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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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Year : 2011  |  Volume : 16  |  Issue : 3  |  Page : 120-121

Authors' reply

Department of Pediatric Surgery, Narayana Hrudayalaya Hospitals, Bangalore - 560 099, India

Date of Web Publication4-Aug-2011

Correspondence Address:
Sanjay Rao
Department of Pediatric Surgery, Narayana Hrudayalaya Hospitals, Bangalore - 560 099
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Source of Support: None, Conflict of Interest: None

PMID: 21897579

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How to cite this article:
Rao S, D'Cruz AL. Authors' reply. J Indian Assoc Pediatr Surg 2011;16:120-1

How to cite this URL:
Rao S, D'Cruz AL. Authors' reply. J Indian Assoc Pediatr Surg [serial online] 2011 [cited 2023 Jun 5];16:120-1. Available from: https://www.jiaps.com/text.asp?2011/16/3/120/83499


Thank you for the queries raised. Please find the clarifications below:

  1. Financial Cost of the treatment

    The cost of the transplantation procedure is packaged at INR 12 lakhs at our center. This includes both the donor, the recipient operations, and postoperative care until discharge. The major items of cost include disposables, medications, drugs used, and laboratory testing of tacrolimus levels. However, this amount varies widely across the country and is by no means the standard. Indirect costs are again very variable and depend entirely on the family's preferences and lifestyles.====In the first year post transplant, the immunosuppression is higher and the tacrolimus testing frequent. The expense for the medications and tests range from INR 12000-15,000 per month in the first year. Subsequently, the costs come down and by the third year post transplant, it works out to about INR 4000 per month. Fortunately, as transplantation becomes more mainstream, the costs - both of the medication and the testing, have been steadily falling.
  2. Survival by etiology

    This data needs to be qualified by the following facts:

    1. Children with biliary atresia are often in poor health. A combination of poor nutritional status, previous abdominal surgery, cholangitis, portal hypertension, and often spontaneous bacterial peritonitis puts these children in a very high-risk category. In this series, most of the deaths happened early in the series; most early cases performed were biliary atresia children, who had had a Kasai procedure by the same team earlier. This is reflected in the fairly high mortality in this group. Of the cases operated later in the series, survivals for biliary atresia have been on par with other indications.

    2. There has been only one child in each of the last four4 groups. Although the only child with fulminant hepatic failure in this series survived, he has residual neurological sequelae. The published literature suggests a survival rate of >70% for acute liver transplantation in fulminant hepatic failure as compared to >90% for other indications. [1]
  3. Indian Experience of Liver Transplantation

    Unfortunately the published Indian experience is scanty and mostly restricted to case reports and short communications. [2],[3] In the major centers, about 10% of the patients undergoing liver transplantation are children. The number of small children (<10 kg) undergoing transplants are even less (personal communication).

   References Top

1.Kelly DA. Liver transplantation in children (Editorial). Indian Pediatr 2006;43:389-91.  Back to cited text no. 1
2.Kaur S, Wadhwa N, Sibal A, Jerath N, Sasturkar S. Outcome of liver donor liver transplantation in indian children with weight <7.5 kg. Indian Pediatr 2011;48:51-4.  Back to cited text no. 2
3.Poonacha P, Sibal A, Soin AS, Rajashekar MR, Rajakumari DV.India's first successful pediatric liver transplant. Indian Pediatr 2001;38:287-91.  Back to cited text no. 3


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