The only centre under GNCTD performing Liver and Kidney transplants.

Speciality

Hepatology

Dr Rakhi Maiwall  
Dr Rakhi Maiwall
Additional Professor
 
Experience

Dr Rakhi Maiwall has completed her MBBS in 2003 with 3 gold medals and finished her MD Internal Medicine from Lucknow University in 2007 with gold medal. She has done her DM in Gastroenterology from Christian Medical College, Vellore in 2011. She is hard working, efficient and compassionate in patient care. She has the capability and skills of performing both upper and lower GI diagnostic and therapeutic procedures with an exposure to ERCPs. She also has experience in hepatic hemodynamics Hepatic Venous Pressure Gradient measurement and transjugular liver biopsies under supervision. She is presently working for ILBS-ECHO project of telemedicine for training general physicians in rural and semi-urban areas of India in the management chronic liver related disorders particularly Hepatitis C and B virus related and leading the department of telemedicine at ILBS. She is having special interest in renal disease and electrolyte abnormalities in patients with chronic liver disease, iron and liver, liver regeneration and artificial liver support therapies.

  • Principal Investigator of two multicentric trials

  • Member of the editorial board of Hepatology International Journal

  • Received first prize for plenary paper at ISGCON 2014,Mumbai “ Development and utility of PIRO model for prediction of kidney failure in patients with ACLF: A multinational cohort study from the aarc database

  • Received runner up award in “Hepatology 360-2015” on clinical research on “AKI in patients with ACLF is different from Acute decompensation of cirrhosis”

 

 Working Experience

  • Worked as senior resident on regular basis in the department of Gastroeneterology, G B Pant Hospital, New Delhi from June, 2007 to October, 2007
  • Worked as an observer in the Department of Pediatric Gastroenterology, SGPGIMS, Lucknow, UP.
  • Currently working as Assistant Professor of  Hepatology in the Institute of Liver and Biliary Sciences, New Delhi since 5th, sep 2011.

PROCEDURAL SKILLS:

  • Upper and lower GI diagnostic and therapeutic procedures
  • Diagnostic and therapeutic ERCP’s
  • Small bowel enteroscopies
  • Hepatic hemodynamics (Hepatic Venous Pressure Gradient measurement)
  • Transjugular Liver biopsies
Qualification

DM-GASTROENTEROLOGY : 2011-Christian Medical College, Vellore

MD-MEDICINE : 2007-King George’s Medical University, Lucknow, U.P.

MBBS : 2003-GSVM Medical College, Kanpur, U.P.

Number of publications
56
Awards

Awards/ Membership (2018):

Member of European Association of Study of Liver (EASL)

Member of American  Association for study of Liver disease (AASLD)

Member of Asian Pacific Association for study of Liver (APASL)

Member of European Society of Critical and Intensive Care Medicine (ESCIM)

Member of Indian Society of Study of Liver (INASL)

• Plenary award at ISGCON 2016 on paper entitled "Cystatin C predicts Acute Kidney Injury and Mortality in Cirrhotics"

