ILBS Annual Book Report 2017

Pediatric Hepatology Institute of Liver and Biliary Sciences (ILBS) was the first centre to officially establish a department of ‘Pediatric Hepatology’. Although pediatric liver units were working in the various centres of the world but “Pediatric Hepatology” as a specialty was not recognized in India. Department of Pediatric Hepatology at ILBS is a full fledged department with well trained faculty and senior residents. We have established a fully functional pediatric hepatology ward which is well equipped for prompt management of infectious, metabolic and hereditary liver diseases in neonates, children and adolescents. There are a lot of structural, infective, inborn errors of metabolism and autoimmune diseases of the liver amongst children. These disorders are very distinct from the liver disease seen among adults. The OPD attendance in the department of Pediatric Hepatology has also shown remarkable exponential growth. Majority of the patients are referred cases of neonatal and childhood liver diseases from all parts of the country. We have referrals from various hospitals of Delhi where junior doctors accompany patient to learn the work and understand the management of the patients and then discuss the monitoring of the patient with us from time to time. The Department has about 60 admissions each month in the ward and PICU. There was pressing need of the increase in beds in PICU as well NICU. The second phase building has already given us the much required increase in beds in ward, NICU and PICU this year. Diagnostic and therapeutic Pediatric GI endoscopies and procedures like hepatic vein pressure gradient and hepatic vein angioplasty as well as stenting are being performed. Fully functioning Pediatric liver transplant unit at ILBS has done 46 Pediatric liver transplants in the last 5 years. Intramural and extramural research is being done regularly in the department to tackle unanswered queries in the field of metabolic and infectious childhood liver disease. We have about 12 research projects involving the faculty and residents of the department. The academic activity of the department includes holding of regular lectures, case presentations, seminars and symposia, journal club, group discussions, clinical meetings and clinical grand rounds. 33

Our Mission The mission of the Department of Pediatric Hepatology has been well sketched out right from the onset. On one side we are dedicated to the state of art patient care, and at the same time we as a department have been making a continued effort in causing more awareness among the pediatricians regarding identification and management of common childhood liver diseases. From time to time we participate in mass awareness programmes also, to help in the prevention and identification of the common hepatic disease among children. Besides we have participated in the prevention of infective hepatitis on televisions and school health programmes. Services Highlights  Outdoor facilities for evaluation of neonatal and childhood liver disease.  Pediatric Hepatology ward for prompt management of infectious, metabolic and hereditary liver diseases in neonates, children and adolescent including NICU and PICU.  Age and clinical profile appropriate protocol based approach to various metabolic liver disorders in neonates, children and adults.  Diagnostic and therapeutic pediatric GI endoscopies.  Procedures like hepatic vein pressure gradient and hepatic vein angioplasty as well as stenting are being performed.  Plasmapharesis in the acute liver failure and acute-on-chronic liver failure patients to bridge the gap to liver transplant.  Pre-transplant evaluation and post-transplant monitoring done by the department along with the HPB surgery and various specialties.  Pediatric hepatobiliary surgeries like Kasai’s portoenterostomy, Hepaticojejunostomy and Partial Hepatectomy are being d one routinely and pre and post-operative care is provided for these patients.  Splenic artery embolization and radiofrequency ablation are the radiological interventions performed routinely for pediatric cases.  Counseling is done to parents through ILBS website and we are in the process of developing a “Query Corner” on ILBS website to help the general pediatricians with the diagnosis and management of different childhood liver diseases. Services Rendered Services 2014 2015 2016 2017 New patients attended OPD 1899 1612 1709 2114 Admissions in Pediatric ward 589 599 587 682 Pediatric admissions in ICU 14 20 26 52 Diagnostic UGIE 134 189 211 263 Therapeutic UGI  Esclerotherapy 25 28 30 28  Band ligation 29 35 37 51  FB removal 01 02 01 01 34

