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Speciality

Hepato-Pancreato-Biliary (HPB) Surgery

Dr. Viniyendra Pamecha  
Dr. Viniyendra Pamecha
Professor (Liver Transplant Surgery)
 
Experience

1995 - 1998

Resident

General Surgery

Maharana Bhupal Singh Hospital
RNT Medical College Udaipur

1999 - 2002

Lectures

General Surgery

Lata Mangeshkar Hospital
NKP Medical College, Nagpur

2002 - 2003

Senior Resident

Surgical Gastroenterology

Bhopal Memorial Hospital

2003 - 2005

Clinical Fellow

Liver Transplant and HPB Surgery

Kings College Hospital, London

2005 - 2010

Specialist Registrar

Liver Transplant and HPB Surgery

Royal Free Hospital, London
University College London

2010 - 2012

Associate Professor

Liver Transplant and HPB Surgery

Institute of Liver and Biliary Sciences,
New Delhi

2012 - 2016

Additional Professor

Liver Transplant and HPB Surgery

Institute of Liver and Biliary Sciences,
New Delhi

2016 - Till date

Professor

Liver Transplant and HPB Surgery

Institute of Liver and Biliary Sciences,
New Delhi

Qualification

M.B.B.S 1993 : M .R. Medical College, Gulbarga

M.S 1998 : R.N.T. Medical College, Udaipur

M.R.C.S 2002 : Royal College of Surgeons of Edinburgh, UK

F.E.B.S 2008 : Multi Organ Retrieval - European Board of Surgery

F.E.B.S 2009 : Liver Transplantation - European Board of Surgery

F.E.B.S 2009 : Hepato Biliary and Pancreatic Surgery – European Board of Surgery

FRCS 2010 : Hepato Pancreatico Biliary and Upper GI Surgery – Intercollegiate Speciality Board, UK

Number of publications
> 120
Awards

Major Achievements

  • Over 25 years of clinical, academic, research and teaching experience. Established the Department of Liver Transplant and Hepato Pancreato Biliary Surgery at ILBS – the only public sector hospital in India with successful liver transplant program both live and cadaveric for adults and children with results at par with best in the world. Experience of more than 1500 liver transplants, 1200 liver resections, and 400 pancreatic resections.
  • Over the last 14 years under his leadership, program has grown from strength to strength and reached 1000 liver transplants at ILBS in 2023. We are performing nearly 100 liver transplants every year for past many years. ILBS is now among very few centers in the world performing a high number LDLT with excellent results. Nearly 15% of these have been in emergency situations, which are highly challenging and a rarity in any transplant program. Outstanding results of live donor liver surgery, among the best in the world. 
  • Started the deceased donor liver transplant program at ILBS, and has now performed the highest number of diseased donor liver transplants in North India, with world class results. Started the trend of interstate organ transportation. We have managed to bring livers from distant cities such as Jaipur, Lucknow, Indore, Chandigarh, Patna, and Kolkata - a first for a public sector hospital in India.
  • Expert member of Apex committee in National Organ and Tissue Organization (NOTTO), providing valuable inputs in establishment of national registry, Organ allocation and framework for various guidelines. Actively involved in promoting organ donation through various government and non-government organization.
  • Started pediatric liver transplant program, a first for a public sector hospital and has now performed more than 140 such operations. Majority of the children were underprivileged, suffering from acute liver failures needing emergency transplantation. Started ABO incompatible, swap and domino liver transplant at ILBS - a first for a public sector hospital.
  • Under his leadership, department has become high volume center for non-transplant hepato- pancreato- biliary surgery. In a short duration, ILBS have now become one of the leading referral center for Complex HPB surgery and have one of the largest experience liver resection for hepatocellular carcinoma, hilar cholangiocarcinoma, pancreatic and gallbladder cancer surgery in the country with outcomes at par with best in the world. ILBS is also now a top referral center for complex bile duct injuries as well.
  • Instrumental in Starting MCI recognized MCh course in Liver Transplant and HPB surgery - a first in the Country. In a very short duration, the MCh course has become one of the most sought after among the NEET-SS aspirants and top rankers are opting for training at ILBS. The number of seats have tripled in the last 10years under his leadership.
  • Started liver transplantation at Sawai Man Singh Medical College, Jaipur and AIIMS Jodhpura first for any government medical institute in second tier city. Trained transplant teams from prominent institutes such as SMS Jaipur, SGPGI Lucknow, JIPMER Pondicherry, IGIMS Patna, KGMC Lucknow, RML New Delhi, AIIMS Jodhpur and Bhubaneswar.
  • Gained experience at world renowned Liver Unit of King's College Hospital London (2003-2005) and Sheila Sherlock Liver Centre, Royal Free Hospital London (2005-2010). Awarded Fellowships in Multi Organ Retrieval, Liver Transplantation & Hepato Pancreatico Biliary Surgery by the European Board of Surgery. Recipient of the prestigious Fellowship of the Royal College of Surgeons of UK (FRCS).
  • Published more than 120 indexed papers and authored four book chapters and more than 500 abstracts. Innovative and influential scientific work in the field of live donor liver transplantation, liver resection surgery, liver regeneration and liver cancer; which has been published in leading journals. Have keen interest in evidence based medicine and have performed many RCTs, a challenging thing to do in surgery especially in transplant surgery. Actively involved in basic and molecular research.
  • Awarded by National Organ and Tissue Transplantation, Ministry of Health and Family Welfare for Exemplary performance in Organ Transplantation
Publications