  • Passed MBBS with three gold medals
  • Gold medal in Biochemistry subject in MBBS Ist Professional exam.
  • Gold medal for securing highest aggregate marks in MBBS IInd Professional exam
  • Gold medal in Pathology.
  • Won Deeptanshu Vedant Gupta award in UPICON, 2006 Quiz competition.
  • Gold medal in MD Medicine.
  • Won 2nd prize in Poster/Paper titled celiac disease is associated with NCIPH/Cryptogenic CLD in our population at INASL session of ISGCON, 2010.
  • Received award for best plenary paper ISGCON 2012,Jaipur
  • Received award for best presidential poster ISGCON 2012
  • Oral paper presentation in AASLD , Washigton 2013
  • Oral paper presentation in EASL 2014 London
  • Completed 9th Advanced Certificate Course in “Applied Enteral Pharmaconutrition In Critical Care” at Chennai June 2014
  • First prize in plenary session of ISGCON 2014, Mumbai
  • Completed certificate course in critical care by American Heart Association
  • “Hepatology 360” runner up award for oral presentation in clinical research
  • Did 6 weeks (from 13 th April -25 th May 2014) training in “Inflammatory and Stress Responses in Chronic Liver Disease” located at the Center of Research on Inflammation (CRI, Paris, France) with Dr Richard Moreau Director of Research (DRCE) Inserm (French NIH) Vice-Director of the Center of Research on Inflammation (CRI)- and Head of Team “Inflammatory and Stress Responses in Chronic Liver Diseases” at the CRI Consultant, Liver Unit, Beaujon Hospital, APHP, Clichy, France During  this  stay she actively participated  in clinical  research on kidney  failure and  in more basic aspects  of  research  on  systemic  inflammation  associated  with  chronic liver  diseases  (e.g.,  using transcriptomics  in  monocytes  from  patients  with  cirrhosis) and co-authored two projects which were presented as oral paper and poster respectively in the annual AASLD meeting in Boston 2014
    Unraveling of multilevel inhibition of interferon (IFN)-β production, signaling and target-gene induction in PAMPs-activated immune cells from patients with alcoholic cirrhosis Emmanuel Weiss, Rakhi Maiwall, Pierre-Emmanuel Rautou, Magali Fasseu, Mikhael Giabicani, Catherine Paugam-Burtz, Francois Durand, Dominique Valla, Didier Lebrec, Sophie Lotersztajn1, Pierre de la Grange5, Richard Moreau
  • High enrichment of circulating mononuclear cells with transcripts encoding CXCL neutrophil-attracting chemokines is a predictor of death in patients with decompensated cirrhosis Emmanuel Weiss, Rakhi Maiwall, Pierre-Emmanuel Rautou, Magali Fasseu Mikhael Giabicani, Catherine Paugam-Burtz, Francois Durand, Dominique Valla, Didier Lebrec, Sophie Lotersztajn, Pierre de la Grange, Richard Moreau
    Collaborating investigator of the ACLF Research Consortium (AARC) an initiative to bring experts from Asia-Pacific region to form a working group on understanding and development of syndrome of acute-on-chronic liver failure, which is a distinct syndrome with a high short term mortality and more importantly, with a potential of reversibility.
  • Written article on “Global burden of liver disease Part I and II “in World Gastroenterology News Official E-Newsletter Of The World Gastroenterology Organisation. Vol. 17, Issue 2 July and Vol. 17, Issue 3 October 2012 and  S. K. Sarin, R.maiwall
  • Leading the department of telemedicine at ILBS
  • Active participation in APAN (Asia Pacific Advanced Network) with connectivity with 12 countries across the world via telemedicine.
  • Organized and moderated Live workshops on demonstration of HVPG and TJLB technique, interactive case discussions and presentation of challenging endoscopic cases in Asia Pacific Advanced Network which is a telemedicine based program wherein ILBS is connected to almost 10-12 different centers across the world i.e. Japan, Korea, Thailand, Egypt, Indonesia, Taiwan, South Korea, Vietnam, China , Australia and others
  • Oral Paper presentation in AASLD, Boston 2016
  • Plenary paper award in ISGCON 2016, New Delhi
  • Attended Certificate Course by EDIC, ESCIM New Delhi 2016
  • Organizing Secretary of the First National Conference of Critical Care and Infections in Liver Disease organized under the aegis of International Club of Ascites, Indian Society of Critical Care and APASL School of Hepatology
Clinical Int
  • Early Versus Late SLED in critically ill cirrhotics-A prospective randomized controlled trial
  • On-Demand versus Protocol-guided RRT in Cirrhotics with Stage 3 AKI-A prospective randomized controlled trial
  • Early Versus Late CRRT in critically ill cirrhotics-A prospective randomized controlled trial
  • High Volume Plasma Exchange versus Standard Medical Treatment in patients with Acute Liver Failure-A Randomized Controlled Trial
  • Epidemiology And Clinical Impact Of Bacterial Infections In Hospitalized Patients With Liver Cirrhosis:A Multicenter Observational Prospective Survey Among The Members Of The International Club Of Ascites
  • High versus Low Target MAP in critically ill cirrhotics with septic shock
Research Int
  1. Critical care medicine
  2. AKI in patients with ACLF and cirrhosis
  3. Liver regeneration and Artificial liver support therapies
  4. Iron and liver

Research Work

Lectures Delivered:

