|Year : 2022 | Volume
| Issue : 1 | Page : 84-87
Meeting report: Fourth annual conference of the liver transplant society of India (LTSICON), 7th – 9th January 2022, Mumbai, India
Ravi Mohanka1, Aabha Nagral2, Prashantha S Rao1, SK Mathur3, Pravin Agrawal1
1 HN Reliance Hospital, Mumbai, India
2 Jaslok Hospital & Research Centre, Mumbai, India
3 Zen Hospital, Chembur, Mumbai, India
|Date of Submission||16-Mar-2022|
|Date of Decision||21-Mar-2022|
|Date of Acceptance||21-Mar-2022|
|Date of Web Publication||28-Apr-2022|
Dr. Ravi Mohanka
HN Reliance Hospital, Mumbai
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mohanka R, Nagral A, Rao PS, Mathur S K, Agrawal P. Meeting report: Fourth annual conference of the liver transplant society of India (LTSICON), 7th – 9th January 2022, Mumbai, India. J Med Evid 2022;3:84-7
|How to cite this URL:|
Mohanka R, Nagral A, Rao PS, Mathur S K, Agrawal P. Meeting report: Fourth annual conference of the liver transplant society of India (LTSICON), 7th – 9th January 2022, Mumbai, India. J Med Evid [serial online] 2022 [cited 2022 Aug 12];3:84-7. Available from: http://www.journaljme.org/text.asp?2022/3/1/84/344286
The fourth annual conference of the Liver Transplant Society of India (LTSICON) was held in Mumbai. The conference was planned as an in-person meeting for participants from India (national) and virtual for the international participants in view of the prevailing COVID pandemic situation in the country and internationally. To be on the safe side, the conference was moved from December 2021 to 7th–9th January 2022, however, due to the 3rd/Omicron variant wave of COVID-19 with rising number of cases in the country and in Mumbai in particular and government regulations limiting the attendees in the meetings, on 26th December, the organising committee decided to convert the conference to completely virtual format.
To neutralise any adverse impact of this on the scientific program and financial losses to the participants, two important decisions were implemented: (1) No major change in topics, days and timings of already communicated program and. (2) Making conference free for all registered participants and refund of full registration fee to all who had already paid and also reimbursed the faculty members the money lost due to cancellations of pre-booked flights.
The organising committee worked hard to accommodate last-minute changes and requests.
The theme of the conference was multidisciplinary integrated approach in liver transplantation focused on deceased donor liver transplantation, therefore most discussions were formatted as panel discussions. Some highlights of the conference were:
- Pearls of wisdom from living legends of liver transplantation
- Keeping the patient with decompensated cirrhosis alive
- Optimal utilisation of marginal donors – getting the best out of the worst
- Liver allocation systems-first amongst equals
- Techniques of liver transplantation – tips and tricks from experts
- Machine perfusion – myth or reality for India?
- Transplantation for liver malignancies – beyond hepatocellular carcinoma (HCC)
- Cutting edge in donor hepatectomy – laparoscopic and robotic
- Liver transplantation for rare indications – medical and surgical challenges
- Challenges in simultaneous liver transplantation and other major surgeries
- Perioperative anaesthesia challenges
- Coordinating liver transplantation in COVID times.
The conference was very well attended with about 1350 registrations, average attendance of 500 delegates and peak attendance of about 750 delegates. There was active participation from the faculty as well as the delegates. The 1st day was the postgraduate course and workshops. We took advantage of a virtual meeting to invite a large number of international faculty and also being a multidisciplinary meeting, we invited and had participation from all specialities which participate in making a liver transplant successful. This included infectious disease specialists, pathologists, radiologists, cardiologists, chest physicians, haematologists, gastroenterologists, oncologists, oncosurgeons, radiation medicine specialists, neurologists and microbiologists. This was in addition to the core faculty of liver transplant physicians, surgeons, anaesthetists and critical care specialists.
There was a separate parallel ½ day programme for transplant coordinators where a wide range of topics from organ allocation to ethical issues. The coordinators also participated in the mainstream programme to give their perspective.