Innovative and Influential Scientific Work  

Randomize Control Trials

Graft Inflow Modulation by Splenic Artery Ligation for Portal Hyper Perfusion does not Decrease Rates of Early Allograft Dysfunction in Adult Live Donor Liver Transplantation: A Randomized Control Trial.

Pamecha V, Tharun G, Patil N, Mohapatra N, Kumar A, Thapar S, Sindwani G, Dhingra U, Yadav A. Annals of Surgery. 2024. June

This is a landmark trial on controversial issue of portal hyper-perfusion in LDLT. Portal hyper-perfusion is thought to be main trigger for development of EAD and SFSS, which is associated with high morbidity and mortality following LDLT. Theoretically, graft portal inflow modulation (GIM) can prevent development of EAD and SFSS. However, current literature shows evidence both in favor and against performing GIM for portal hyper-perfusion. This study is a first randomized trial of GIM by splenic artery ligation (SAL) in LDLT. The trial results showed no benefit of performing GIM with SAL in LDLT on EAD and SFSS. The trial results opens up the discussion on our basic understanding of the concept of portal hyper-perfusion in LDLT and to look beyond the portal hyper-perfusion to improve outcomes in LDLT.

 

Temporary porto -caval shunt provides superior intraoperative hemodynamics and reduces blood loss and duration of surgery in live donor liver transplantation: A randomized control trial

Yl MK, Patil NS, Mohapatra N, Sindwani G, Dhingra U, Yadav A, Kale P, Pamecha V.Annals of Surgery. 2024 Jan

Blood loss during recipient hepatecomy remains a major concern. This is a unique and first trial to show benefit of routine use of temporary porta caval shunt (TPCS) during LDLT. TPCS significantly improved intraoperative hemodynamics in an-hepatic phase as compared to no-TPCS group, requiring significantly less vasopressor support. This led to significantly better renal function as evidenced by higher intraoperative urine output in TPCS group. Because of technical simplicity, TPCS group had significantly fewer IVC injuries and substantially shorter hepatectomy time and total duration of surgery. Early graft dysfunction was twofold lower and tolerance to enteral feed was earlier in the TPCS group.

 

Lifestyle Optimization Leads to Superior Liver Regeneration in Live Liver Donors and Decreases Early Allograft Dysfunction in Recipients: A Randomized Control Trial.

Gupta A, Patil NS, Mohapatra N, Benjamin J, Thapar S, Kumar A, Rastogi A, Pamecha V. Annals of Surgery. 2023 Sep 

This is first and unique trial to assess the efficacy of donor lifestyle optimization on liver regeneration and outcome following live donor liver transplantation. Live liver donors (LLDs) who were fit with no or minimal steatosis were randomized to receive either a customized low-calorie diet with calorie intake equaling their basal requirement along with exercise for 2 weeks before surgery versus to continue their normal routine lifestyle. The results showed that lifestyle optimization of LLD is simple to comply with, improves liver regeneration in LLDs, and decreases EGD in recipients, thus can enhance donor safety and outcomes in live donor liver transplantation. This trial has far reaching impact not only in LDLT but it is also a proof of concept that lifestyle optimization can improve liver health. 

 

Randomized control trial on perioperative antibiotic prophylaxis in live liver donors: Are three doses enough?

Gupta S, Sinha PK, Patil NS, Mohapatra N, Sindwani G, Garg N, Khillan V, Pamecha V.  J Hepatobiliary Pancreatic Sciences. 2021 Oct 

First RCT on the duration of perioperative antibiotic prophylaxis following live liver donor hepatectomy (LDH). This is a double-blind equivalence trial. The results sowed three doses of perioperative antibiotic are equally effective in preventing infective complications and thus reduces antibiotic resistance and decrease the cost after donor hepatectomy.

 

Early drain removal after live liver donor hepatectomy is safe - a randomized controlled pilot study.

Durairaj P, Pamecha V, Mohapatra N, Patil NS, Sindwani G. Langenbecks Arch Surg. 2023 Sep

This is first trial aimed to assess the safety of early drain removal (EDR) after live donor hepatectomy (LDH). The trial outcomes showed that EDR by the "3 × 3" rule after LDH is safe and associated with better pain relief. On per-treatment analysis, EDR was associated with significantly less hospital stay and lower pulmonary and overall complications.

