Chiang Mai University’s Liver Transplant Successes
Liver cancer is one of Thailand’s biggest killers, especially amongst the elderly with more men than women diagnosed annually. Yet across Thailand there are fewer than 50 specialists in the field. A number of these specialists are residents of Chiang Mai University’s Faculty of Medicine.
“As a hepatobiliary and pancreatic surgeon, I throw everything into every case I take on and always hope for the best results,” said Assistant Professor Arnon Chotirosniramit, M.D., Hepatobiliary and Pancreatic Surgery at Chiang Mai University’s Liver Transplantation Project leader, under the Solid Organ Transplantation Centre, who went on to say that liver surgery is generally considered one of the most challenging surgeries.
The centre has conducted more adult living donor liver transplants than anywhere else in Thailand and is the only place which continuously and consistently conducts living donor liver transplants on adult patients. Over thirty liver transplants have been done by the centre and on the 4th of March 2020, it successfully transplanted a liver through laparoscopic surgery, the first in Thailand.
Thailand saw its first liver transplant twenty years ago and since then most have been done in medical schools in Bangkok. In 2008 Chiang Mai University succeeded in its first liver transplant, but with few cases, it wasn’t until 2014 that this operation became a regular part of the university’s portfolio. Liver transplants are very expensive and use a vast amount of personnel and technological resources, so it was only then that the Faculty of Medicine set up this dedicated project to develop its team and its medical technology.
The team currently running the liver transplant project comprise of Assistant Professor Sanhawit Janrungsee, M.D., Dr. Worakitti Lapisatepun, M.D., and Assistant Professor Arnon Chotirosniramit, M.D.
“Our belief is that our students must surpass us in every way,” said Assistant Professor Arnon who honed his expertise in Shanghai, China where there were many patients of liver cancer. “Otherwise if we get ill then who will take care of us? Our job is to foster great doctors.”
Assistant Professor Sunhawit, who studied and worked under Assistant Professor Arnon spent three years at the university before heading to the University of California, Los Angeles to work and study liver transplant. The United States has over 200 liver transplant surgeries per year, with most livers donated by patients who are brain dead. He then went on to study in Korea, where there are more living donor liver transplants than anywhere in the world.
There are two ways to treat liver cancer patients; liver operations, which are preferable, and liver transplants which use donated livers. It is preferable to use donated livers from patients who may be brain dead than those donated by living relatives, as there could be more possible complications. However, there is no waiting period should a living donor be found.
“After I worked in the US, I headed to Korea where each year over 350 people undergo liver transplant surgery,” said Assistant Professor Sanhawit “That meant that every day there was a surgery. After I conducted three surgeries from brain dead donors, I returned and began to plan for living donor transplants. The reason I began to focus on this is that Thai people tend not to donate their loved one’s organs as much as some other countries do. I therefore consulted with Assistant Professor Arnon and we agreed to focus on living donors transplants.”
Between 2014 and 2018 the center focused on living donor transplants with satisfactory results. That was the time when Dr. Worakitti Lapisatepun, M.D., a student of both doctors, joined the team.
“After studying under these doctors and operating on donated livers by brain dead donors, I then practiced surgery with live donor livers, which helped me have a good overview as well as gain experience on the matter.” said Dr. Worakitti. “The thing left to learn then was laparoscopic surgery, or minimally invasive surgery. After being a lecturer myself for two years and gaining more experience in aftercare, I went to the University of California, Los Angeles to work on liver transplant from patient preparation all the way through surgery and post operational care. After one year in the US I then spent four months in Korea, gaining more experience, returning to my first case here in Chiang Mai in 2020.”
“The challenge of using live donors is in ensuring the safety of the donor as well as the patient,” explained Assistant Professor Arnon. “It is very complicated and challenging to minimise the risk, though harder still to find an actual matching donor.”
The doctor went on to explain that there are social stigma attached to organ donation, a practice which is still in its infancy in Thailand. “Imagine if a father needs a liver from his adult child,” explained Assistant Professor Arnon. “The father may feel ashamed to ask such a thing of his son or daughter. On the other hand if the son or daughter refuses to donate, will they be condemned for not doing so?”