Schulich school of Medicine and Dentistry logo Anesthesia and Perioperative Medicine Schulich School of Medicine & Dentistry

Transplant

Dr. Achal Dhir
Program Director

Transplant Faculty:  Dr. Anthony Vannelli, Dr. Marc St-Amand, Dr. Ramiro Arellano, and Dr. Stephen Morrison

The liver transplantation program continues to provide excellent clinical care to patients for liver transplantation, liver resections and major Hepato- biliary surgeries. CIHI recently published results of orthotopic liver transplantation in nine centres across Canada for 2009 – 2013. Our results for one- month, one-year and two-year patient survival were better than rest of Canada and were significantly improved in the sickest patients (Status 3F, 4 and 4F).

Drs. Marc St-Amand and Ramiro Arellano joined the group while Drs. Harle and Ralley decided to step down. We thank Drs. Ralley and Harle for their services, dedication and contribution to this specialty. Dr. Dobkowski also decided to stop doing liver transplants as a step towards his retirement. No words can describe Dr. Dobkowski’s passion and commitment to this exciting specialty. He has agreed to lend his helping hand even after his retirement and we thank him for decades of excellent patient care, teaching and leadership.

From January to December 2015, we provided anesthesia for 56 liver transplantations including many critically ill recipients from the ICU. 43 livers came from brain dead donors, 10 were donations after cardiac death and there were living related liver transplants.

During the same period, our group also provided services to about 100 major liver resections including several ALPPS procedures. The group is also involved with preoperative assessment and optimization of patients before they are listed for liver transplant.

We also run a successful fellowship program with two fellows. Dr. Kamal Kishore completed his transplant fellowship and was the only fellow for one year. He is now doing cardiac fellowship. Dr. Nelson Gonzalez and Dr. Hussein Sadkhan joined ‘Liver transplant’ fellowship in July 2015 while Dr. Bassem joined as a research fellow. 

Aside from getting excellent clinical training, fellows are also involved with research and academic activities. We are trying to incorporate Trans Esophageal Echocardiography basic training for liver fellows. We also conduct monthly PBLDs and journal clubs. Liver Transplantation Anesthesia group attends Bon-Mots Transplant rounds regularly and participates in ‘Liver assessment’ and ‘M & M’ rounds conducted by Transplant surgeons & Hepatology colleagues. We presented an interesting and clinically challenging case report of liver transplantation and tuberculosis at the annual meeting of ‘International Liver Transplantation Society’ in Chicago, USA. The project on Infusion of ketamine and Lidocaine for pain management after major liver resection is nearing its completion. A multidisciplinary research project using ROTEM technology in major liver resections has just begun and we have started recruiting patients for the project of ‘Peripheral circulation during end stage liver disease’. 

For several years, Dr. Dhir and Dobkowski have been collaborating and organizing ‘Transplant symposium / session’ during the CAS annual conferences. The session targets non-transplant anesthesiologists across Canada and focuses on transplant related issues. 2015 was no exception and the ‘Transplant symposium’ in CAS Ottawa was a huge success.

A case report of ‘Successful hepatectomy using venovenous bypass in a patient with carcinoid heart disease with severe tricuspid regurgitation’ was published in the Journal of Cardiothoracic and Vascular Anesthesia, August 2015.

Dr. Dhir delivered invited lectures on ‘Pulmonary problems in liver disease’ in 2015 CAS in Ottawa and on ‘Peri-operative renal issues in Liver Transplant recipients’ and ‘Acute renal failure post transplant – what matters’ in New Delhi, India. Dr. Dhir was also a panelist on ‘Challenging case of liver transplant’ and chaired a session on ‘Combined vs Sequential Liver Kidney Transplant’ in the same symposium. Dr. Dhir also conducted a breakfast session on ‘Cardiac surgery in a patient with ESLD’ in Indian Association of Cardiac Anesthesiologists annual conference in Jaipur, India.

For more information, please visit our Transplant Program site.