  • Human Albumin Structure Functions and Therapeutic Role in Cirrhosis–International Ascites Club-APASL, Shanghai 2017
  • "Immunomodulation in Liver Failure"-APASL, Shanghai 2017 Management of AKI- beyond HRS- INASL, New Delhi 2017 Management of Hyponatremia- Special Interest Group-Ascites, INASL,New Delhi 2017
  • Plasmapheresis in Liver disorders-Expanding Indications? Endothelium in Liver Diseases”, CMC Vellore 2017
  • Plasma-Exchange in Liver Failure-Can it change prognosis? Critically ill liver patient at Frontiers in Liver disease, Aster Integrated Liver Care, Kochi Kerala
  • Chronic Hepatitis B-Therapeutic Options and Challenges, Kanpur 2
  • Chairperson/Panelist in various National Meetings

 

Papers presented

  • Acute Kidney Injury In Critically Ill Cirrhotics With Severe Sepsis And Septic Shock Has Major Influence On Organ Failures And Outcomes- A Single Center Prospective Study, APASL, Shanghai 2017
  • Incidence, Predictors and Outcomes of Transition of Acute Kidney Injury to Chronic Kidney Disease in patients with Cirrhosis-ISGCON Plenary
  • Degree of Hepatic and Systemic Hemodynamic Alterations Predicts Development of AKI and Mortality in Patients with Cirrhosis, AASLD, Washington 2017
  • Neutrophil-Gelatinase-Associated Lipocalin and Cystatin C predict AKI Progression and Transition to Chronic kidney disease in Critically Ill Cirrhotics, AASLD, Washington 2017
  • Assessment of Presence and Dynamic evolution of Organ Failures during Early Intensive Management by MERCIC model can guide inappropriate ‘Futile Care’ in the first week in Critically Ill Cirrhotics, ESCIM, Vienna
  • Organ Failures Associated with Acute Kidney Injury in Critically Ill cirrhotics have a major influence on disease progression and outcomes- a prospective ICU based study, ESCIM, Vienna
  • Dynamic AARC-AKI score determines Extrarenal Organ Failures and Bacterial Infection in patients with Acute on Chronic Liver Failure , AASLD, Washington, 2017
  • Done MD Medicine thesis on “the study of hepatopulmonary syndrome in patients with chronic liver disease” under the guidance of Prof. Mam Chandra, in the Department of Medicine, King George’s Medical University, Lucknow, UP, INDIA and the study was conducted for 1 year from August 2005 to August 2006.
  • Done DM Gastroenterology thesis on “The effect of gluten free diet on celiac disease in patients with celiac disease and NCIPH/Cryptogenic chronic liver disease” under the guidance of Prof. C E Eapen at CMC, Vellore and the study was conducted for 2 years from Jan 2009 to Jan 2011.
Expertise Area
  • Upper and lower GI diagnostic and therapeutic procedures
  • Diagnostic and therapeutic  ERCP’s
  • Small bowel enteroscopies
  • Hepatic hemodynamics (Hepatic Venous Pressure Gradient measurement)
  • Transjugular Liver biopsies

 

Trainings

Name of the conf./course/training/workshop attended (2018):

  • The abstract “Early vs. Late initiation of SLED in critically ill cirrhotics”also considered as Best of AASLD” abstracts
  • The abstract on Therapeutic Plasma-Exchange Improves Systemic Inflammation and Survival in patients with Acute on Chronic Liver Failure-Best of EASL abstracts

Best Poster EASL:Determinants of clinical efficacy of empirical antibiotic treatment in patients with cirrhosis and bacterial infections: Results from the ICA Global study

  • Poster of Distinction “Dynamic AARC-AKI score determines Extrarenal Organ Failures and Bacterial Infection in patients with Acute on Chronic Liver Failure”
  • Invited as faculty to Baylor College of Medicine to conduct the transplant grand rounds and inspire the students how to peruse clinical research
  • Delivered several lectures in national and international meetings
  • European Association for Study of Liver (EASL)- Coagulation as a predictor of sepsis in Acute on Chronic Liver Failure

APASL 2018, New Delhi: Early initiation of dialysis should be considered in critically ill cirrhotics

Use of albumin in the context of critically ill patient with liver disease

Won the American  Association for study of Liver disease (AASLD) Foundation Award for her research on High-Volume Plasma-Exchange Improves Transplant-Free Survival in Patients with Acute Liver Failure- A Prospective Randomized Controlled TrialNCT02718079. Workshop on AKI and CRRT in Hyderabad