Services 2014 2015 2016 2017 ERCP 10 32 16 30 HVPG 08 10 02 08 Colonoscopy 19 22 26 20 Sigmoidoscopy 12 08 09 15 Liver Biopsies: • Percutaneous 104 122 139 153 • TJLB 07 05 06 10 • HVPG 08 10 08 8 • HV Angioplasty 02 01 03 01 • IVC Angioplasty - - - 01 • TIPSS 02 01 02 03 New Services and Facilities  It was for the rst time at our centre we have developed an algorithm guided approach to metabolic liver disease would help cost-effective investigative work up and early detection of the disorders. Diagnosis of the metabolic liver disease has been made easier and costeffective by the development of age and clinical profile appropriate protocol based approaches to various presentations of liver disorder in neonates, children and adults. We have proven that it increases the case detection as well as decreases the cryptogenic/ indeterminate cases.  Complete evaluation of the hereditary liver and pancreatic disorders is available in the department.  Pediatric Liver Transplant Program available at the lowest cost in India. Educational Activities Details of the Educational activities (CME/Conf/workshop) hosted by the department in 2016  Clinical Scenarios in Pediatric Liver Disease 2017 (CSPLD 2017): Department of Pediatric Hepatology organizes annual conference with the aim to spread awareness about Pediatric Hepatology among young pediatricians and fresh post-graduates. CSPLD 2017 was the 4th annual conference in this series. The basic concept of the conference includes real life case scenarios in pediatric liver diseases laying emphasis on approach based learning for their management. There was focused approach on ‘Wilson’s disease’ and ‘autoimmune hepatitis’ at this year’s conference. We also had case based discussion where cases were presented by freshly passed out post graduates and senior residents. Each such case was allotted a moderator who advised the presentation of the case and also posed questions during the presentation in order to send across clear concepts. The conference has seen increasing participation with more than 200 delegates this year. The event had participation from dedicated international and national faculty working in the field of Pediatric Hepatology. 35

 Monthly Teleconference: The department runs a monthly teleconference with Texas Children’s Hospital on first Tuesday of every month. This teleconference is an opportunity for pediatric hepatology teams from each centre to discuss latest research, clinical approach and other topics on the subject. This conference gives an opportunity to our residents to interact with international faculty and discuss issues related to day-to-day management of patients, management protocols as well as research topics. So far we have had 6 such sessions. Course Offered No of Candidate Student admitted Student Passed in Name of Course /year in year 2017 year 2017 DM in Pediatric Hepatology 1 Dr Priti Vijay Dr Bikrant Bihari Lal PDCC in Pediatric Hepatology 2 Dr Stanzen Chakdour Dr Sheetal Ganju Dr Sneha Madasu Dr Ruchika Kumar Department’s Achievements  C.P Mittal award for Young Investigator- Awarded to Dr Bikrant Bihari Lal at 4th Annual conference of ISPGHAN, held at Guwahati, India in 2017.  Best Oral Paper award in Hepatology section- Awarded to Dr Bikrant Bihari Lal at 4th Annual conference of ISPGHAN, held at Guwahati, India in 2017.  Best Oral Paper Award at Master class in Liver Disease (MCLD) 2017, held in Chennai, India- Awarded to Dr Snehavardhan Pandey for paper titled ‘Profile and Outcome of first 109 cases of Pediatric Acute liver Failure at a Specialised Pediatric Liver Unit in India’.  Second prize in ‘Best thesis Award’ category- Awarded to Dr Bikrant Bihari Lal at Annual conference of IJP, held at AIIMS, New Delhi, India in 2017. Conference Presentations 26th Annual Conference of Asian Pacific Association for Study of Liver Diseases (APASL) 2017, Shanghai, China held on 16-19th Feb 2017.  Oral presentation titled ‘Predictors of Acute kidney Injury in Children with Acute- onchronic Liver Failure’ by Dr. Seema Alam.  Oral presentation titled ‘Plasma Lactate Predicts Mortality in children with Hyperacute Liver Failure’ by to Dr. Arti Pawaria.  Poster presentation on “Subjective Global Nutritional Assessment Vs Conventional anthropometry” by Dr. Arti Pawaria.  Poster presentation on “Liver involvement in Hemophagocytic lymphohistiocytosis – Experience from a tertiary liver referral centre” by Dr. Arti Pawaria.  Poster presentation on “Duct Paucity in children: Spectrum, clinical Profile and Outcome” by Dr. Babu Lal Meena. 36

