited the ICU to breastfeed Ulung,
her second child.

Didik, Ulung's father, said his son was born on July 19,
2005, in a healthy condition and weighed 3.4 kilograms.
However, when he was two days old, his skin began to turn
yellow and remained so until he was two months old.
Meanwhile, his feces were lime-like white.

Later the doctor diagnosed him as suffering from Attresia
Biliaris in his liver. "His bile cannot be channeled so it
piles up in his liver and causes cirrhosis," Supriatna, a
member of the liver transplant team, told The Jakarta Post.

Didik and Lia, who live at Jl. Puspowarno IV Semarang, later
made every effort to have their second child cured of his
disease.

Finally, they learned that the only way was to have liver
transplant for Ulung in Singapore but they could not take
Ulung to Singapore quickly as they still had to get their
passports, visas and references from the doctor.

"Suddenly, Kariadi Hospital's team of doctors offered a
liver transplant in Semarang. We took up the offer.
Honestly, I was worried because my wife and Ulung had to
undergo surgery.

"Therefore, we tried to find out whether the team of doctors
here was really capable of undertaking this liver
transplant. Only when we were convinced of the capability of
the doctors did we agree for the liver transplant for Ungul.

"Of course, we left everything in the hands of Our Lord,"
Didik said, after seeing Ulung with his wife.
Simply put, a liver transplant involves the removal of the
diseased liver and replacing it with a healthy liver from a
donor.

Until 1992, the one year post-transplant survival rate rose
to 90 percent. Singapore saw 107 liver transplants between
1990 and 2005 with an 86 per cent rate of success.

In the United States some 15,000 patients were on the liver
transplant waiting list in 2000. Unfortunately, a third
could not undergo this surgery for various reasons.

Pediatrician Ag. Soemantri took the initiative for the liver
transplant in Semarang. He was prompted by a desire to help
children afflicted with liver trouble and requiring a liver
transplant in 1996. Of 10,000 births, he said, one to two
babies have a defect in their liver.

That year, six doctors left for the National University
Hospital (NUH) in Singapore to learn about liver transplants
from Quak Seng Hock, head of the pediatric gastrohepatology
division.

The six were Hartantyo, ModerikTaman, Bambang Sudarmanto,
Asri Purwanto, Latiyani and Yanti.

The transfer of liver transplant knowledge and skills to
Indonesian doctors continued in 1997 and a team of doctors
from NUH went to Semarang.

Unfortunately, the plan was postponed because of the acute
economic crisis. It was not until August 2005, when the
Asia-Pacific Hepatology Congress was held in Bali, that a
meeting was held by the embryo of Kariadi Hospital/School of
Medicine of Diponegoro University liver transplant team and
the NUH Team, represented by Prabhakaran, Quak Seng Hock and
their colleagues.

In late August 2005, an official liver transplant team of
Kariadi Hospital/School of Medicine of Diponegoro
University, involved scientists of various disciplines and
motivation so that a liver transplant could be conducted in
Semarang.

The plan to carry out a liver transplant in Semarang came
close to being realized when two patients were ready for it.
In May 2006, Prabhakaran of Singapore's NUH came to
Semarang.

As many as 18 medical specialists in Semarang were involved
in a serious discussion with the NUH team over
implementation of the transplant.

In August 2006, the liver transplant team of Kariadi
Hospital/School of Medicine of Diponegoro University, headed
by Yulianto, discussed the final preparation for the liver
transplant with their colleagues from NUH, led by
Prabhakaran.

On Oct. 1, the liver transplant began at 8.15 a.m. and ended
at 9 p.m. "The transplant ran smoothly. It took three hours
to take out the diseased liver, take the healthy liver from
the mother and transplant it to Ulung's liver," Supriatna
said.
Yulianto, the chairman of the liver transplant team, said
that after the transplant, Ulung would still undergo weekly
monitoring to prevent complications such as hepatic arterial
thrombosis, portal vein thrombosis, tractus biliaris
complication, rejection and infection.

In addition, Ulung will have to take Takrolimus all his
life. With today's sicentific progress, someone with a liver
transplant has a survival rate of 85 per cent. On the other
hand, Lisa's liver, part of which has been taken for her
son, was expected to regrow and return to normal in three
weeks.

A liver transplant, Prabhakaran stressed, will be considered
a success if the patient lives normally afterwards. At
least, this success will be evident from the health
condition of the patient in one or two months after the
transplant.

How much does a liver transplant cost? In Singapore, it
costs between Rp 1 billion and Rp 1.5 billion. In Indonesia,
it is between Rp 500 million and Rp 750 million.

Specially in Ulung's case, his parents have been exempted
from all charges because his transplant was a pilot project
for the Semarang liver transplant team.

"The government pays all the charges," Ag. Soemantri said.

Currently 11 patients are on the liver transplant waiting
list at Kariadi Hospital, Semarang. The team is yet to
decide the fee for this transplant.

"But we have all the necessary medical equipment for this
transplant," Supriatna said.

Some members of the liver transplant team, such as Ag.
Soemantri, Supriatna, Budi Santoso and Tatty ES said after
the transplant, the critical period could last up to three
weeks and that serious attention had to be paid to this
critical period.

"So, in a liver transplant, there are three periods that
require careful handling. First the pre-transplant period,
which is related to the health and psychological preparation
for the donor and the patients, then the transplant period
and eventually the post-transplant period," Soemantri added.

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Joyo Indonesia News Service
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