 

Delivered lecture on

  • Challenges in advanced cirrhotics –Acute Kidney Injury” in ISGCON 2014 Mumbai
  • AKI in ACLF” in International Conference of Ascites-Asian Ascites Club- PGIMER Chandigarh
  • NSBB and PPI in advanced cirrhosis: Recommendations in clinical practice” –International Ascites Club-APASL, Istanbul 2015

International Conferences attended in 2014 :

  • International liver congresstm 49th meeting of the European association for the study of the liver in London, UK, 9 - 13 april, 2014.
  • AASLD- The liver meeting 2014 , Boston, USA
  • APASL-2015, Istanbul 2015
  • Organized and moderated Live workshops on demonstration of HVPG and TJLB technique, interactive case discussions and presentation of challenging endoscopic cases in Asia Pacific Advanced Network which is a telemedicine based program wherein ILBS is connected to almost 10-12 different centers across the world i.e. Japan, Korea, Thailand, Egypt, Indonesia, Taiwan, South Korea, Vietnam, China , Australia and others
  • Leading ILBS-ECHO project of telemedicine for training general physicians in rural and semi-urban areas of India in the management chronic liver related disorders particularly Hepatitis C and B virus related.
Publications

Total Number of publications (till date):                                                    56

Total Number of publications in 2018:                                                       12

List of ongoing Projects (2018):                                                                   2

 

 

