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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Internal biliary diversion for medically refractory pruritus in a child with Alagille syndrome: a novel alternative for liver transplantation(Sri Lanka College of Paediatricians, 2024-12) Tillakaratne, S.; Fernando, M.; Batepola, T.; Gunetilleke, B.; Appuhamy, C.; Weerasuriya, A.; Siriwardana, R.No abstract availableItem Auditory and visual hallucinations in an adolescent following orthotopic liver transplantation(Sri Lanka College of Psychiatrists, 2024-10) Chandradasa, M.; Abeyrathne, M.; Sithara, P.; Kodithuwakku, K.; Fernando, M.No abstract availableItem Image guided naso-jejunal tube placement in paediatric liver transplant patients in low resource settings: Feasibility, technique, and outcome(Sri Lanka College of Paediatricians, 2024) Appuhamy, W.N.D.P.C.; Fernando, M.; Tillakaratne, S.B.; Gunathilake, M.B.; Ganewatte, E.; Gishanthan, S.; Jayakody, R.D.C.G.; Siriwardana, R.C.No abstract availableItem 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 Challenges faced in establishing a pediatric liver transplant program in a lower‐middle‐income country with free healthcare service(Wiley, 2024) Fernando, M.; Tillakaratne, S.; Gunetilleke, B.; Liyanage, C.; Appuhamy, C.; Weerasuriya, A.; Uragoda, B.; Welikala, N.; Ranaweera, L.; Ganewatte, E.; Dissanayake, J.; Mudalige, A.; Siriwardana, R.ABSTRACT: BACKGROUND: Liver transplant is the cure for children with liver failure. Sri Lanka is a lower-middle-income country with a predominant free, state health system. Pediatric liver transplant program in Sri Lanka is still in the budding state where the initial experience of the program is yet to be documented. METHODS: A retrospective review was performed including the clinical characteristics of all pediatric liver transplant recipients of Colombo North Centre for Liver Diseases since the inception of the program from June 2020 to May 2023. RESULTS: There were 14 PLT performed in 3 years. The median recipient age and weight were 8 years (6 months–15 years) and 23.3 kg (6.4–49.2), respectively. The majority were boys (64%). All were from low-income backgrounds. Indications for LT were acute liver failure (5/14), decompensated chronic liver disease (5/14), and acute on chronic liver failure (4/14). Underlying liver diseases were Wilson disease (6/14), autoimmune liver disease (3/14), biliary atresia (2/14) and progressive familial intrahepatic cholestasis type 3 (1/14), and unknown etiology (2/14). The majority were living donor liver transplants (86%). Of the living donors, 42% (5/12) were Buddhist priests. There were three immediate deaths and two late deaths. The 3-month survival was 78%, and overall survival was 64%. Living donor transplants carried a higher success rate (92%) compared to diseased donor transplants (0%; 2/2). CONCLUSIONS: Initial experience of pediatric liver transplant program of Sri Lanka is promising despite being established in a free healthcare system amidst the crisis circumstances.Item An ABO-incompatible living donor liver transplant in an infant with acute liver failure in the Sri Lankan setting(The Sri Lanka Medical Association, 2023) Fernando, M.; Tillakaratne, S.; Gunetilleke, B.; Liyanage, C.; Appuhamy, C.; Weerasuriya, A.; Dissanayake, J.; Siriwardana, R.Liver transplant (LT) is the standard therapy for medically refractory acute liver failure (ALF). Finding a deceaseddonor graft in an emergency is challenging and often overcome by living-donation. Blood group matching is practised for LT though ABO-incompatible liver transplant (ABOi-LT) is performed inselected circumstances. We report an infant who underwent successful ABOincompatible living donor LT for ALF of unknown aetiology. This being the country’s first ABOi-LT, the youngest LT recipient to date and the youngest receiving emergency LT for ALF; we describe the novel experience at a resource-limited setting in Sri Lanka (SL).Item Role of interventional radiology in paediatric liver transplantation(Sri Lanka Medical Association, 2023) Fernando, M.; Gunetilleke, B.; Tillakaratne, S.; Siriwardana, R.C.; Appuhamy, W.N.D.P.C.; Padmasiri, U.G.M.INTRODUCTION: Interventional radiology advances have rendered it attainable to treat many of the complications of liver disease in a minimally invasive manner, and they play a major role in liver transplantation. OBJECTIVES: We aimed to