South Asian liver institute starts ERAS for liver transplant

South Asian Liver Institute successfully introduces ERAS Protocol to Liver Transplantation, with far reaching implications for Liver Disease Patients in terms of Cost, and Post-operative Outcomes.

Cost, along with organ shortage are the two key reasons keeping patients with liver failure away from a life-saving liver transplant. This protocol might reduce the hospital stay by approximately 20-30% and hence in the future, reduce costs. By default it also brings down the complication rate which clearly will improve the overall outcomes. With over 300 million patients with liver disease in our country and over 100,000 deaths every year, such medical advances can be ‘game changers’, explained renowned Liver Surgeon Prof Dr Tom Cherian, Founder & MD of South Asian Liver Institute.

Enhanced recovery after surgery (ERAS) started a revolution that changed age-old surgical stereotypical practices. In the last decade, ERAS has gained significant acceptance in other surgical specialties. One of the last remaining fields, given its significant complexity, is liver transplantation. “Enhanced Recovery After Surgery is a evidence-based, peri-operative care pathway developed to minimize the response to surgical stress” said Transplant Surgeon, Prof Dr Tom Cherian.

Of 112 patients who underwent a liver operation, 18 patients successfully benefitted from this new programme at South Asian Liver Institute. We compared our first12 months to the last 12, in terms of length of stay in hospital for our liver transplant recipients and found a 21% reduction in the average length of stay. Whereas only 3% of our patients were discharged in < 8 days in the first period, 15% of our patients were discharged in the second period, a ‘5 X’ increase. “‘Prehabilitation’, Short acting anaesthetics, Early extubation (< 6 hrs after the end of LT), Early mobilization, Patient-controlled analgesia, technical expertise & improvements in transplant anaesthesia are crucial requirement to achieve success with ERAS. This 20-30% reduction in hospital stay is a huge shift which will help to further reduce the currently high cost of transplants which is the biggest barrier to this life saving procedure” noted South Asian Liver Institute Gastro-Enterologist, Dr Srilekha.

Some Patient’s comments were revealing we had entered the hospital with great fear of this huge operation after years of living with liver related complications, then to go home within 7 days was a pleasant surprise. It had been explained & we had received the new protocols from the SALi team but it still was unbelievable, until we left”, remarked a patient Mrs. Mohini.

Prof Dr Tom Cherian has performed over 700 liver transplants, of which over 400 were carried out in London prior to him moving back to India. He has always been known to be a trail blazer in making liver transplants available to the common man, and performed the first ever liver Transplant in Osmania Hospital, and then again at Nizams Institute of Medical Sciences(NIMS) a year later. Prof Dr Tom Cherian was nominated a 'LEGEND IN LIVER TRANSPLANTATION‘ by Times of India in 2015.

In conclusion, Prof Tom Cherian remarked, “I started South Asian Liver Institute to bring about advances in liver care in India, and I am pleased that it is living up to its ambitions”. South Asian Liver Institute now runs 4 Liver transplant centres and 11 liver centred clinics, in 8 states across the country. Its vision statement reads.. ‘To bring treatment of liver disease in India on par with the best in the world, in quality ethics, skill & knowledge, at a cost that makes such treatment, an option’.