Total Number of publications in 2017: 13

Total Number of Projects: 4

  1. Maiwall R, Kumar A, Sarin SK. Liver regeneration during acute-on-chronic liver failure using growth factors: in vivo or ex vivo indulgence of bone marrow? Gastroenterology. 2013 Oct;145(4):901-4. doi: 10.1053/j.gastro.2013.08.031. Epub 2013 Aug 21. PubMed PMID: 23973679.
  2. Rastogi A, Maiwall R, Bihari C, Ahuja A, Kumar A, Singh T, Wani ZA, Sarin SK. Cirrhosis histology and Laennec staging system correlate with high portal pressure. Histopathology. 2013 Apr;62(5):731-41. doi: 10.1111/his.12070. Epub 2013 Mar 7. PubMed PMID: 23470026.
  3. Rastogi A, Bihari C, Maiwall R, Ahuja A, Sharma MK, Kumar A, Sarin SK. Hepatic stellate cells are involved in the pathogenesis of acute-on-chronic liver failure(ACLF). Virchows Arch. 2012 Oct;461(4):393-8. doi: 10.1007/s00428-012-1291-2.Epub 2012 Aug 11. PubMed PMID: 22886437.
  4. Management of acute kidney injury in cirrhosisSuman Lata Nayak Rakhi Maiwall Ashish Nandwani Sivaramakrishnan Ramanarayanan R. P. Mathur Ramesh Kumar S. K. Sarin Chitranshu Vashishtha Hepatology International 2013 | 7 | 3 | 813-819
  5. Acute Kidney Injury in ACLF is different from patients with cirrhosis Hepatology Volume 58, Issue S1, October 2013, Pages: 36A–91A,
  6. Addition of serum potassium to Low MELD score increases its prognostic accuracy- Rakhi Maiwall Suman Kumar  Hepatology Volume 56, Issue Supplement S1, Article first published online: 1 OCT 2012
  7. Maiwall R, Kumar S, Chaudhary AK, Maras J, Wani Z, Kumar C, Rastogi A, Bihari C, Vashisht Sarin SK. Serum ferritin predicts early mortality in patients with decompensated cirrhosis. J Hepatol. 2014 Jul;61(1):43-50.
  8. Jaswinder Singh Maras, Rakhi Maiwall, H. C. Harsha, Sukanta Das Md, Shabir Hussain, Chandan Kumar, Chhagan Bihari, Archana Rastogi,Manoj Kumar,Nirupama trehanpati, Shvetank Sharma,Akhilesh Pandey and Shiv Kumar Sarin,*Dysregulated iron homeostasis is strongly associated with multi-organ failure and early mortality in acute-on-chronic liver failure Hepatology. 2014 Dec 5. doi: 10.1002/hep.27636. [Epub ahead of print]
  9. Investigation into celiac disease in Indian patients with portal hypertension.Maiwall R, Goel A, Pulimood AB, Babji S, Sophia J, Prasad C, Balasubramanian KA, Ramakrishna B, Kurian S, Fletcher GJ, Abraham P, Kang G, Ramakrishna BS, Elias E, Eapen CE.Indian J Gastroenterol. 2014 Sep 18. [Epub ahead of print
  10. Serum Ferritin in decompensated cirrhosis: Marker of both iron excess and inflammation! Maiwall R, Maras JS, Kumar S, Sarin SKJ Hepatol. 2014 Nov 11. pii: S0168-8278(14)00819-8. doi: 10.1016/j.jhep.2014.11.004. [Epub ahead of print].
  11. Reply to: "Low free T3 levels are related to early mortality in patients with decompensated cirrhosis and acute-on chronic liver failure".Maiwall R, Kumar S, Sarin SK.J Hepatol. 2014 Dec;61(6):1447-8. doi: 10.1016/j.jhep.2014.08.049. Epub 2014 Sep 6.
  12. Two-tier regenerative response in liver failure in humans.Rastogi A, Maiwall R, Bihari C, Trehanpati N, Pamecha V, Sarin SKVirchows Arch. 2014 May;464(5):565-73. doi: 10.1007/s00428-014-1547-0. Epub 2014 Mar 4.
  13. An Interesting Case of CMV Retinitis in a Case of ALL on Maintenance Therapy.Singh PK, Dayama AP, Maiwall R, Sehgal V, Venkatesh P, Mishra PC, Seth T, Mahapatra M.Indian J Hematol Blood Transfus. 2014 Sep;30(Suppl 1):154-8. doi: 10.1007/s12288-013-0305-9. Epub 2013 Dec 6.
  14. Liver dialysis in ACLF-Current and Future Perspectives-Rakhi Maiwall, Jaswinder Singh Maras, Suman Lata Nayak, Shiv Kumar Sarin-Hepatology International Hepatology International September 2014, Volume 8, Issue 2 Supplement, pp 505-51
  15. Bone marrow stem-cell therapy for genetic and chronic liver diseases Veena Kochat, Prakash Baligar, Rakhi Maiwall, Asok Mukhopadhyay in Hepatology International(2014) (Accepted Online)
  16. Growth factors enhance liver regeneration in acute on chronic liver failure Chandan Kumar, L.Anand, A.Khanam, A.Kumar , R.Maiwall,Shiv Sarin Hepatology international (Accepted article april 2014)
  17. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014Revised ACLF Consensus Hepatol Int (2014) 8:453–471 DOI 10.1007/s12072-014-9580-2
  18. Sharma S, Khosla R, David P, Rastogi A, Vyas A, Singh D, Bhardwaj A, Sahney A,Maiwall R, Sarin SK, Trehanpati N. CD4+CD25+CD127(low) Regulatory T Cells Play Predominant Anti-Tumor Suppressive Role in Hepatitis B Virus-Associated Hepatocellular Carcinoma. Front Immunol. 2015 Feb 25;6:49. doi:10.3389/fimmu
  19. Kedarisetty CK, Anand L, Bhardwaj A, Bhadoria AS, Kumar G, Vyas AK, David P,Trehanpati N, Rastogi A, Bihari C, Maiwall R, Garg HK, Vashishtha C, Kumar M,Bhatia V, Sarin SK. Combination of Granulocyte Colony-Stimulating Factor and Erythropoietin Improves Outcomes of Patients with Decompensated Cirrhosis.Gastroenterology. 2015 Mar 4. pii: S0016-5085(15)00304-2.
  20. A Haemodynamic Analysis to Assess the Safe Dose of Carvedilol across Different Child Class of Liver Disease Zeeshan Ahmad Wani1 , Riyaz Ahmad Bhat2*, Ajeet Singh Bhadoria3 , Showkat Ali Zargar4 , Altaf Hussain Shah4 , Rakhi Maiwall1 , Iqra Hameed5 and Syed BasitBritish Journal of Medicine & Medical Research 7(5): 355-368, 2015 Article no.BJMMR.2015.342 ISSN: 2231-0614
Book Chapters 
Written chapter on “Hepatitis B virus infection and Hepatocellular carcinoma” 

 
  • ECHO
  • APASL
  • Acuteon
  • DORSO
  • NSI
  • HBSCE
  • NLDB

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