Team

WHY US

• Cirrhosis
• 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 and 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 need liver transplants. 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 the centre 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 a 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 Transplant.

However, after the Transplant, most of these patients will grow the virus in their bloodstream quite soon. It will start damaging the liver with time! This cycle must be broken.

At CLBS, all patients who undergo liver transplants for hepatitis C are evaluated for this routinely six 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! It targets the virus and stops it from damaging the newly 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 countries like Japan. Genotype 3 is much more common in India, Pakistan, and other countries in this subcontinent. The behavior of Genotypes 1 and 3 are so widely different that it may happen in the future that they are renamed as entirely different viruses rather than labeling them too simply as various subtypes of the same ‘Hepatitis C virus.’

Much of our research focuses on the difference between these genotypes. Differentiated behavior also means differences in response to treatment!

Liver cancer: HCC

Unfortunately, many patients with longstanding liver disease have 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 tumors when they are still quite small. When detected early, the treatment results are quite good!

For patients with small HCC, 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, these patients will do well with liver transplants. Chances of the tumor growing back are really low when a 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. Many centres worldwide perform Liver Transplants for patients with ALF when they meet certain criteria. However, it has been repeatedly seen that some of the patients of ALF who meet these criteria have recovered without a transplant! It set us thinking.

The result of our clinical research is that we need to 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 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 with ALF are best treated with a transplant and who would do well without.

Hepatitis C

Interferon injections are the only effective treatment that targets the Hepatitis C virus. But when the hepatitis C virus has already begun its damage to the liver, these patients tolerate Interferon injections poorly. Hence, most patients with Hepatitis C-related Cirrhosis will need a transplant, not interferon therapy.