The first-panel discussion was moderated by Dr. Sanjiv Saigal on recipients with recurrent infections such as urinary tract infection, spontaneous bacterial peritonitis, cellulitis and others, which was a case-based discussion on the definition, diagnosis, guidelines and treatment of these infections. The panellists were Dr. Shweta Singh, Dr. Simantika Ghosh, Dr. Sunil Taneja, Dr. Ruhi Kohli and Dr. Mala Kaneria.
The second-panel discussion was moderated by Dr. Prashant Bhangui on patient selection, surveillance, bridging, downstaging, withdrawal of care and recurrence of hepatocellular carcinoma with liver transplant with panellists Dr. Amit Gupte, Dr. Amit Singhal, Dr. Ritu Kakkar, Dr. Tejal Modi, Dr. Sudheer Pargewar and Dr. Unnikrishnan. The panel discussion was appreciated by all.
This was followed by a panel discussion on alcoholic liver disease (alcoholic hepatitis and cirrhosis) where it was discussed whether and how these patients should be evaluated for liver transplant, what should be the abstinence period and whether alcoholic hepatitis should be given any priority for transplantation. The moderator for the session was Dr. Anil Arora and along with him the panellists were Dr. Shaleen Agarwal, Dr. Hemamala Ilango, Dr. Rahul Pandit, Dr. Kiran Shetty, Dr. Sheetal Bidkar and Dr. Prajakta Gupte.
Next on the agenda was a very interesting panel discussion on subacute liver failure without hepatic encephalopathy moderated by Dr. Vaishali Solao, Dr. Balbir Singh, Dr. Eapen, Dr. Akila, Dr. Zubair and Dr. Prajakta Gupte. Dr. Eapen also spoke about their centres experience in plasma exchange in liver failure.
Next Dr. Neeraj Saraf moderated a very important panel discussion on the recipient with renal dysfunction and refractory ascites and he also touched upon when to offer simultaneous liver and kidney transplant and when kidney after liver transplant. The panellists to this session were Dr. Venugopal Kota, Dr. Sanjeev Rohatgi, Dr. Rakhi Mahiwal, Dr. Lakshmi, Dr. Selva and Dr. Urmila Anandh.
Dr. Aabha Nagral moderated the discussion on hepatopulmonary syndrome and portopulmonary hypertension. The various aspects of diagnosis, management, when to offer and when not to offer liver transplant and post-operative management of these difficult to treat patients were discussed. The panellists' were Dr. Magnus Jayaraj, Dr. Madhumita Premkumar, Dr. Ambreen, Dr. J Gopi Krishna and Dr. Unmil Shah.
Following this, there were parallel sessions on the scope of careers in the various aspects of liver transplant: Transplant surgery, hepatology and anaesthesia with critical care. The surgical session was moderated by Dr. Gomati Narashimhan. The stalwarts of liver transplant surgery in India Dr. AS Soin, Dr. Subhash Gupta, Dr. Mohammed Rela and Dr. Sanjay Govil gave guidance to the young budding liver transplant surgeons. Dr. Sameer Shah conducted the discussion in the hepatology session with Dr. Shiv Sarin, Dr. Sanjeev Saigal, Dr. Dharmesh Kapoor and Dr. Neelam Mohan as panellists'. The anaesthesia and critical care discussion were conducted by Dr. Sharmila and Dr. Sangeeta Shetty and with them the faculty present were Dr. Vijay Vohra, Dr. Sanjeev Aneja, Dr. Vaishali Solao and Dr. Ilan kumaran.
Next was the panel discussion on Budd–Chiari syndrome (acute/chronic) presentation moderated by Dr. Akash Shukla. The experts on the panel were Dr. Abhideep, Dr. V Jayanthi, Dr. Deepanjali Pant, Dr. Naveen Kalra, Dr. Shaji Marar and Dr. Samir Shah (Jaslok).
This was followed by two talks on post-transplant lymphoproliferative disorders by Dr. Girish Gupte, followed by acute liver failure presentation of Wilson's disease and autoimmune hepatitis by Dr. Julia Wendon. Dr. Abhishek Yadav, Dr. Soumil Vyas, Dr. Neelam Mohan, Dr. Milaap and Dr. Mehboob Basade moderated the first talk while Dr. Naresh Shanmugam, Dr. Seema Alam and Dr. Rachel Brown presided over the second.