 

Antegrade Arterial and Portal Flushing Versus Portal Flushing Only for Right Lobe Live Donor Liver Transplantation - A Randomized Control Trial.

Pamecha V, Sandhyav R, Sinha PK, Bharathy KGS, Sasturkar S. Transplantation. 2018 Apr

Early allograft dysfunction following LDLT is multi-factorial. This is a unique RCT and the first study show the impact of antegrade arterial perfusion on live donor liver graft. Graft function improved significantly with antegrade arterial perfusion on bench. This concept can contribute in improving the outcome of patients undergoing LDLT.

 

Efficacy of rectal indomethacin in prevention of post-operative hyperamylasemia following pancreatoduodenectomy: a randomized controlled trial.

Kumar AH, Pamecha V, Patil NS, Mohapatra N, Kilambi R, Sinha PK. Langenbecks Arch Surg. 2023 Dec

Post-operative hyperamylasemia (POH) following pancreatoduodenectomy (PD) may play a key role in pathogenesis of post-operative pancreatic fistula (POPF). Aim of the current study was to evaluate efficacy of perioperative administration of indomethacin in preventing POH. Single-center, double-blind, randomized controlled trial (RCT) conducted on consecutive patients undergoing PD. Primary endpoint was incidence of POH in the two arms. POH was noted in 20/44 (45.5%) with significantly lower incidence of POH (60.9% vs. 28.6%, p = 0.032) in intervention arm (IA). The severity of delayed gastric emptying (DGE) was significantly lower in the IA (grade B/C DGE 23.8% vs. 47.8%, p = 0.023). Evaluation of risk factors for POH showed IA to confer an independent protective effect. Perioperative per-rectal indomethacin administration is effective in decreasing the incidence of POH following PD.

 

Innovative Surgical Techniques

Hepatic artery-related complications after live donor liver transplantation.

Pamecha V, Sinha PK, Mukund A, Patil NS, Mohapatra N, Thapar S, Choudhury A, Sindwani G, Kumar AH, Gupta S. Langenbecks Arch Surg. 2023 Jan 13;408(1):24.

Hepatic artery-related complications (HARC) after live donor liver transplantation (LDLT) is associated with high morbidity and mortality rate. A simple innovative technique of hepatic arterial reconstruction which was developed over the time was described and analyzed. Prospectively maintained data from July 2011 to September 2020 was analyzed for etiology, detection, management, and outcome of HARC. The results showed that clock wise suturing technique, early detection, and revascularization can achieve good outcome in patients with HARC after LDLT. The graft and patient salvage rate following HARC was high as compared to published literature.

 

Biliary Reconstruction in Adult Living Donor Liver Transplantation: The All-Knots-Outside Technique.

Pamecha V, Sasturkar SV, Sinha PK, Mohapatra N, Patil N. Liver Transplantation. 2021 Apr;27(4):525-535. doi: 10.1002/lt.25862.

Biliary complications (BCs) following living donor liver transplantation (LDLT) can lead to significant morbidity and occasional mortality. The present study describes our innovative experience of the all-knots-outside technique (AKOT) of biliary reconstruction (BR) and its impact on BCs. The incidence of BCs decreased significantly from 20% to 6%. This paper also highlighted that in adult LDLT, with standardization of the donor and recipient surgery, preferential use of LHA for right lobe arterial reconstruction, reduction in the number of anastomoses, and AKOT for BR significantly decreased the incidence of BCs.

 

Single Orifice Outflow Reconstruction: Refining the Venous Outflow in Modified Right Lobe Live Donor Liver Transplantation.

Pamecha V, Pattnaik B, Sinha PK, Patil NS, Mohapatra N, Sasturkar SV, Sundararajan VB, Thapar S, Sindwani G, Arora MK. J Gastrointestinal Surgery. 2021 Aug;25(8):1962-1972. doi: 10.1007/s11605-020-04776-3.

MHV reconstruction is essential to avoid anterior sector congestion in adult LDLT using a modified right lobe graft. The objective of this study is to evaluate the graft and patient outcomes with single orifice outflow reconstruction technique (SORT) (RHV + neo-MHV combined reconstruction on IVC) vs. dual outflow reconstruction technique (DORT) (RHV and neo-MHV separately reconstructed on IVC) in a modified right lobe LDLT. Prospectively collected data of consecutive patients undergoing LDLT from June 2011 to August 2018 were analyzed. The patients were divided into two groups: SORT (n = 207) and DORT (n = 108). SORT leads to improved early graft function and perioperative morbidity in modified right lobe LDLT in spite of having lower GRWR and higher portal flow.

 

Biliary complications after living donor hepatectomy: A first report from India.

Pamecha V, Bharathy KG, Kumar S, Sasturkar SV, Sinha PK. Liver Transplantation. 2016 May; 22(5): 607-14. doi: 10.1002/lt.24374

Biliary complications are a major cause of live donor morbidity and rarely, mortality. This paper describes the technique for safe donor hepatectomy with special reference to the prevention of biliary complications. Overall biliary complications were 2% with only 0.6% grade III biliary complications. These results are among the best in world literature.

