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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 A quest for enhanced recovery after liver transplant at the colombo north center for liver disease: The first decade(College of Anaesthesiologists of Sri Lanka, 2023) Gunetilleke, B.Cirrhosis is a significant contributor to non-communicable disease related deaths in Sri Lanka and the only cure for cirrhosis constitutes liver transplant. Nonalcoholic fatty liver disease (NAFLD) which is the hepatic component of the metabolic syndrome is the main aetiology of cirrhosis in patients presenting for liver transplant at CNCLD. Enhanced recovery after surgery (ERAS) is a concept originally adopted in colorectal surgery, and is a multimodal- multidisciplinary approach to perioperative care aiming to reduce perioperative surgical stress response and improve short-term outcome. Targeting improved outcome, components of ERAS have been incorporated in the perioperative care of liver transplant at the Colombo North Center for Liver Disease since 2016. Sri Lanka needs to define its own enhanced recovery after liver transplant (ERALT) protocols based on local data and audit performance.Item The long-term quality of life following liver transplantation in a developing country with a free health care system(The Sri Lanka Medical Association, 2022) Siriwardana, R.C; Gunetilleke, B.; Jayatunge, S.; Weerasooriya, A.; Niriella, M.A.; Dassanayake, A.S.; Ranaweera, S.P.; Tillakaratne, S.B.INTRODUCTION: Developing countries with limited resources are yet to establish universal liver transplant (LT) services to cater to their population free of charge. In this unique setting, no data are published on the long-term Quality of life (QOL) of LT survivors. OBJECTIVES: Compare the long-term quality of life of post-liver transplant patients with a matching cohort of pretransplant cirrhotic patients and a matching non cirrhotic control group. Methods: Of the 45 liver transplants that were performed there were 24 patients who completed over 6 months of follow-up. Of these, 4 patients died (including one lost to follow-up) after six months. The remaining 20 post-transplant patients were the subjects for QOL assessment. One post-transplant recipient was matched with two pre-transplant cirrhotic patients and non-cirrhotic healthy control group. QOL was evaluated by the SF-36 questionnaire. RESULTS AND CONCLUSIONS: The median age was 54 years (27-67) and 85% (n=17) were male. The median follow up was 24 months (6- 94 months). The median MELD score was 17 (11-22) and 75% (n=15) were due to cryptogenic cirrhosis. Post-operatively three (15%) developed graft rejection, five (25%) had infections and ten (50%) suffered drug related complications. 95% (n= 19) of the population had satisfactory drug compliance. The study population had significantly better QOL compared to control in all eight domains (p<0.05) including physical functioning (76% vs 52.7%), physical health (80% vs 7.9%), emotional problems (93% vs 17.1%), energy (77% vs 47%), emotional wellbeing (80% vs 61.1%), social functioning (86.9% vs 56.9%), pain (82% vs 47.5%) and general health (67.5% vs 37.5%). The study population had similar quality of life compared to the healthy control group with better-perceived emotional well-being. CONCLUSION: Long-term survivors after LT have significantly improved QOL in a setting with limited resources