Anaesthesia, Intensive Care and Pain Medicine - St Vincent's ...
Anaesthesia, Intensive Care and Pain Medicine - St Vincent's ...
Anaesthesia, Intensive Care and Pain Medicine - St Vincent's ...
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<strong>St</strong>.Vincent’s Healthcare Group<br />
Liver Transplant Pro g r a m m e<br />
<strong>and</strong> Liver Unit<br />
Departmental Review<br />
134<br />
<strong>St</strong>aff<br />
Surgical<br />
Medical<br />
Registrars<br />
Mr. Oscar Traynor, Mr. Justin Geoghegan,<br />
Mr. Donal Maguire, Mr Gerry McEntee.<br />
Professor John Hegarty,<br />
Dr. Aidan McCormick.<br />
Dr. Garret Cullen,Dr.Chun Seng Lee,<br />
Dr. Lorraine Power, Dr. Diarmuid Manning,<br />
Dr. Conor O’Brien,Mr. Ragu Varadarajan,<br />
Mr. Mashood Ahmed,<br />
Mr Richard Mascarhenas.<br />
Transplant Co-ordinators<br />
Ms.Aoife Coffey, Ms.Jennifer Fleming,<br />
Ms Yvonne Mc Garry. Ms. Sheila O’Toole<br />
Nursing<br />
Administration<br />
Liver Transplant Programme<br />
Ms.Maureen Flynn,Ms.Margaret Cullen,<br />
Ms Brenda O’Sullivan.Ms.Anne Brennan,<br />
Ms.Elizabeth Burke, Ms.Valerie O’Brien,<br />
Ms.Antoinette Flynn,<br />
Ms.Dolores Dempsey Ryan,<br />
Ms.Susan Patton,Ms.Siobhan Cronin,<br />
Ms.Carol Mc Nulty<br />
Ms.Rita Burns,Ms Noreen Kelly,<br />
Ms Aideen Holden,Ms.Georgina O’Reilly.<br />
A total of 32 liver transplants were performed in 28 patients<br />
during the year 2003. There were 20 elective transplants <strong>and</strong> 4<br />
emergency transplants,along with 8 re-transplant operations.<br />
The total number of liver transplants performed from January<br />
1993 until December 2003 was 294.The overall success rate is<br />
just over 84%, which is in keeping with the best rates achieved<br />
in large liver transplant units in the United <strong>St</strong>ates <strong>and</strong> Europe.<br />
The biggest challenge facing the National Liver Transplant<br />
Programme during 2003 was the constraint placed by the<br />
physical limitations of the Liver Unit in <strong>St</strong> Brigid’s Ward. The<br />
ward unit <strong>and</strong> staffing complement remains the same as when<br />
the programme commenced in 1993 <strong>and</strong> the workload now far<br />
exceeds the facilities available. During 2003,the hospital<br />
management in collaboration with the Department of Health<br />
<strong>and</strong> Children began work on an enlarged Liver Unit which will<br />
have 21 beds,including 5 high dependency beds <strong>and</strong> a<br />
corresponding increase in staff numbers. The enlarged unit<br />
should be open <strong>and</strong> functioning by September 2004 <strong>and</strong> will<br />
greatly enhance our ability to deliver a service which matches<br />
the needs of the National Liver Transplant Programme.<br />
Organ donation continued at a very satisfactory level during<br />
2003.Irel<strong>and</strong> is in an almost uniquely favourable position in<br />
relation to organ donation. Most transplant units throughout<br />
Europe <strong>and</strong> the United <strong>St</strong>ates are struggling to maintain an<br />
adequate service in the face of dwindling organ donations. We<br />
are extremely fortunate to have a population who are well<br />
disposed to the concept of organ donation at a time of<br />
bereavement <strong>and</strong> great personal distress.<br />
In January 2003 we marked the 10th anniversary of the first<br />
liver transplant operation. A number of commemorative events<br />
took place to mark the occasion. In February 2003 there was a<br />
commemorative celebration for patients <strong>and</strong> their families<br />
which took place in the hospital. A great many of the patients<br />
who have received liver transplants over the past 10 years<br />
attended this wonderful event, including the first patient who<br />
was transplanted in January 1993. In March 2003,a gala dinner<br />
was held for past <strong>and</strong> current staff members <strong>and</strong> this was also a<br />
highly successful event. Great credit is due to the liver<br />
transplant co-ordinators <strong>and</strong> members of the nursing staff who<br />
organised these events.<br />
The success of the National Liver Transplant Programme over<br />
the past 10 years has resulted in an ever increasing pattern of<br />
referral of patients with complex medical <strong>and</strong> surgical problems<br />
of the liver which do not necessarily require liver<br />
transplantation, but who might be treated non surgically or by<br />
