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Liver Transplants: A Cuban Public Health Success

100 operations at Cuba's CIMEQ centre
12 October 2005

By JOSE A. DE LA OSA

Liver transplants are today considered the most complex of those performed, including heart transplants. The difficulty lies in the surgery and in the organ itself due to the significant number of vital functions it performs in our body

Sandra Arias graduated in nursing, but after little more than two months she began to feel unwell. "I blamed the hospital shifts that I was doing systematically," she said. Later she noticed that her urine was "very yellow." The day before being admitted into the Medical-Surgical Research Center (CIMEQ), in Havana, her skin and eyes were perceptibly yellowing.

She explained that the analyses that they did were disturbing, with coagulation disorders. The clinical and laboratory tests gave a conclusive diagnosis: severe acute hepatitis caused by a medication, Ketoconazol, an anti-mycotic known to be toxic for the liver, which, according to the specialists consulted by Granma, "rarely causes liver failure", although Sandra is not the exception.

After complications developed the only option for treatment they could offer the patient was an urgent liver transplant.

THE LIVER

Liver transplants are today considered the most complex of those performed, including heart transplants. The difficulty lies in the surgery and in the organ itself due to the significant number of vital functions it performs in our body.

The liver, the largest organ in the human body, functions as an ultra complex and perfect biochemical laboratory. It is responsible for the synthesis of the proteins that circulate in the blood, which are of vital importance and include coagulation factors and the proteins which take care of transporting various substances. It regulates the concentration of glucose in the blood and stores it in the form of glucogen to be used at times when energy is required.

Ernesto Armando Cespedes Blanco, 50 years old. Ernesto works in the Finlay Medical Research Institute and lives in the town of Bejucal, east of Havana. He suffered from cirrhosis of the liver and recieved a transplant two and a half years ago.

No less important is the function of detoxification of drugs and substances that are produced in the organ. The liver makes the bile salts, substances that carry out the digestion of fats and it also acts as an organ depository for numerous minerals such as copper, iron and zinc.

THE TRANSPLANTS

The pioneer of liver transplants in the world is the US surgeon Thomas Starzl, who in 1963 performed the first liver graft between humans, a three year old boy, who sadly only survived for five hours.

The progress of surgical techniques and anti-rejection drugs has consolidated the success of transplants in the world, and also in Cuba. Up to 1970, a mere 30 percent of the patients had a life expectancy of one year, which with each advance has risen to 50 percent... then 80 percent..., so that at the dawn of the twenty-first Century no maximum limit can be put on the life expectancy brought by these grafts.

The first liver transplant in Cuba took place January 26, 1986 in Havana, at the Hermanos Amejeiras Clinical and Surgical Hospital. The procedure, carried out by a multidisciplinary team headed by surgeons Rene Vallejo and Jose M. de Dios Vidal, lasted more than 12 hours and the patient remained alive for five days.

The main disorders that may require a liver transplant are cirrhosis, active chronic hepatitis, birth anomalies in the bile duct of children and metabolic diseases. Alcohol severely affects the liver, hence the importance of controlling alcohol consumption before it leads to irreversible damages.

LIVER TRANSPLANT AT CIMEQ

In July, 1999, Cuba began to develop a Liver Transplant Program in collaboration with Spain’s Virgen del Rocio Hospital, with CIMEQ as the local headquarter. Since then CIMEQ has carried out one hundred grafts with survival rates similar to those achieved in highly developed institutions worldwide.

Patients’ ages range from 12 to 62; nine of them have had a second graft and two of them have had a combined liver and kidney transplant. This work is the result of a highly specialized team of surgeons, anaesthesiologists, intensive care doctors, haematologists, immunologists, radiologists, pathologists and nurses, among others.

According to CIMEQ statistics, the three main disorders that may require liver transplants in adults are cirrhosis resulting from the hepatitis C virus and alcohol consumption, and liver failure, while among children the main reasons are atresia (absence) of bile ducts and biliary cirrhosis.

The success of this program has greatly relied on the generosity of many Cuban families who, overcoming the grief of having lost a relative, have donated organs to save another person’s life, and on the self-sacrificing attitude of Cuban scientists and professionals.

Doctor Manuel Cepero Nogueira, director of CIMEQ, puts the results achieved by the center in a wider context saying that none of this would have been possible without the support of the National Health System, the Communist Party of Cuba, airplanes that have been provided to transport the organs, the Ministry of the Armed Forces, the Ministry of the Interior and the solidarity of the Cuban families.

Other medical experts involved, such as Dr. Omar Lopez Cruz, specialist in Anaesthesiology and Resuscitation techniques, and Dr. Anselmo Abdo Cuza, intensive care specialist and transplant coordinator, believe that these surgeries are a serious challenge for them as professionals. On the other hand, Dr. Leonel Gonzalez Rapado, chief surgeon and head of the team in charge of Liver Transplants says that through the years, the surgical team has gained a lot of expertise, increasing the prestige of CIMEQ.

At 29, Sandra Arias has begun a new phase in her life, a few weeks after receiving the transplant. During this initial period, she must protect herself from the surrounding environment by covering her mouth and nose. "But not my eyes —she mischievously says—, which I’m sure reflect my happiness; because I have become engaged with a neurosurgeon from the hospital."

http://www.periodico26.cu/english_new/health/liver101005.htm


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