The Indian healthcare sector is rapidly growing and is projected to reach $638 billion by 2025, according to a recent study by Bajaj Finserv AMC. This growth is primarily driven by significant advancements and extensive research across various areas of healthcare, which have greatly enhanced care and treatment processes. Remarkably, the country boasts some of the top hospitals equipped with the latest technology and state-of-the-art infrastructure. Additionally, expert specialized doctors and surgeons are playing a crucial role in further strengthening the healthcare system.

The Professional Trajectory
Dr Dharmendra Kumar Dangi, a liver transplant and HPB Surgeon is one amongst the gamut of healthcare specialists who seek greater recognition for their keen contribution to the community at large. He completed his MBBS at Surat Medical College in Gujarat and then secured a position in surgery at Lady Hardinge Medical College in Delhi, where he earned his MS in General Surgery.

During his training, the liver was seen as a challenging organ to operate on, which sparked his interest in liver diseases and hepatobiliary issues. The surgery rounds focused heavily on patient care over financial concerns, especially in a government hospital. After his MS, he took the NEET exam for super-specialization and was accepted into ILBS Hospital in Delhi, a leading institute for liver transplants. There, he observed a greater emphasis on specialized management, particularly for patients with liver diseases, which are often complex and neglected. Effective treatment requires specialized knowledge, and careful selection is crucial when determining candidates for liver transplants, as the success rate depends on the patient’s condition before hand.

During three years of M.Ch training at ILBS, he performed over 100 liver transplant cases each year, along with various liver surgeries like hepatectomies and pancreatic procedures, focusing exclusively on the liver and related organs. After two years as a consultant in Delhi, he moved to Ahmedabad to continue his practice.

He states, “The complexity of treating the liver diseases is what draws me to liver transplantation. I would like to acknowledge Dr Thomas from Lady Harding, Dr Vinendra Pameja from ILBS Hospital, and Dr Puneet Singla from JP Hospital and Maringo E.C. Hospitals for their contri -butions to this important field”.

The Significant Advances & Innovations
Liver transplantation gained recognition in Delhi about ten years ago, with the first transplant leading to a gradual acceptance of the procedure. Initially, outcomes were poor, but advancements in ICU management,

post operative care and surgical techniques have significantly improved results. Today, the success rate of liver transplants are around 90 percent, which is remarkable considering the nearly 90 to 100 percent mortality rate for patients with severe liver disease without a transplant. Improvements in minimally invasive techniques have reduced incision sizes and scarring, with an emphasis on laparoscopic and robotic surgeries providing better cosmetic results. Notably, long-term survival rates have also increased, with over 80 percent of patients surviving five years and more than 70 percent surviving ten years. Overall, liver trans -plantation is now a much more effective and aesthetically favorable procedure than in the past.

Approach to Managing Best Patient Outcomes Navigating Challenges
Liver transplant surgery involves significant risks, including a 5 percent chance of mortality during the procedure, which can last up to 12 hours. Both the donor and recipient undergo surgery, with risks of massive bleeding and fluctuating hemodynamics. For living donors, a serious complication is a bile leak due to the small size of the anastomosis, which can lead to biliary sepsis. Complications can be categorized as early (within the first three months) or late. Early complications include hepatic artery thrombosis and portal vein thrombosis.

Rejection is a critical concern, occurring either hyperacute or acute, and can be antibody-mediated, necessitating plasmapheresis and immunosuppression. Later complications often involve infections, such as those from Klebsiella pneumoniae, Pseudomonas, and fungal infections like Candida and Aspergillus. Prophylactic treatment for cytomegalovirus (CMV) is common to reduce risks. Prolonged hospital stays can lead to critical illness myopathy and drug-related side effects, including kidney injuries and seizures. It is essential to closely monitor these common complications associated with liver transplants to relish positive outcomes.

The Accomplishing Case Studies
Dr Dharmendra has had several intriguing experiences in his career handling diverse patient cases. One of those is where he once treated a six-month-old girl who had biliary atresia and under went a liver transplant. After complications, including thrombosis and rejection, he treated her successfully with plasmapheresis and medication. Despite her low weight of 8 kg, she fully recovered and was discharged, which was incredibly rewarding.

Another one was a young girl with neurological Wilson’s disease who underwent a liver transplant with her mother as the donor, despite the typical risks involved. Remarkably, she experienced an excellent recovery, regaining the ability to eat, talk, and walk. Now, she attends school and manages her daily routine independently.

Innovations & Emerging Trends in Liver Transplantation & HPB Surgery
There has been a significant increase in cadaver donations recently, particularly in the western part of India. As these donations rise, the number of liver transplants from deceased donors are also expected to grow, reducing the need for living donor surgeries and improving patient outcomes, especially for those with severe diseases. Robotic surgery has further enhanced the safety of living donor transplants, marking a positive shift in organ transplantation. Increased awareness about organ donation is also contributing to this trend.

Advice to Upcoming Leaders
Dr Dharmendra, an aspiring liver transplant surgeon, highlights the complexity of this field. He advises the leaders, “While both cadaver and living donor liver transplants are performed, cadaver donations offer greater promise for the future. Managing a career in liver transplantation requires a flexible schedule, as calls for available cadavers can come at any time, including late at night. Hence, being dedicated is a must”.

He adds, “As more patients learn about their liver treatment options, many are seeking transplants. However, community acceptance remains a challenge due to the high mortality rates and complexities associated with the procedure. Recovery can also be difficult, so it is required of healthcare providers to be dedicated to supporting their patients”.

However, a significant challenge is the acceptance of liver transplants within the community, as they are associated with high mortality rates and represent a complicated procedure. Recovery after a transplant can also be quite challenging.