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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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 Hepatocellullar carcinoma: the Sri Lankan perspective(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Siriwardana, R.Ragama has become a center of excellence in the management of hepatocellular carcinoma (HCC). Since 2012 we have managed approximately 500 patients with HCC referred from different parts of the country. Sri Lanka appears to have an unique pattern of disease not seen in any other part of the world. The large majority of HCC in our population is related to non-alcoholic fatty liver disease (NAFLD). With novel treatment of hepatitis C and hepatitis B vaccination globally, it is predicted that NAFLD will be the leading cause of liver disease in the future. In Sri Lanka with rapidly rising prevalence of NAFLD, liver cancer will also continue to rise. In this background of NAFLD, diffuse variant of HCC has higher incidence in our patients. Consumption of alcohol is a risk factor to develop diffuse type HCC. Diffuse type HCC has a grave prognosis. A significant proportion of NAFLD patients develop HCC in non-cirrhotic liver. This raises the need to screen at-risk groups in the future. These non-cirrhotic hepatomas are larger in size and have a better prognosis than others. Alpha-feto protein is an unreliable marker in the assessment of our patients with NAFLD induced HCC. Our cohort of patients is an excellent sample to study the future pattern of HCC worldwide.Item Education and imaging. hepatobiliary and pancreatic: carcinoid tumor with cystic liver metastases(Wiley-Blackwell, 2010) Wijesuriya, S.R.E.; Siriwardana, R.; Deen, K.I.No Abstract Available