After this was the lunch symposium on infectious complications in liver transplants. Dr. Subramanium Swaminathan covered complicated bacterial infections while Dr. Vasant Nagvekar spoke on complicated invasive fungal infections. The chairpersons for this session were Dr. Smita Malhotra and Dr. Suvadeep Sen.
Being a virtual meeting, we could organise multiple parallel workshops in the post-lunch session covering interpretation of Thrombo-Elasto-Graphy (TEG) and Rotem, pathology in liver transplant, diagnostic and interventional radiology in liver transplant, invasive monitoring, split cadaveric liver transplant, multiorgan retrieval and machine perfusion. Dr. Piyush Shrivastav and Shweta Singh were the moderators for the TEG and Rotem workshop with Dr. Selva, Dr. Anil Agarwal and Dr. Nandakumar as faculty. Dr. Dharmesh Kapoor guided the discussion on pathology using a case-based discussion with Dr. Mukul Vij, Dr. Archana and Dr. Dhiraj Gautam. Dr. Pravin Agarwal conducted the workshop on diagnostic radiology with Dr. Manoj Shrivastav, Dr. Amardeep, Dr. Shridhar Shasturkar, Dr. Samarjeet Ghuman, Dr. Tarun Piplani, Dr. Chawla and Dr. Parul Garde participating. The workshop on invasive monitoring was conducted by Dr. Rishab Jain and Dr. Annu Sarin Jolly and Dr. Vasant Roopan were the faculty. Dr. Raghavendra Babu brought out the importance of interventional radiology in transplant using case-based discussions with Dr. Shailesh Sable, Dr. Amar Mukund, Dr. Rahul Sheth and Dr. Shaji Marar. Anurag Shrimal conducted the workshop on multi-organ retrieval where he brought out the nuances of multi-organ retrieval by putting forth questions to Dr. Gaurav Gupta, Dr. Prashantha S. Rao and Dr. Vrishali Patil. Dr. Darius Mirza (UK) moderated the workshop on machine perfusion with Dr. Ilango Sethu, Dr. Thiagarajan and Dr. Karthik as faculty. He also conducted the workshop on split cadaveric liver transplants with participation from Dr. Somnath, Dr. Vikram Raut and Dr. Rajanikanth. Following the workshops, there was a discussion on the national liver allocation policy conducted by Dr. Srinivas Reddy, Dr. SK Mathur and Dr. Sudhindaran. The day came to an end with a Indian Liver Transplant Registry (ILTR) committee discussion headed by Dr. AS Soin and Dr. Sonal Asthana.
Day 2 began with a talk on hepatoblastoma by Dr. Rakesh Sindhi chaired by Dr. Giriraj Bora, Dr. Swapnil Sharma, Dr. Vishnu Biradar and Dr. Girish Chinaswami. This was followed by a talk on the limitations of MELD score by Dr. Paul Martin which was chaired by Dr. Venugopal P, Dr. Aurobindo Prasad Das and Dr. Yogesh Chawla. Next was a talk by Dr. Abhinav Humar on the use of DCD Livers. Dr. Thiagarajan and Dr. Prashant Borade chaired this session.
The talks were followed by interesting panel discussions. First was on the importance of sarcopenia/frailty and how it can be used to prognostic the transplant patient. Dr. Pankaj Puri moderated the discussion with Dr. Hitesh Chawda, Dr. Amit Gupte, Dr. Rashmi Badhe, Dr. Pooja Lakhani and Dr. Tanuja participating in the panel.
This was followed by the panel discussion on an important topic that we all deal with on a daily basis acute-on-chronic liver failure moderated by Dr. Shiv Sarin. Dr. Neerav Goyal, Dr. Ashok Choudhary, Dr. Prem GV, Dr. Sourabh Phadtare and Dr. Vasant Nagvekar discussed how to manage, when to offer transplant and futility of care in these sick patients.