50th annual European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) meeting held at Prague, Czech Republic in May 2017.  Oral paper presentation by Dr Rajeev Khanna titled ‘Prevalence, Clinical Spectrum and Outcome of Pediatric Drug Induced Liver Injury’. Annual Conference of American Association of Liver Disease ‘The Liver Meeting 2017’ held in Washington DC, USA  Paper presentation by Dr Seema Alam titled ‘Decompensated Wilson’s disease: Advanced Hepatic Encephalopathy and High Bilirubin decide the need for Liver Transplantation. Does the New Wilson’s index help?’.  Paper presentation by Dr Seema Alam titled ‘Analysis of the efficacy and safety of sequential therapy using Pegylated Interferon and nucleos(t)ide analogue versus standard therapy for treatment of immunotolerant and immunoclearance cases of chronic hepatitis B infection in children’.  Poster presentation by Dr Babu Lal Meena titled ‘HVOTO in Children- Etiology, Clinical Profile and Outcome following Radiological Interventions’.  Travel Award to Dr Arti for her paper ‘Plasma Lactate Predicts Mortality in children with Hyperacute Liver Failure. 4th Annual conference of ‘Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition 2017’ held in Guwahati, India  Oral presentation by Dr Bikrant Bihari Lal titled’ Weekly regimen of Vitamin D3 supplementation is better that stoss therapy for vitamin D deficiency treatment in children with CLD’.  Oral presentation by Dr Bikrant Bihari Lal titled ’Sequential therapy versus standard therapy for treatment of immunoactive and immunoclearance children with chronic hepatitis B infection.  Poster presentation by Dr Babu Lal Meena titled ‘HVOTO in Children- Etiology, Clinical Profile and Outcome following Radiological Interventions’.  Clinical aspect of “Clinicopathological correlation” in a case of “Infantile liver failure” from PGIMER, Chandigarh presented by Dr. Rajeev Khanna. Visiting Faculty To The Department In 2017 Name Institution Department of Pediatric Gastroenterology and Liver Dr. Tamir Miloh Transplantation, Children’s Hospital, Houston, Texas, USA Dr. Marianne Samyn Department of Pediatric Hepatology, King’s College hospital, UK Prof. S.K. Yachha SGPGIMS, Lucknow, India Dr. Anshu Srivastava SGPGIMS, Lucknow, India Prof. B R Thapa PGI Chandigarh, India Dr Naresh Shanmugam Global Hospital, Chennai, India 37

Dr V.S Sankaranarayanan Chennai, India Dr Ashish Bavdekar KEM Hospital, Pune Prof. Jayantee Kalita Department of Neurology, SGPGI, Lucknow, India Dr J. Barath Department of Pediatrics, JIPMER, Pondicherry, India Staff Name Designation Prof. Seema Alam Professor and Head Dr Rajeev Khanna Associate Professor Dr Vikrant Sood Assistant Professor Senior Resident Dr Bikrant Bihari Lal, Dr Arti Pawaria, Dr Snehavardhan Pandey, Dr Babu Lal Meena, Dr Stanzen Chakdour, Dr Priti Vijay Nurses Leena Kurian, Geena Devasia, Monika, Manju Jose, Sheeja George, Jomol P.J, Jaya Krishan Academic and Research Achievements of Faculty Prof. Seema Alam Prof. Seema Alam established the first ever department of Pediatric Hepatology in the country. The department has achieved various milestones since then: starting the Pediatric Liver Transplantation program in September 2011 where we have transplanted 35 children, initiation of Post-doctoral Certificate Course in Pediatric Hepatology in January 2013 and we have finally trained 9 PDCC fellows successfully. The DM program in the specialty from September 2013 – nationally the first ever and only training in this superspeciality is in its fourth year. Number of children attending out-patient clinic as well as those admitted in the wards have been increasing steadily. She is keenly interested in metabolic liver disease and her earnest enthusiasm has helped create widespread awareness about such disorders among pediatricians and adult gastroenterologists. Clinical Scenarios in Pediatric Liver disease was an idea introduced by her and it is successfully running in its fifth year.  Total Number of publications 61  Total Number of publications in 2017 8 Conference attended 1. Invited Faculty in the 4th Annual conference of Indian society of Pediatric. Gastroenterology Hepatology and Nutrition (ISPGHAN) held at Guwahati, 2017. 2. Invited Faculty in ‘’Hepaticon 2017’’ held in Mumbai, 2017. 3. Invited Expert in the Task Force on Wilson’s Disease, held in Mumbai, 2017. 38