types of surgery other than transplantation. This referral<br />
pattern has had highly beneficial effects on training for doctors,<br />
nurses <strong>and</strong> para medical staff at <strong>St</strong> Vincent’s University Hospital<br />
but it has also stretched the resources of the <strong>Intensive</strong> <strong>Care</strong><br />
Unit <strong>and</strong> the Department of Diagnostic Imaging.The<br />
programme has exp<strong>and</strong>ed well beyond what was envisaged in<br />
early 1993, <strong>and</strong> the success of the programme has made <strong>St</strong><br />
Vincent’s University Hospital the natural site of referral for the<br />
vast majority of complex hepatology <strong>and</strong> hepatobiliary surgery<br />
problems in Irel<strong>and</strong>.<br />
Finally, we were pleased at the arrival in September 2003 of Mr<br />
Donal Maguire as an additional consultant surgeon on the<br />
National Liver Transplant Programme. Mr Maguire has recently<br />
completed his higher surgical training with a special interest in<br />
hepatobiliary surgery <strong>and</strong> has undergone two years of training<br />
at Kings College Hospital London. His addition to the progra m m e<br />
means that we now have three surgeons based at <strong>St</strong> Vincent’s<br />
University Hospital with a major interest in liver surgery <strong>and</strong><br />
liver transplantation.<br />
Liver Research Group<br />
The Liver Research group is concerned with a variety of areas<br />
of research including Liver Transplant Immunology, Hepatic<br />
Cytokines in Health <strong>and</strong> Disease,Tumour Immunology <strong>and</strong><br />
Hepatitis C Virus infection <strong>and</strong> has been a recipient of significant<br />
funding from Enterprise Irel<strong>and</strong> <strong>and</strong> The Health Research Board<br />
in 2003. Over twenty scientific papers were presented at<br />
National <strong>and</strong> International meetings with Dr. Lucy Golden-<br />
Mason,Dr.Anna Kelly <strong>and</strong> Dr. Margaret O’Brien being recipients<br />
of awards for work presented. Higher degrees have been<br />
conferred on Dr Tony Kenna (PHD),Dr. Michael Curry (MD)<br />
<strong>and</strong> Mr. Ragu Varadarajan (NCH). For her outst<strong>and</strong>ing<br />
commitment <strong>and</strong> achievements in a wide spectrum of clinical<br />
<strong>and</strong> basic research activities,Cliona O’Farrelly was appointed<br />
adjunct Professor in the faculty of <strong>Medicine</strong> U.C.D. in 2003.<br />
Publications<br />
Kenna T, Golden-Mason L1, Porcelli SA, Koezuka Y, Hegarty JE,<br />
O’Farrelly C, Doherty DG. Selective depletion of Vα24Vß11 + T<br />
cell receptor-positive NKT cells in the livers of patients with hepatic<br />
malignancy. J Immunol 2003 Aug 15;171(4):1775-9 PMID<br />
12902477<br />
Kenna T, Golden-Mason L, Porcelli SA, Koezuka Y, Hegarty JE,<br />
O’Farrelly C, Doherty DG. NKT cells from normal <strong>and</strong> tumorbearing<br />
human livers are phenotypica <strong>and</strong> functionally distinct from<br />
murine NKT cells. J.Immunol.2003 Aug 15;171(4):1775-9.PMID<br />
12902477<br />
Smith F, Golden-Mason L,Deignan T, Norris S,Nolan N,Traynor<br />
O, McEntee G,Hegarty J,O’Farrelly C. Localisation of T <strong>and</strong> B<br />
Lymphocytes in Histologically Normal Adult Human Donor Liver J.<br />
Hepato-Gastro 2003;Sep-Oct:50(53):1311-5 PMID 14571725<br />
Curry MP, Golden-Mason L,Doherty DG,Norris S,Duffy M,<br />
Nolan N,Hall W, Hegarty JE,O’Farrelly C. Expansion of Innate<br />
CD5pos B Cells Expressing High Levels of CD81 in HCV Infected<br />
Liver J.Hepatol 2003; 38:642-650 PMID 12713876<br />
V<strong>and</strong>eputte C, McCormick PA, Docherty JR. Responsiveness to<br />
noradrenaline in aorta from wild-type, nitric ocide synthase-2,nitric<br />
oxide synthase-3 <strong>and</strong> alpha 2A/D-adrenoceptor knockout mice.<br />
European Journal of Pharmacology. 2003;466:129-136.<br />
Lee CS,McCormick PA. Telephone reminders to reduce nonattendance<br />
rates for endoscopy. J R Soc Med 2003;96:547-8<br />
McCormick PA,Treanor D, McCormack G,Farrell M.Early<br />
death from paracetamol (acetaminophen) induced fulminant<br />
hepatic failure without cerebral oedema. J Hepatol 2003,<br />
39:547-51<br />
Hade AM, Shine AM, Kennedy NP,<br />
McCormick PA. Both under-nutrition<br />
<strong>and</strong> obesity increase morbidity<br />
following liver transplantation.<br />
Ir Med J 2003;96:140-2<br />
135