 

Explant portal vein for reconstructing middle hepatic vein in right lobe living donor liver transplantation - outcome analysis.

Borle DP, Pamecha V, Bharathy KGS, Sasturkar SV, Sinha PK, Patidar Y, Sureka B, Thapar Laroia S. HPB (Oxford). 2018 Dec;20(12):1137-1144. doi: 10.1016/j.hpb.2018.05.008. 

Reconstruction of middle hepatic vein is a very important step in LDLT. This study showed explant portal vein which is easily available, cost effective and can be effectively used for reconstruction of Neo MHV with excellent patency rates.

 

Liver transplantation for Acute Liver Failure

Living Donor Liver Transplantation for Acute Liver Failure: Donor Safety and Recipient Outcome.

Pamecha V, Vagadiya A, Sinha PK, Sandhyav R, Parthasarathy K, Sasturkar S, Mohapatra N, Choudhury A, Maiwal R, Khanna R, Alam S, Pandey CK, Sarin SK. Liver Transplantation. 2019 Sep;25(9):1408-1421. doi: 10.1002/lt.25445.

First of its kind study, sharing experience of one of the largest single center experience of LDLT for ALF. Our experience showed emergency LDLT is lifesaving in select patients with ALF. Outcomes of emergency living liver donation were comparable to that of elective donors. Postoperative worsening of CE, preoperative SIRS, and sepsis predicted outcome after LDLT for ALF. This paper invited an editorial commentary.

Live donor liver transplantation for pediatric acute liver failure: challenges and outcomes.

Pamecha V, Patil NS, Falari S, Mohapatra N, Kumar AH, Sindwani G, Garg N, Alam S, Khanna R, Sood V, Lal BB. Hepatology International. 2023 Aug 16. doi: 10.1007/s12072-023-10571-4.

This is largest single center experience of emergency LDLT for ALF in pediatric patients. A total of 315 patients with PALF were treated over a period of 11 years. 42 underwent LT (41 LDLT and one DDLT), constituting 38% (41/110) of all pediatric transplants during this duration. 75.6% (n = 31) were on mechanical ventilation, 50% had cerebral odema and One-third required hemodynamic support. SIRS and sepsis were observed in 46.3% and 41.4%. Post-LDLT 1- and 5-yr patient and graft survival were 75.6% and 70.9%, respectively. The survival in children did not undergo LT was 24%. . LDLT for PALF is lifesaving and provides a unique opportunity to time transplantation. Good long-term survival can be achieved, despite the majority of patients presenting late for transplantation. Early referral and better selection can save more lives through timely transplantation.

 

Acute on Chronic Liver Failure

Liver transplantation in acute on chronic liver failure: challenges and an algorithm for patient selection and management.

Pamecha V, Kumar S, Bharathy KG. Hepatology International. 2015 Oct; 9(4): 534-42. doi: 10.1007/s12072-015-9646-9.

ACLF is associated with very high short term mortality and the timing of liver transplant is most important to change the natural history of disease. This was one of the first papers to describe natural history in the context of selection and timing of liver transplant in ACLF. A concept diagram was proposed on natural history and management algorithm based on the clinical condition of the patient.

 

'First week' is the crucial period for deciding living donor liver transplantation in patients with acute-on-chronic liver failure.

Choudhury A, Vijayaraghavan R, Maiwall R, Kumar M, Duan Z, Yu C, Hamid SS, Jafri W, Butt AS, Devarbhavi H, Ning Q, Ma K, Tan SS, Shukla A, Dhiman R, Duseja A, Taneja S, Eapen CE, Goel A, Treeprasertsuk S, Al-Mahtab M, Ghazinyan H, Kim DJ, Sahu MK, Lee GH, Lesmana LA, Lesmana RC, Shah S, Abbas Z, Sollano JD, Rao PN, Kulkarni A, Shiha G, Shrestha A, Dokmeci A, Yuen MF, Payawal DA, Kalista KF, Prasad VGM, Lau GK, Karim F, Jain P, Kumar G, Arora V, Pamecha V, Sinha P, Sarin SK; APASL ACLF Research Consortium (AARC) for APASL ACLF Working Party.Hepatol Int. 2021 Dec;15(6):1376-1388. doi: 10.1007/s12072-021-10206-6. Epub 2021 Oct 4.PMID: 34608586

 

Liver failure determines the outcome in patients of acute-on-chronic liver failure (ACLF): comparison of APASL ACLF research consortium (AARC) and CLIF-SOFA models.