assess the role of interventional radiology in a cohort of paediatric liver transplant patients. METHODS: Thirteen paediatric patients underwent liver transplantations from July 2020–February 2023 at Colombo-North Teaching Hospital, Ragama. Seven patients (53.84%) required special interventional radiological procedures. The need for an interventional radiological procedure was decided by a multidisciplinary team. A retrospective database was maintained with demographic and liver transplant data. RESULTS: Four patients (57.14%) requiring radiological intervention underwent procedures involving the thoracic cavity, and 5 patients (71.42%) who required radiological intervention underwent procedures involving the abdominal cavity. Two patients (28.57%) out of the seven who had interventional radiological procedures went through both abdominal and thoracic radiological interventions. As abdominal radiological interventions, splenic artery embolization (20%), hepatic venous stenting (20%), subhepatic drain placement (20%), and two abdominal pigtail drain insertions (40%) have been done. Four patients underwent pigtail insertion, which was performed as a thoracic radiological intervention. CONCLUSIONS: Interventional radiology plays a crucial role in the management of paediatric post-liver transplantation patientsItem Hepatic and renal status of paediatric patients with thalassaemia(Sri Lanka Medical Association, 2023) Wijenayake, W.; Pathiraja, H.; Thennakoon, R.; Fernando, M.; Bandara, D.; Mettananda, S.INTRODUCTION: Thalassaemia is a chronic disorder affecting many organ systems. Although cirrhosis is a well-recognised complication, sub-clinical hepatic and renal dysfunction in thalassaemia are poorly studied. OBJECTIVES: We aimed to describe the hepatic and renal status and dysfunction of paediatric patients with thalassaemia. METHODS: A cross-sectional descriptive study was conducted at Kurunegala and Ragama Thalassaemia Centres during February and March 2023. All patients aged less than 16 years attending the thalassaemia centres were recruited. Data were collected using a data collection form by interviewing parents and perusal of clinical records and analysed using SPSS 27.0. Ethical approval was obtained from the Sri Lanka College of Paediatricians. RESULTS: Sixty-five patients (mean age-7.7; males-46%) were recruited. Of them 48(73%) had homozygous beta-thalassaemia and 17(26%) had HbE thalassaemia; 52(80%) were transfusion-dependent and 13(20%) were non-transfusion-dependent. Hepatomegaly and splenomegaly were found in 45(69%) and 30(46%), respectively. Regarding hepatic status, 34(52%) had high (>40IU/L) alanine transaminases, of which 8(12%) had >3-fold elevation of alanine transaminases. A higher proportion of children with HbE thalassaemia (71%) had elevated alanine transaminases compared to homozygous beta-thalassaemia (46%, χ2=3.0, p=0.07). Also, a higher proportion of children on deferasirox (57%) had elevated alanine transaminases compared to those who were not on the drug (27%, χ2=3.3, p=0.06). Four (5%) had <2+ proteinuria in urinalysis however, the urine protein: creatine ratio was normal in all. CONCLUSION: High alanine transaminases were noted in over 50% of paediatric patients with thalassaemia. HbE thalassaemia type and use of deferasirox were associated with high alanine transaminase levels.Item Item Optimizing intraoperative haemodynamics and haemostasis to enhance recovery after liver transplantation for cirrhosis in adults(College of Anaesthesiologists of Sri Lanka, 2022) Gunetilleke, B.; Welikala, N.; Ranamuni, R.; Jayaweera, D.; de Silva, T.; Amerasinghe, O.; Liyanage, C.; Dissanayake, J.; Appuhamy, C.; Fernando, M.; Thilakarathne, S.; Dassanayake, A.; Niriella, M.; Siriwardana, R.; Gilbert-Kawai, E.Cirrhosis with end stage liver disease is a leading cause of non-communicable disease related deaths in Sri Lanka. Liver transplantation remains the only curative treatment for such patients. Multi-organ dysfunction characteristic of end stage liver disease, surgical and anaesthetic factors, quality of the graft, coagulopathy and haemodynamic instability, all lead to the complexity of the perioperative care for liver transplant. Aggressive management focused particularly on maintaining intra-operative haemodynamic stability and optimizing haemostasis, directly impacts successful patient outcomes and forms the core of the anaesthetic strategy.