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IKEM performs unique surgery to save poisoned patient

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Prague, Aug 27 (CTK) – Surgeons from the Prague-based Institute for Clinical and Experimental Medicine (IKEM) have performed a world unique liver transplant to save the life of a 34-year-old man poisoned by paracetamol, transplant surgery clinic head Jiri Fronek told reporters Thursday.

The patient, Lukas Musil, suffered from liver failure caused by an acute poisoning by anti-fever medicines. He received a smaller, auxiliary liver first so that his own liver could have some time for regeneration, and a few days later he underwent a complete liver transplant.

The patient would die in a fairly short time without a liver transplant. The hope of his rescue was very low, Fronek said.

“The serious condition required a quick decision and courage to perform something that no one in the world has done yet,” he added.

Musil overdosed on paracetamol unwittingly. He had a headache and fever for several days. As he avoided doctors so far and the troubles continued, he took a few kinds od medicines with the same active substance. He was not aware of it since the products had different names.

He started vomiting blood on Wednesday, July 15. He was hospitalised and on Friday, he was flown to IKEM in induced sleep. Doctors did not believe then that he would survive the transport.

The patient received an offer of a liver from a dead donor quite quickly, but the organ was too small and of an unsuitable blood group. This is why the doctors used this smaller liver as auxiliary one only that were sewed into his pelvis.

After three days, they checked the patient’s condition and regulated the vascular supply of both livers. His condition started improving first, but after ten days it was clear that he needed a transplant. During this surgery, both his own and the auxiliary livers were removed, and he got a liver from a dead donor of the same blood group.

Musil told reporters Thursday that his condition was so good that he might see his son to primary school on his first school day on Tuesday.

Fronek recalled that this patient was not the only one with liver failure to be helped at IKEM. This year has been the most successful in the number of liver transplants in the centre. To date, its surgeons have transplanted liver into 93 people this year, which is 15 more than during the same period last year.

Poisoning by an overdose of paracetamol, which is an active substance in many commonly used pain-killers, is one of the most frequent causes of acute liver failure. Such patients would die within a few days without a liver transplant.

Liver failure is caused by ten and more tablets containing paracetamol, but sometimes only four suffice, that is two grammes of the active substance.

IKEM has annually 10 to 15 patients with an acute liver failure who need a liver transplant, a half of whom suffer from poisoning. Other tens of patients have health troubles after an overdose, but they need not undergo a liver transplant.

Last year, the IKEM surgeons, as the first in the Czech Republic, performed an operation in which they removed only a half of liver and transplanted a liver lobe from a dead donor. The patient was a man suffering from liver failure also caused by paracetamol overdose.

There are seven transplant centres in the Czech Republic with some 10.5-million inhabitants.

Only two of them provide liver transplants – IKEM and the Centre of Cardiovascular and Transplant Surgery in Brno. They together performed 169 such transplants last year and 104 by the end of July this year.

IKEM launched a regular liver transplant programme in 1995.

Number of transplants, repeated transplants of liver at IKEM
year first liver transplants repeated liver transplants
1995 13 –
1996 25 1
1997 30 –
1998 39 3
1999 45 2
2000 39 2
2001 38 3
2002 39 1
2003 34 4
2004 56 3
2005 57 5
2006 66 1
2007 74 5
2008 63 3
2009 69 3
2010 70 4
2011 60 4
2012 80 3
2013 81 6
2014 109 10
2015 until Aug 24 81 12

Source: IKEM

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