Choudhury A, Jindal A, Maiwall R, Sharma MK, Sharma BC, Pamecha V, Mahtab M, Rahman S, Chawla YK, Taneja S, Tan SS, Devarbhavi H, Duan Z, Yu C, Ning Q, Jia JD, Amarapurkar D, Eapen CE, Goel A, Hamid SS, Butt AS, Jafri W, Kim DJ, Ghazinian H, Lee GH, Sood A, Lesmana LA, Abbas Z, Shiha G, Payawal DA, Dokmeci AK, Sollano JD, Carpio G, Lau GK, Karim F, Rao PN, Moreau R, Jain P, Bhatia P, Kumar G, Sarin SK; APASL ACLF Working Party.Hepatol Int. 2017 Sep;11(5):461-471. doi: 10.1007/s12072-017-9816-z. Epub 2017 Aug 30.PMID: 28856540

 

Systemic inflammatory response syndrome in acute-on-chronic liver failure: Relevance of 'golden window': A prospective study.

Choudhury A, Kumar M, Sharma BC, Maiwall R, Pamecha V, Moreau R, Chawla YK, Duseja A, Mahtab M, Rahman S, Hamid SS, Butt AS, Jafri W, Tan SS, Devarbhavi H, Amarapurkar D, Ning Q, Eapen CE, Goel A, Kim DJ, Ghazinyan H, Shiha G, Lee GH, Abbas Z, Payawal DA, Dokmeci AK, Yuen MF, Lesmana LA, Sood A, Chan A, Lau GK, Jia JD, Duan Z, Yu C, Yokosuka O, Jain P, Bhadoria AS, Kumar G, Sarin SK; APASL ACLF working party.J Gastroenterol Hepatol. 2017 Dec;32(12):1989-1997. doi: 10.1111/jgh.13799.

 

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014.

Sarin SK, Kedarisetty CK, Abbas Z, Amarapurkar D, Bihari C, Chan AC, Chawla YK, Dokmeci AK, Garg H, Ghazinyan H, Hamid S, Kim DJ, Komolmit P, Lata S, Lee GH, Lesmana LA, Mahtab M, Maiwall R, Moreau R, Ning Q, Pamecha V, Payawal DA, Rastogi A, Rahman S, Rela M, Saraya A, Samuel D, Saraswat V, Shah S, Shiha G, Sharma BC, Sharma MK, Sharma K, Butt AS, Tan SS, Vashishtha C, Wani ZA, Yuen MF, Yokosuka O; APASL ACLF Working Party.Hepatol Int. 2014 Oct;8(4):453-71. doi: 10.1007/s12072-014-9580-2. Epub 2014 Sep 26.PMID: 2620275

 

Liver Regeneration

Serial changes of cytokines and growth factors in peripheral circulation after right lobe donor hepatectomy.

Sasturkar SV, David P, Sharma S, Sarin SK, Trehanpati N, Pamecha V Liver Transplantation 2016 Mar; 22(3): 344 doi: 10.1002/lt.24373.  

Although there is immense literature about liver regeneration in animals, very little is known in healthy normal humans. This was a first study in humans to evaluate various clinical factors and biomarkers involved in liver regeneration in healthy donors. Study described various biological markers (HGF, IL-6, TNF-α, TPO, TGF-β1, IFNγ, IFN α) involved in upregulation and downregulation of liver regeneration in healthy donors undergoing right lobe donor hepatectomy.

 

Preoperative Alanine Aminotransferase and Remnant Liver Volume Predict Liver Regeneration After Live Donor Hepatectomy.

Mohapatra N, Sinha PK, Sasturkar SV, Patidar Y, Pamecha V. J Gastrointest Surg. 2019 Aug 6. doi: 10.1007/s11605-019-04332-8.

Regeneration of the remnant liver in early postoperative period determines the outcome in live liver donors (LLDs). This study showed liver regenerates rapidly in LLDs following hepatectomy. Low RLV, RLVBWR, and preoperative ALT levels were predictors of liver regeneration in the first week following donor hepatectomy. 

 

Improving outcomes in live donor liver transplantation 

e-GLR Score Predicts Early Graft Loss in Adult Live-Donor Liver Transplantation.

Pamecha V, Patil NS, Gattu T, Kumar G, Pattnaik B, Mohapatra N, Sindwani G, Choudhury A. Ann Surg Open. 2023 Oct 9;4(4):e332. doi: 10.1097/AS9.0000000000000332.

This study aimed to analyze risk factors and develop a predictive model for early allograft loss due to early graft dysfunction (EGD) in adult live-donor liver transplantation (LDLT). Data of patients who underwent LDLT from 2011 to 2019 were reviewed for EGD, associated factors, and outcomes. A homogeneous group of 387 patients was analyzed: random cohort A (n = 274) for primary analysis and random cohort B (n = 113) for validation. Of 274 recipients, 92 (33.6%) developed EGD. The risk of graft loss within 90 days was 29.3% and 7.1% in those with and without EGD, respectively (P < 0.001). Multivariate logistic regression analysis determined donor age (P = 0.045), estimated (e) graft weight (P = 0.001), and the model for end-stage liver disease (MELD) score (0.001) as independent predictors of early graft loss due to EGD. Regression coefficients of these factors were employed to formulate the risk model: Predicted (P) early graft loss risk (e-GLR) score = 10 × [(donor age × 0.052) + (e-Graft weight × 1.681) + (MELD × 0.145)] - 8.606 (e-Graft weight = 0, if e-Graft weight ≥640 g and e-Graft weight = 1, and if e-Graft weight < 640 g). Internal cross-validation revealed a high predictive value (C-statistic = 0.858). Conclusions: Our novel risk score can efficiently predict early allograft loss following graft dysfunction, which enables donor-recipient matching, evaluation, and prognostication simply and reliably in adult LDLT.