Next were two-panel discussions on deceased organ donation. The first was on deceased donor selection and allocation in the setting of local or systemic infections. This was moderated by Dr. Dinesh Zirpe with Dr. Shailesh Sable, Dr. Vineet Shah, Dr. Saurabh Kamat, Dr. Ansari, Dr. Sunil, Dr. Subramanium Swaminathan and Dr. Camilla Rodrigues as panellists.
The next panel was moderated by Dr. Ravichandra Siddachari on deceased donor selection and allocation in the setting of donor comorbidities and marginal grafts due to abnormal LFT, significant previous history steatosis and poorly managed donors. How to assess and decided a plan of action. On the panel were Dr. Sumana, Dr. Bipin, Dr. Naveen Ganjoo, Dr. Harshit, Dr. Prasad Akole and Dr. Sunil.
This was followed by a panel discussion on liver allocation systems in India moderated by Dr. Srinivas Reddy and Dr. S K Mathur with panellists' Dr. Anand Khakar, Dr. Swarnalatha and Dr. Sheetal Mahajani.
This was followed by a series of talks the first on normothermic regional perfusion by Dr. Amelia Hessheimer. Dr. Prashantha S. Rao, Dr. Vinayak Nikam and Dr. Bharat Shah chaired the session.
The next talk was on liver transplantation for colorectal liver metastasis by Prof. Rene Adams and it was chaired by Dr. Mahesh Goel, Dr. Chetan Kantharia and Dr. Prachi Patil.
Following this, Dr. Ashish Bavdekar spoke on metabolic liver diseases chaired by Dr. Nishant Wadhwa, Dr. Aarti Pawaria and Dr. Snehal Mallakmir. The last talk before lunch on day 2 was the living legend lecture by Dr. Henri Bismuth with the session being chaired by Dr. Sudhindaran and Dr. Neeraj Saraf.
The day 2 lunch symposium was on immunosuppression in a patient with renal dysfunction with two talks given by Dr. Neeraj Saraf and Dr. Gaurav Gupta. Dr. Paari Vijayaraghavan and Dr. Mihir Vohra were the chairpersons.
The post-lunch session started with a panel discussion on ethical issues in DDLT such as directed/conditional donation, orphan liver and donor/recipient death in the operating room. This was moderated by Dr. Puneet Dhar with the panellists' being Dr. Anand Bharatan, Dr. Avnish Seth and Dr. Rekha Barot.
The next panel moderated by Dr. Sanjay Nagral was on policy interventions to improve access to liver transplantation in India and the participants were Dr. Samiran Nundy, Dr. Sunil Shroff, Dr. Marti and Mrs. Sujata Ashtekar.
This was followed by the discussion on immediate pre-transplant recipient issues such as hyponatraemia, fever and abnormal computed tomography chest moderated by Dr. Charles Panackel. The panellists were Dr. Ramdip Ray, Dr. Ameya Sonawane, Dr. Sonali Saraf and Dr. Anita Mathews.
The last three sessions for the day were all talks starting with COVID-19 and liver transplant by Dr. Joy Varghese chaired by Dr. Prabhu, Dr. Pavan Hanchanale and Dr. Tanu Singhal. Next was the talk on ILTR by Dr. AS Soin and chaired by Dr. Madhusudhan and Dr. Ameet Mandot. The last talk of the day was on recent advances in liver transplantation by Dr. Sonal Asthana and was chaired by Dr. Sachin Dagga and Dr. Pathik Parikh.
This was followed by inauguration, LTSI executive committee meeting and the general body meeting.
The last day of the meeting started with a talk on multivisceral transplants by Dr. Kareem. The chairpersons for this session were Dr. Mahesh Gopashetty, Dr. Nayeem and Dr. Sandeep Attawar. Next, Dr. AS Soin spoke on management of portal vein thrombus during liver transplant. The session was chaired by Dr. Gaurav Chaubal, Dr. Dinesh Balakrishnan and Dr. Prakash Jain. This was followed by the presentation on the use of induction in liver transplant by Ashok Jain with Dr. Vivekanand Shanmugam, Dr. Sharath Putta and Dr. Saurabh Mukhewar moderating the session.
