There is a high annual requirement of pediatric liver transplant in Sri Lanka (101 referrals to the North Colombo Center for Liver Disease in 2021) whereas only 01 transplantation could be done with the available resources. Out of the demand, 10 surgeries had been done in India on personal expenditure, the cost ranging from LKR 80-200 lakhs. Eight children have died while being in the waiting list. This number is a relatively high. Lack of resources and exposure to carry out pediatric liver transplantation in the country is an area needs attention. As such, there was a dire need to grasp the know-how and acquire skills on advanced surgery techniques by surgery teams in Sri Lanka to better cater to local pediatric liver patients thus, infusing with cutting-edge technology and fast-track pediatric liver transplantation that helps saving many lives of children.
Whole liver graft being not suitable for pediatric patients due to the size mismatch has been addressed worldwide by Living Donor Liver Transplantation (LDLT), Split Liver Transplantation, and Reduction Techniques. The NSF provided Dr Buddhika Uragoda, Acting Consultant/ Gastroenterological and Hepatobiliary Surgeon of the Colombo South Teaching Hospital, Kalubowila a Training Scholarship under the ‘Overseas Special Training Programme (OSTP) in 2022 for a 01-month period to get hand-on-experience in split liver transplantation at the National Center for Child Health and Development (NCCHD) in Tokyo, Japan which carries the largest pediatric liver transplantation program in the world.
Dr Uragoda is now trained to handle monosegment (Monosegmentectomy) and split liver transplants focusing on children and infants, techniques for reconstruction of the Hepatic venous outflow, novel techniques of biliary reconstruction and is able to take actions to prevent post-operative infections. He has transferred the know-how gained through the training to his collaborating surgery teams in the Colombo South Teaching Hospital and the National Hospital of Sri Lanka. Dr Uragoda has been able to establish links between liver transplantation surgery and anesthesia teams of both countries. Dr Uragoda has been donated with a surgical loupe by the Japanese surgery team, which he currently uses for magnification for Whipple's operation at the Colombo South teaching hospital.
With the know-how and skills acquired through this training, Dr Uragoda, his research team and the system has now expedited pediatric liver transplants in Sri Lanka. Before the training, in 2021, only two transplants had been carried out. However, 08 peditric liver transplants had been done in 2022 after the training. Further, Prof Mureo Kasara, Japanese collaborator/supervisor of this specific training delivered an online talk on pediatric liver transplantation in 2022 at the Annual sessions of the Sri Lanka Society of Gastroenterology (SLSG) to an audiene of around 250 participants including pediatricians, gastroenterologists, and surgeons.
Ultimately, this has yielded a socioeconomic impact in terms of a significant reduction of patients’ post operative hospital stay, the cost on medication, reduced wait-list mortaity and foreign exchange saving within the country.
Benefits at large are envisaged with strengthened cooperation and collaboration with the National Center for Child Health and Development (NCCHD), Tokyo, Japan by the trainee.