 

Early Allograft Dysfunction After Live Donor Liver Transplantation: It's Time to Redefine?

Pamecha V, Pattnaik B, Sinha PK, Patil NS, Sasturkar SV, Mohapatra N, Kumar G, Choudhury A, Sarin SK. J Clin Exp Hepatol. 2022 Jan-Feb;12(1):101-109. doi: 10.1016/j.jceh.2021.03.007. Epub 2021 Mar 30.PMID: 35068790

An ideal definition of early allograft dysfunction (EAD) after live donor liver transplantation (LDLT) remains elusive. The aim of the present study was to compare the diagnostic accuracies of existing EAD definitions, identify the predictors of early graft loss due to EAD, and formulate a new definition, estimating EAD-related mortality in LDLT recipients. The new model of EAD-LDLT, based on total bilirubin >10 mg/dL, INR >1.6 and serum urea >100 mg/dL, for five consecutive days after day 7, has a better predictive value for mortality due to EAD in LDLT recipients.

 

A Long-Term Prospective Study of Quality of Life, Abdominal Symptoms, and Cosmesis of Donors After Hepatectomy for Live-Donor Liver Transplantation.

Sinha PK, Mohapatra N, Bharathy KG, Kumar G, Pamecha V. J Clin Exp Hepatol. 2021 Sep-Oct;11(5):579-585. doi: 10.1016/j.jceh.2020.11.005. Epub 2020 Dec 7.PMID: 34511819

First of its kind study from India for comprehensive assessment of quality of life of live liver donors.  Assessment of all aspects of liver donation over a long period was done to have complete understanding of the donation process. The results showed that donors whose recipients died were less likely to continue with the study. After surgery, physical domain took 2 years to reach to predonation level while psychological and social relationship domains took 3 months and 1 month, respectively; environmental domain remained stable throughout. There was significant weight gain in donors. Donors understood the consent process well, but did not use it for decision making. Overall, they showed a high level of satisfaction in the donation process.

Sarcopenia in Cirrhosis: Fallout on Liver Transplantation.

Kumar V, Benjamin J, Shasthry V, Subramanya Bharathy KG, Sinha PK, Kumar G, Pamecha V. J Clin Exp Hepatol. 2020 Sep-Oct;10(5):467-476. doi: 10.1016/j.jceh.2019.12.003. Epub 2019 Dec 31.PMID: 33029056

Liver transplantation (LT) is a game changer in cirrhosis. Poor muscle mass defined as sarcopenia may potentially upset the LT scoreboard. To assess the prevalence and impact of sarcopenia on the intraoperative and early postoperative outcomes in Indian patients undergoing LT. Almost 50% of LT recipients had sarcopenia, who had a higher incidence of postoperative sepsis, neurological complications, longer ICU stay and ventilatory support. Low SMI, ACLF presentation, and intraoperative blood loss were the independent predictors of early mortality.

 

Incidence and predictors of alcohol relapse following living donor liver transplantation for alcohol related liver disease.

Falari SS, Mohapatra N, Patil NS, Pattnaik B, Varshney M, Choudhury A, Sarin SK, Pamecha V. J Hepatobiliary Pancreat Sci. 2023 Aug;30(8):1015-1024. doi: 10.1002/jhbp.1325. Epub 2023 Mar 15.PMID: 36866490

Alcohol relapse after liver transplantation has a negative impact on outcomes. There is limited data on its burden, the predictors, and impact following live donor liver transplantation (LDLT). A single-center observational study was carried out between July 2011 and March 2021 for patients undergoing LDLT for alcohol associated liver disease (ALD). The incidence, predictors of alcohol relapse, and post-transplant outcomes were assessed. Our results show that the overall incidence of relapse and rate of harmful drinking following LDLT is low. Donation from spouse and first degree relative was protective. History of daily intake, prior relapse, shorter pretransplant abstinence duration and lack of family support significantly predicted relapse.

 

Selection and outcome of the potential live liver donor.

Pamecha V, Mahansaria SS, Bharathy KG, Kumar S, Sasturkar SV, Sinha PK, Sarin SK Hepatololgy International 2016 Jul; 10(4): 657-64. doi: 10.1007/s12072-016-9715-8.