These were followed by a panel discussion on simultaneous liver transplants and bariatric surgery moderated by Dr. Vigyan Jain. The panellists were Dr. Chirag Desai, Dr. Sharmila and Dr. Pooja Bhangui.
Next was a panel discussion on the management of post-transplant graft dysfunction moderated by Kaushal Madan. The faculty on the panel were Dr. Viniyendra Pamecha, Dr. Dinesh Jothimani, Dr. Rajat Bhargav and Dr. Mukul Vij.
Dr. Dmitri Benzinover spoke about the role of transesophageal echocardiography in liver transplants chaired by Dr. Ashish Malik and Dr. Seema Balhotra. Following this, Dr. Vasudevan KR spoke on the surgical challenges of dense adhesions during transplant. The session was chaired by Dr. S Bhalerao and Dr. Saurabh Kapoor.
Next, Dr. Vijay Vohra moderated a panel discussion on intraoperative fluid, inotropes and dialysis management. The panellists were Dr. Ameya Panchwagh, Dr. Manish Pathak, Dr. Sumit Goyal and Dr. Vaity Charudatta.
Following this, Dr. Ravi Mohanka spoke about outflow reconstruction in DDLT. The chairpersons were Dr. Pranjal Modi, Dr. Sujoy Pal and Dr. Sneha Vaswani. This was followed by a talk on portal vein reconstruction in paediatric recipients by Dr. Mureo Kasahara. Dr. Sanjay Goja and Dr. Naimish Mehta chaired the session. Next Dr. Shaleen Agarwal spoke about how to avoid hepatic dissection and its management. The session was chaired by Dr. Punit Singla and Dr. Kumar Palaniapan. This was followed by Dr. P Balachandran speaking on biliary reconstruction techniques and the role of stents/T-tubes. The chairpersons for this session were Dr. Shailendra Lalwani and Dr. Manish Verma. Next, Dr. Mohammed Rela spoke about his experience in auxiliary partial orthotopic liver transplant with Dr. Rajiv Lochan, Dr. Ninad Deshmukh and Dr. Vibhor Borkar chairing the session.
The panel discussion on simultaneous liver transplant and coronary artery bypass graft moderated by Dr. Amit Rastogi was followed by lunch. The panellists were Dr. Rajshekhar Perumala, Dr. Chetan Salunkhe, Dr. Ravi Ghavat and Dr. Chandrashekhar Kulkarni.
The day 3 lunch symposium was on laparoscopic and robotic donor hepatectomy. Dr. Biju Chandran and Sudhindran spoke on robotic donor hepatectomy and Dr. Vivek Vij spoke about laparoscopic donor hepatectomy. The chairpersons were Dr. Rajesh Rajalingam and Dr. Palanivelu.
The post-lunch session started with two-panel discussions. The first was on reperfusion syndrome and cardiac arrest during transplant moderated by Dr. Shanshank Pandey. The faculty on the panel were Dr. Suresh Raghavaiah, Dr. Nivash Chandrashekaran and Dr. Suresh Vasanth. Next was the panel discussion on coagulation management conducted by Dr. Shyam. Dr. Chitra, Dr. Manjunath and Dr. Puneet Jain were the panellists.
This was followed by a talk on antibody-mediated rejection by Dr. Manav Wadhavan. The chairpersons were Dr. Kamlesh Bokil, Dr. Chetan Kalal, Dr. Nalini Bansal and Dr. Ushma. Next, Dr. Narendra Chaudhary spoke on improving compliance for recidivism. Dr. Anand Vijay and Dr. Mihir Vohra chaired the session. The talk on neurological complications: PRES and others was given by Dr. Pankaj Agarwal chaired by Dr. Gaurav Mehta and Dr. Ruchi Shetty. The last talk of the meeting was on ABO-incompatible liver transplant by Dr. Subhash Gupta. This was chaired by Dr. Biju Pottakat and Dr. Olith Selvan.
The proceedings came to an end with the announcement of the awards for the best poster, oral and video presentations and vote of thanks by Dr. Ravi Mohanka and Dr. Aabha Nagral.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.