Suherdjoko, The Jakarta Post, Semarang
Indonesia's liver transplant team, comprising doctors of the Semarang's Kariadi Hospital and of the School of Medicine, Diponegoro University, together with the liver transplant team of National University Hospital of Singapore successfully conducted a liver transplant on 15-month-old Ulung Hara Hutama on October 1.
Ulung's liver, which could no longer function, was removed and replaced by 25 percent of the liver of his mother, Lisa Olivia, 28.
The operation, the first ever in Indonesia, was a success.
Ulung's condition is improving and he is now treated in an Intensive Care Unit (ICU) at Kariadi Hospital. A balloon is placed next to him while a nurse keeps monitoring his health condition.
Lisa, Ulung's biological mother, who has donated 25 per cent of her liver, looks healthy. She has been discharged from the hospital. She has visited the ICU to breastfeed Ulung, her second child.
Didik, Ulung's father, said his son was born on July 19, 2005, in a healthy condition and weighed 3.4 kilograms. However, when he was two days old, his skin began to turn yellow and remained so until he was two months old. Meanwhile, his feces were lime-like white.
Later the doctor diagnosed him as suffering from Attresia Biliaris in his liver. ""His bile cannot be channeled so it piles up in his liver and causes cirrhosis,"" Supriatna, a member of the liver transplant team, told The Jakarta Post.
Didik and Lia, who live at Jl. Puspowarno IV Semarang, later made every effort to have their second child cured of his disease.
Finally, they learned that the only way was to have liver transplant for Ulung in Singapore but they could not take Ulung to Singapore quickly as they still had to get their passports, visas and references from the doctor.
""Suddenly, Kariadi Hospital's team of doctors offered a liver transplant in Semarang. We took up the offer. Honestly, I was worried because my wife and Ulung had to undergo surgery.
""Therefore, we tried to find out whether the team of doctors here was really capable of undertaking this liver transplant. Only when we were convinced of the capability of the doctors did we agree for the liver transplant for Ungul.
""Of course, we left everything in the hands of Our Lord,"" Didik said, after seeing Ulung with his wife.
Simply put, a liver transplant involves the removal of the diseased liver and replacing it with a healthy liver from a donor.
Until 1992, the one year post-transplant survival rate rose to 90 percent. Singapore saw 107 liver transplants between 1990 and 2005 with an 86 per cent rate of success.
In the United States some 15,000 patients were on the liver transplant waiting list in 2000. Unfortunately, a third could not undergo this surgery for various reasons.
Pediatrician Ag. Soemantri took the initiative for the liver transplant in Semarang. He was prompted by a desire to help children afflicted with liver trouble and requiring a liver transplant in 1996. Of 10,000 births, he said, one to two babies have a defect in their liver.
That year, six doctors left for the National University Hospital (NUH) in Singapore to learn about liver transplants from Quak Seng Hock, head of the pediatric gastrohepatology division.
The six were Hartantyo, ModerikTaman, Bambang Sudarmanto, Asri Purwanto, Latiyani and Yanti.
The transfer of liver transplant knowledge and skills to Indonesian doctors continued in 1997 and a team of doctors from NUH went to Semarang.
Unfortunately, the plan was postponed because of the acute economic crisis. It was not until August 2005, when the Asia-Pacific Hepatology Congress was held in Bali, that a meeting was held by the embryo of Kariadi Hospital/School of Medicine of Diponegoro University liver transplant team and the NUH Team, represented by Prabhakaran, Quak Seng Hock and their colleagues.
In late August 2005, an official liver transplant team of Kariadi Hospital/School of Medicine of Diponegoro University, involved scientists of various disciplines and motivation so that a liver transplant could be conducted in Semarang.
The plan to carry out a liver transplant in Semarang came close to being realized when two patients were ready for it. In May 2006, Prabhakaran of Singapore's NUH came to Semarang.
As many as 18 medical specialists in Semarang were involved in a serious discussion with the NUH team over implementation of the transplant.
In August 2006, the liver transplant team of Kariadi Hospital/School of Medicine of Diponegoro University, headed by Yulianto, discussed the final preparation for the liver transplant with their colleagues from NUH, led by Prabhakaran.
On Oct. 1, the liver transplant began at 8.15 a.m. and ended at 9 p.m. ""The transplant ran smoothly. It took three hours to take out the diseased liver, take the healthy liver from the mother and transplant it to Ulung's liver,"" Supriatna said.
Yulianto, the chairman of the liver transplant team, said that after the transplant, Ulung would still undergo weekly monitoring to prevent complications such as hepatic arterial thrombosis, portal vein thrombosis, tractus biliaris complication, rejection and infection.
In addition, Ulung will have to take Takrolimus all his life. With today's sicentific progress, someone with a liver transplant has a survival rate of 85 per cent. On the other hand, Lisa's liver, part of which has been taken for her son, was expected to regrow and return to normal in three weeks.
A liver transplant, Prabhakaran stressed, will be considered a success if the patient lives normally afterwards. At least, this success will be evident from the health condition of the patient in one or two months after the transplant.
How much does a liver transplant cost? In Singapore, it costs between Rp 1 billion and Rp 1.5 billion. In Indonesia, it is between Rp 500 million and Rp 750 million.
Specially in Ulung's case, his parents have been exempted from all charges because his transplant was a pilot project for the Semarang liver transplant team.
""The government pays all the charges,"" Ag. Soemantri said.
Currently 11 patients are on the liver transplant waiting list at Kariadi Hospital, Semarang. The team is yet to decide the fee for this transplant.
""But we have all the necessary medical equipment for this transplant,"" Supriatna said.
Some members of the liver transplant team, such as Ag. Soemantri, Supriatna, Budi Santoso and Tatty ES said after the transplant, the critical period could last up to three weeks and that serious attention had to be paid to this critical period.
""So, in a liver transplant, there are three periods that require careful handling. First the pre-transplant period, which is related to the health and psychological preparation for the donor and the patients, then the transplant period and eventually the post-transplant period,"" Soemantri added.