In LDLT donor safety is paramount. This was the first of its kind study from India to describe the selection, surgical technique and outcomes of LDLT donors. Large sample showed outcomes with commendable results and extremely low complication rates. There was no donor mortality. The results were at par with the best mentioned in the literature. 

 

Expanding donor pool for live donor liver transplantation: utilization of donors with non-alcoholic steatohepatitis after optimization.

Pamecha V, Patil NS, Parthasarathy K, Sinha PK, Mohapatra N, Rastogi A, Rudrakumar K, Mukund A, Chaudhary A, Kanal U. Langenbecks Arch Surg. 2022 Jun;407(4):1575-1584. doi: 10.1007/s00423-022-02444-5. Epub 2022 Mar 4.PMID: 3524353

 

Association of thrombocytopenia with outcome following adult live donor liver transplantation.

Pamecha V, Mahansaria SS, Kumar S, Bharathy KG, Sasturkar SV, Sinha PK, Kumar N Transplant International 2016 Oct; 29(10): 1126-35. doi: 10.1111/tri.12819

Platelets play an integral role in liver regeneration. This is the first study to evaluate the association of thrombocytopenia with outcome following an adult LDLT. Results showed postoperative PLT of <30 × 10(9)/l was a strong predictor of major postoperative complications, early graft dysfunction and perioperative mortality. This unique new information can be used to prognosticate patients post-transplant with respect to high risk of infection and can help modulate immunosuppression.

 

Functional hepatic venous outflow and its correlation with early graft function in live donor liver transplantation

V Pamecha, Appukuttan M, S Kumar, KGS Bharathy, SV Sasturkar, PK Sinha, SK Sarin Journal of Clinical and Experimental Transplantation 2019

Outflow obstruction is a major cause of graft dysfunction in LDLT. This paper described a new concept showing functional obstruction because of high caval pressure can cause outflow obstruction which can be prevented by taking simple measures to decrease high caval pressure.

 

"No go" donor hepatectomy in living-donor liver transplantation.

Pamecha V, Bharathy KGS, Mahansaria SS, Sinha PK, Rastogi A, Sasturkar SV. Hepatol Int. 2018 Jan;12(1):67-74. doi: 10.1007/s12072-017-9832-z.

Three-Dimensional Volumetric Assessment of Graft Volume in Living Donor Liver Transplantation: Does It Minimise Errors of Estimation?

Mohapatra N, Gurumoorthy Subramanya Bharathy K, Kumar Sinha P, Vasantrao Sasturkar S, Patidar Y, Pamecha V.J Clin Exp Hepatol. 2020 Jan-Feb;10(1):1-8. doi: 10.1016/j.jceh.2019.03.006. Epub 2019 Mar 26.PMID: 32025161 

In spite of all the evaluation, sometimes intraoperative surprises are found during live donor surgery. This paper highlighted the problems faced and made unique a contribution to literature on live donor selection and safety.

 

Hepato Pancreato Biliary Cancers

Upfront pancreaticoduodenectomy in severely jaundiced patients: is it safe?

Pamecha V, Sadashiv Patil N, Kumar S, Rajendran V, Gupta S, Vasantrao Sasturkar S, Kumar Sinha P, Arora A, Agarwal N, Baghmar S. J Hepatobiliary Pancreat Sci. 2019 Nov;26(11):524-533. doi: 10.1002/jhbp.671. 

Usually severely jaundiced (serum bilirubin level ≥15 mg/dl) patients with malignant distal common bile duct (CBD) obstruction are not offered upfront Surgery. Analysis of our experience showed upfront PD can be performed safely in the selected severely jaundiced patients and is associated with significantly lower infective complications.

 

Major Liver Resection for Large and Locally Advanced Hepatocellular Carcinoma.

Pamecha V, Sasturkar SV, Sinha PK, Mahansaria SS, Bharathy KGS, Kumar S, Rastogi A. Indian J Surgery 2017 Aug; 79(4): 326-331. doi: 10.1007/s12262-016-1545 

This is the first study from India to describe selection of patients with large and locally advanced HCC for resection. As per international guidelines, most of these patients will be offered palliative treatment but the study showed that in selected patients excellent results can be achieved by performing surgical resection.

 

Bile multi-omics analysis classifies lipid species and microbial peptides predictive of carcinoma of gallbladder.

Sharma N, Yadav M, Tripathi G, Mathew B, Bindal V, Falari S, Pamecha V, Maras JS. Hepatology. 2022 Oct;76(4):920-935. doi: 10.1002/hep.32496. Epub 2022 May 16.PMID: 35357716

 

Prognostic Factors and the Role of Adjuvant Treatment in Periampullary Carcinoma: a Single-Centre Experience of 95 Patients.

