| Abstract|| |
Chronic liver disease is common in Saudi Arabia with viral hepatitis and schistosomiasis being the common causes. I herewith describe the experience on the first liver transplantation in Saudi Arabia and the Arab World. The patient was a 23-year old Saudi male who had cirrhosis of the liver secondary to sclerosing cholangitis. He underwent orthotopic liver transplantation on July 30, 1990. The post-operative course was uneventful and immunosuppression comprised of small doses of cyclosporine, azathioprine and prednisolone. The patient continues to be well six years post-transplant and is adequately rehabilitated.
Keywords: Chronic liver disease, Liver transplantation, Saudi Arabia.
|How to cite this article:|
Jawdat M. Story of the First Liver Transplant in Saudi Arabia. Saudi J Kidney Dis Transpl 1996;7:178-81
| Introduction|| |
Chronic liver disease is common in Saudi Arabia and usually results from schistosomiasis or viral hepatitis, which, in turn can cause primary hepatocellular carcinoma , . Congenital liver diseases, biliary atresia, metabolic disturbances and sclerosing cholangitis are also seen and constitute further indications for liver transplantation  . The Riyadh Armed Forces Hospital (RAFH) has been involved in organ transplantation activities from 1979 when the first renal transplant was performed. Heart transplantation began in 1986 and bone marrow transplantation, in 1989 , .
The acceptance of cadaveric donation by the Islamic community was already achieved and announced in the Senior Ulama Commission's Decision No.99, on August 25, 1992, which was adopted not only in Saudi Arabia but also in other Islamic countries  .
Until the liver transplantation program was started, treatment offered to patients with endstage liver disease was limited to supportive medical management of encephalopathy, ascitis and esophageal varices  . I herewith describe the experience with the first liver transplant performed in Saudi Arabia.
| Case Report|| |
Our patient was a 23-year old Saudi male, a third year student at the University of Madinah [Figure - 1],[Figure - 2]. He was suffering from chronic liver disease of eighteen months duration caused by cirrhosis developing secondary to sclerosing cholangitis. He was evaluated and investigated according to a pre-set protocol including percutaneous transhepatic cholangiogram, pre-transplant laparotomy and liver biopsy [Figure - 3]. On July 29, 1990, the Saudi Center for Organ Transplantation (previously the National Kidney Foundation), informed us that a 17-year old road traffic accident victim whose blood group was O-negative, had sustained brain-death and that his relatives had kindly agreed to donate his organs.
Our liver donor criteria were the same as the internationally accepted criteria applicable to a heart-beating donors with confirmed brain-death. The harvesting of the liver graft, hepatectomy of the diseased liver [Figure - 4] a and b and the transplantation of the liver into the recipient was performed according to the accepted techniques ,,,,, . The veno-venous by-pass technique was applied, which obviated the need for systemic anti-coagulation  . Thus, on July 30, 1990, the first-ever orthotopic liver transplantation, not only in Saudi Arabia but in the entire Arab World, was performed at the RAFH  . The post-transplant immunosuppressive treatment comprised of a combination of low-dose cyclosporin-A, azathioprine and prednisolone.
The post-transplant progress of the patient was uneventful. Following discharge, the patient was followed-up in our surgical and gastro-enterological out-patient clinics. His liver function improved progressively posttransplant [Figure - 5]. The patient continues to be well six years after transplantation and is fully rehabilitated with useful employment. This achievement was made possible by the fact that the RAFH has advanced multi-disciplinary facilities which enabled the expansion of the organ transplant program to include liver transplantation.
| Comment|| |
The number of patients in Saudi Arabia with end-stage liver disease who require liver transplantation is increasing with each passing year. Two years after the first liver transplant was performed at the RAFH, two other centers have been established in Riyadh; the King Fahad National Guard Hospital and the King Faisal Specialist Hospital, and a third in Jeddah at the King Fahd Hospital. Over one hundred liver transplants have been performed in Saudi Arabia since then.
