The Medical City performs second liver transplant: Cebu doctor gets a new life

MANILA, Philippines - The Medical City (TMC) has placed the Philippines on the map once again for liver transplant surgery as it recently successfully performed its second liver transplant operation giving a 61-year-old doctor from Cebu a new lease on life. This means that Filipinos will no longer have to go abroad for the surgery.

This was the hospital’s first liver transplant in an adult patient using a liver from a deceased donor. In January 2011, TMC performed the first successful pediatric liver transplant in the country in a three-year-old patient, Catherine Erica Buenaventura. Erica then had a living donor, her 17-year-old uncle.

“As in the first case, the well-planned, seamlessly orchestrated and coordinated procedures — from the preparation of the patient to the procurement of the deceased donor liver to the transplant surgery itself, up to the post-operative management — have saved another Filipino life,” says Dr. Eugenio Jose F. Ramos, senior vice president of TMC Medical Services Group.

The liver transplant team, composed of highly qualified and internationally-trained experts led by Dr. Vanessa de Villa, head of TMC’s Center for Liver Disease Management and Transplantation (CLDMT), undertook the delicate surgery lasting 14 hours and giving the patient, Dr. Amytis de Dios Batao, a “second life.” The team removed her diseased liver and transplanted a cadaver liver from a brain-dead person. Dr. Batao underwent the surgery on July 26, 2012 and was discharged from the hospital three weeks after. Dr. Batao is a general practitioner and former town mayor of Carmen, Cebu.

Dr. Janus Ong, a transplant hepatologist at TMC and a member of the liver transplant team, was the patient’s attending physician. In July 2011, the patient was referred to Dr. Ong by her doctor from Chong Hua Hospital in Cebu City, Dr. Judy Y. Lao-Tan. The patient was diagnosed with cryptogenic cirrhosis, portal hypertension, and hepatocellular carcinoma (or primary liver cancer). Since then Dr. Batao has been flying from Cebu to Metro Manila for her consultations with doctors at TMC as well as for her tests and treatment.

Transplant evaluation was initiated in January 2012 when her liver function started to deteriorate. Dr. Batao was approved for listing by the transplant selection committee and was put on the deceased donor waiting list in February 2012.

A liver transplant became imminent when Dr. Batao developed hepatorenal syndrome and hepatic encephalopathy, conditions associated with high mortality. Hepatorenal syndrome is a life-threatening medical condition characterized by rapid deterioration in kidney function in persons with cirrhosis or liver failure. Hepatic encephalopathy is the occurrence of confusion, altered level of consciousness, and coma as a result of liver failure.

Fortunately, a potential deceased donor came into the picture on July 25 through the Human Organ Preservation Effort (HOPE) and the alertness of Dr. Rica San Diego, TMC’s dedicated organ transplant coordinator.

HOPE is a non-profit organization in the Philippines under the umbrella of the National Kidney & Transplant Institute (NKTI) and is dedicated to the legal procurement of donor organs for transplantation to patients afflicted with various types of end-stage organ disease.

In less than 24 hours, TMC’s team of liver doctors and nurses were mobilized, performing the procurement surgery in NKTI, giving anesthesia and removing the cirrhotic liver from the patient in TMC, implanting the donor liver, up to post-operative monitoring and addressing medical and nursing problems as they arose.

“It was teamwork at its best, made more seamless by the thoroughness of preparations, attention to detail, an aversion to complacency and a genuine care for the life of the patient,” says Dr. Ramos.

Dr. Ong said the cooperation, albeit informal, among different institutions, TMC, Chong Hua Hospital and NKTI, cannot be understated.

“It shows that we’re able to offer something to a patient who’s in dire need in a manner that is multidisciplinary and cooperative in spirit not just among members of a healthcare team but also among different institutions,” said Dr. Ong.

Dr. Batao’s 22-year-old daughter, Arianne, earlier volunteered to be the patient’s liver donor. Arianne was evaluated earlier this year and was found to have fatty liver which is not an uncommon condition among potential liver donors. A few months of strict diet and exercise made her lose weight, making her fit to be Dr. Batao’s liver donor. The transplant with Arianne as the donor did not push through as the liver from the deceased donor became available.

Dr. Batao and her family are very grateful that TMC and NKTI were able to facilitate organ donation from a deceased donor since it spared a healthy member of the family like Arianne from such a delicate operation.

For over a year, it was indeed a scary fight for Dr. Batao. Part of her worries was attributed to her family’s search for a possible liver donor.

“There are some people who do not agree with organ donation. Although we cannot force them to do so, I believe they should at least think about it and consider it as a worthwhile decision that can save lives,” said Dr. Batao.

Dr. De Villa, a liver transplant surgeon who has worked in some of the best transplant centers in the world and who plays a lead role in the history of liver transplant in the country, couldn’t agree more with Dr. Batao.

Organ donation is a gift one can leave others when he or she dies. While it is also possible to donate organs while one is still living, more often donation takes place upon death.

“Since CLDMT started in 2008, we have had a number of patients who died while waiting for a liver donor,” said Dr. De Villa.

“Many patients die every year due to organ failure and the lack of organ donors. We believe more people should consider donating a part of themselves so that others may live,” Dr. De Villa added. She remarked that one donor can save up to a dozen lives with transplantable organs and tissues.

Liver disease is a common problem in the country, affecting adults and children alike. Among adults, chronic hepatitis B infection, alcoholic liver disease, and nonalcoholic fatty liver disease are the most common liver ailments. One in four of those with these diseases develop complications such as liver cirrhosis, liver failure and liver cancer. For most of these patients with severe complications of liver disease, the only option is liver transplantation. Liver transplant can use an organ either from a deceased donor or a living donor.

“We have proven again that we can do successful liver transplants here at The Medical City. We can offer our patients in the Philippines the same world-class quality healthcare that overseas liver centers provide,” says Dr. De Villa.

Dr. Batao’s core team of doctors includes Dr. De Villa, head of CLDMT and the liver transplant surgery team, Dr. Ong as hepatologist and as the patient’s attending physician; Drs. Dante Ang, Tony Yap, Ramon de Vera, and Edgar Macaraeg as surgeons; Drs. Grace Herbosa Celine Ancheta, Alexandra Odi, and Ace Prodigalidad as anesthesiologists; Drs. Eric Arcilla, Catherine Yap-Asedillo and Glenn Genuino as microvascular surgeons; Drs. Luis Habana and Jep Palo as intensivists; nephrologist Dr. Robert Tanchanco; pulmonologist Dr. Kim Silos; infectious disease specialist Dr. Isa Alejandria; liaison psychiatrist Dr. Lou Querubin and rehabilitation specialist Dr. Noel Bate.

Dr. Batao expressed her gratitude to Dr. De Villa and Dr. Ong and to all the doctors, nurses and TMC medical and non-medical staff for giving her the best care possible.

“I went through a lot but my faith in God, my confidence in my doctors and the support of family and friends helped me survived all these challenges,” said Dr. Batao.

“I knew the hospital and my doctors can provide me with the best care I need and that thought helped me a lot especially during my lowest times,” she added.