Baghmar S, Agrawal N, Kumar G, Bihari C, Patidar Y, Kumar S, Chattopadhyay TK, Panda D, Arora A, Pamecha V. J Gastrointest Cancer. 2019 Sep;50(3):361-369. doi: 10.1007/s12029-018-0058-7

 

Improving outcomes following liver resection - Portal Vein Embolization / Two stage hepatectomy / Tumor growth

The below body of work on portal vein embolization was a unique contribution to the literature. The studies evaluated the role of portal vein embolization to increase the future liver remnant, resectability and safety of major liver resection. These were first few studies in the literature at that time showing long term results. The effect of PVE on tumor growth was evaluated – a first in the literature. The increase in tumor growth rate after PVE can be detrimental and recommendations were made to prevent this.

 

Portal vein embolization prior to extensive resection for colorectal liver metastases.

Pamecha V, Davidson B.Ann Surg Oncol. 2009 Nov; 16(11): 3214.

 

Effect of portal vein embolisation on the growth rate of colorectal liver metastases.

Pamecha V, Levene A, Grillo F, Woodward N, Dhillon A, Davidson BR. British Journal of Cancer. 2009 Feb 24; 100(4): 617-22.

Long-term survival and disease recurrence following portal vein embolisation prior to major hepatectomy for colorectal metastases.

Pamecha V, Glantzounis G, Davies N, Fusai G, Sharma D, Davidson B. Ann Surg Oncol. 2009 May; 16(5): 1202-7.

Prospective evaluation of two-stage hepatectomy combined with selective portal vein embolisation and systemic chemotherapy for patients with unresectable bilobar colorectal liver metastases.

Pamecha V, Nedjat-Shokouhi B, Gurusamy K, Davidson BR. Digestive Surgery. 2008; 25(5): 387-93.

 

Vocal for Local

Deceased donor liver transplant: Experience from a public sector hospital in India.

Pamecha V, Borle DP, Kumar S, Bharathy KGS, Sinha PK, Sasturkar SV, Sharma V, Pandey CK, Sarin SK. Indian J Gastroenterol. 2018 Jan;37(1):18-24. doi: 10.1007/s12664-017-0801-1.

DDLT is uncommon in North India especially in public hospitals. A first study from India to report experience of DDLT from public sector hospital. The results were comparable to best international centers. The study also highlighted the logistic problems faced to establish DDLT program in India.

 

Living donor liver transplantation for hepatocellular carcinoma in Indian patients- Is the scenario different?

Pamecha V, Sinha PK, Rajendran V, Patil NS, Mohapatra N, Rastogi A, Patidar Y, Choudhury A. Indian J Gastroenterol. 2021 Jun;40(3):295-302. doi: 10.1007/s12664-020-01138-4.

First of its kind study from India. Living donor liver transplant (LDLT) for hepatocellular carcinoma (HCC) has been controversial in terms of selection and outcome. Our experience of LDLT for HCC in Indian patients was analysed. The results showed, patients with HCC in India present late for liver transplant. Most patients have some form of decompensation before they undergo LT. In selected patients, overall survival was comparable with other indications for LDLT with acceptable recurrence rates. RETREAT score was best to predict recurrence.

 

Systemic Reviews and Meta-Analysis

Veno-venous bypass versus none for liver transplantation.

Gurusamy KS, Koti R, Pamecha V, Davidson BR.Cochrane Database Syst Rev. 2011 Mar 16;(3):CD007712. doi: 10.1002/14651858.CD007712.pub2.PMID: 21412907

 

Piggy-back graft for liver transplantation.

Gurusamy KS, Pamecha V, Davidson BR.Cochrane Database Syst Rev. 2011 Jan 19;(1):CD008258. doi: 10.1002/14651858.CD008258.pub2.PMID: 21249703

 

Techniques for liver parenchymal transection: a meta-analysis of randomized controlled trials.

Pamecha V, Gurusamy KS, Sharma D, Davidson BR.HPB (Oxford). 2009 Jun;11(4):275-81. doi: 10.1111/j.1477-2574.2009.00057.x.PMID: 19718353

 

Ischaemic pre-conditioning for elective liver resections performed under vascular occlusion.

Gurusamy KS, Kumar Y, Pamecha V, Sharma D, Davidson BR.Cochrane Database Syst Rev. 2009 Jan 21;(1):CD007629. doi: 10.1002/14651858.CD007629.PMID: 19160339

 

Palliative cytoreductive surgery versus other palliative treatments in patients with unresectable liver metastases from gastro-entero-pancreatic neuroendocrine tumours.

Gurusamy KS, Pamecha V, Sharma D, Davidson BR.Cochrane Database Syst Rev. 2009 Jan 21;2009(1):CD007118. doi: 10.1002/14651858.CD007118.pub2.PMID: 1916032

 

Techniques for liver parenchymal transection: a meta-analysis of randomized controlled trials.

Pamecha V, Gurusamy KS, Sharma D, Davidson BR. HPB (Oxford). 2009 Jun; 11(4): 275-81.

 

This study, which has been widely cited, evaluated various techniques of liver parenchymal transection described in the literature. It showed that expansive gadgets do not decrease the complication rates in comparison to precise old fashioned surgical transection.

 

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