Liver transplantation is the treatment of choice for patients with end-stage liver disease, secondary to sclerosing cholangitis , . Also, liver transplantation is a promising alternative to current therapy in the management of several forms of serious liver diseases. The reported one-year patient survival after liver transplantation is over 70%  . Our patient is nearly six years post-transplant at the time of writing this paper. He is doing well and after completing his education, he is working as a school teacher. He has also resumed his social activities, is now married, and has 18-month old, healthy daughter.
Previously, a number of Saudi patients used to have renal transplant abroad, but over the last few years, this trend has changed , . Considering the fact that the first liver transplantation in Saudi Arabia was successful, followed by the successful launching of liver transplant programs in three other centers in the Kingdom, it is hoped that in the future, we will be able to perform more liver transplants and thereby, cater to the needs of the patients with end stage liver disease.
| References|| |
|1.||Mohamed AE, Al Karawi MA, Masawy MI, Intestinal and hepatosplenic schistosomiasis. JAMA 1990;22:35-44. |
|2.||Al Karawi MA, Shariq S, El Shiekh Mohamed AR, Saeed AA, Ahmed AM. Hepatitis C virus infection in chronic liver disease and hepatocellular carcinoma in Saudi Arabia. J Gastroenterol Hepatol 1992;7:237-9. |
|3.||Ahmad FE, Al Tayeb AA, Satti MB. Wilson's diseases in Saudi Arabia: report of a Saudi Arab family. Ann Saudi Med 1991;ll(6):605-10. |
|4.||Jawdat M. Renal transplantation a personal series. Saudi Med J 1988;9:72-7. |
|5.||Al Otaibi K, Al Khader A, Abomelha MS. The first Saudi cadaver kidney donation. Saudi Med J 1985;6:217-223. |
|6.||Mohamed AE, Al Karawi MA, Al Otaibi R, Hanid MA. Results of sclerotherapy in 100 patients comparison of the outcome between schistosomiasis and hepatitis B. Hepatogastroenterology 1989;36:333-36. |
|7.||Jawdat M, Qattan N, Bassas A, Al Karawi MA, Mohamed E, Khallil H. The first liver transplant in Saudi Arabia and the Arab world. Hepatogastroenterology 1993;40:297-300. |
|8.||Starzl TE, Miller C, Brozniok B, Makowka L. An improved technique for multiple organ harvesting. Surg Gynecol Obstet 1987;165:343-348. |
|9.||Starzl TE, Iwatsuki S, Shaw BE, et al. Technique of liver transplantation, in blumgart LH (ed): Surgery of the liver and biliary tract. Edinburgh, Churchill, Livingstone 1989;2:1537-1552. |
|10.||Starzl TE, Iwatsuki S, Shaw BW, et al. Transplantation of the human liver, in Schwartz SI, Ellis H (eds): Maingots abdominal operations, Norwalk, Connecticut, AppletonCentury Crofts 1985;1687-1722. |
|11.||Calne RY. Recipient operation, in Calne RY (ed):Liver transplantation, London, Grune and Stratton 1983;155-73. |
|12.||Brolsch C, Dippe B. The technique of orthotopic liver transplantation. Chirurg 1988;59:509-18. |
|13.||Griffith BP, Shaw BW Jr, Hardesty RL, Iwatsuki S, Bahnson HT, Starzl TE. Venovenous bypass without systemic anticoagulation for transplantation of the human liver. Surg Gynecol Obstet 1985;160:270-2. |
|14.||Bismuth H. Liver transplantation: the Paul Brousse experience. Transplant Proc 1988;20:486-9. |
|15.||Iwatsuki S, Starzl TE, Todo S, et al. Experience in 1,000 liver transplants under cyclosporine-steroid therapy: survival report. Transplant Proc 1988;20:498-504. |
|16.||Furukawa H, Todo S, Imventarza O, et al. Effect of cold ischemia time on the early outcome of human hepatic allografts preserved with UW solution. Transplantation 1991;51:1000-4. |
Department of Surgery, Riyadh Armed Forces Hospital, P.O. Box 7897, Riyadh 11159
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]