4. Invited Faculty in the ‘Master class in Liver Disease- MCLD 2017’ held in Chennai, 2017. 5. Invited Faculty at the 25th Silver Jubilee meet of the ‘Indian National Association for Study of Liver Disease’ held in New Delhi 2017. 6. Invited Faculty in the Taskforce on Chronic Hepatitis B Management-Pediatric Liver. Transplantation, held in New Delhi, 2017. 7. Presented two papers at the Annual Conference of American Association of Liver Disease ‘The Liver Meeting 2017’ held in Washington DC, USA titled:  Decompensated Wilson’s disease: Advanced Hepatic Encephalopathy and High Bilirubin decide the need for Liver Transplantation. Does the New Wilson’s index help?  Analysis of the efficacy and safety of sequential therapy using Pegylated Interferon and nucleos(t)ide analogue versus standard therapy for treatment of immunotolerant and immunoclearance cases of chronic hepatitis B infection in children’. Award  Received award for being the ‘Guide’ for thesis which was awarded the second position in the best thesis awards of the Indian Journal of Pediatrics, held at AIIMS on 10th September 2017. Dr. Rajeev Khanna Dr. Rajeev Khanna joined the department in July 2011 and has contributed significantly to the growth of the department, on account of his diligent work and enthusiasm. His research interests include pediatric portal hypertension, biliary atresia, acute liver failure, neonatal cholestasis, viral hepatitis and pediatric liver transplantation. The department has received national and international acclaims on account of his academic work. He believes in a team-work model; acknowledging and promoting others who have contributed towards his achievements. He is an active member of the Echo program initiated by the Institute, and delivered talk related to pediatric hepatology via tele-conferencing on several occasions with active involvement of pediatric residents and faculty from various medical colleges.  Total Number of publications 29  Total Number of publications in 2017 6  Total No. of Projects 1  As a principal investigator titled: “Association of jejunal and stool microbial profile with cholangitis and short-term outcome in infants with biliary atresia after Kasai portoenterostomy”. Shortlisted for subsequent approval by Departmental of Health Research (DHR). Conference attended 1. Invited Faculty in the 4th Annual conference of Indian society of Pediatric Gastroenterology 39

Hepatology and Nutrition (ISPGHAN) held at Guwahati, 2017. Presented clinical aspect of “Clinico-pathological correlation” of a case of Infantile Liver failure from PGIMER Chandigarh. 2. Drug Induced Liver Injury’ at the 50th annual European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) meeting held at Prague, Czech Republic in May, 2017. Dr. Vikrant Sood After completing his super-speciality training in Pediatric Hepatology (DM course) from Institute of Liver and Biliary Sciences, New Delhi, Dr Vikrant Sood joined as Assistant Professor in the same department, the only said department in the country. He has been working in the present department since its very inception and the entire team has been instrumental in establishing a fully functional pediatric hepatology unit which is well equipped for prompt management of infectious, metabolic and hereditary liver diseases in neonates, children and adolescent, including successful running the only public sector Pediatric liver transplant program in the country. In his limited career span, he has initiated research and published papers in the field of wilson’s disease, pediatric acute liver failure, portal hypertension and other core areas of pediatric hepatology.  Total Number of publications 29  Total Number of publications in 2017 8  List of Projects 1  National collaborative proposal under consideration under Department of Biotechnology, Govt of India- titled “Indian Collaborative Research Network on Wilson’s Disease (ICROWD): Understanding molecular genetics towards better diagnosis and therapy” 40

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Hepatopancreatobiliary and Liver Transplant Surgery 42

Hepatopancreatobiliary and Hepatopancreatobiliary and Liver Transplant Surgery Liver Transplant Surgery The Department of Hepatopancreatobiliary and Liver Transplant Surgery offers high end services to patients with hepatobiliary and pancreatic diseases. ILBS has become a high volume centre of excellence for complex liver and pancreatic surgeries. It is the only public sector undertaking in India with a successful liver transplant program, performing both live and deceased transplants for adults and children. We have performed over 450 liver transplants. Advanced laparoscopic surgeries are being performed with increasing frequency and success. The department is equipped with the state of the art infrastructure and dedicated professionals. Our results are at par with the best international standards. The department is successfully conducting the M.Ch. program in HPB Surgery which has become one the most sought after surgical super specialty. The department has deep interest in research, both clinical and basic, as evidenced by publications in national and international journals. Services Rendered Services 2016 2017 Liver Transplantation 95 92 Donor hepatectomy 74 81 Lap Cholecystectomy 275 277 Lap Minor Hepatectomy 3 6 Lap Necrosectomy 12 9 Lap CDC Excision 4 3 Advanced Laparoscopic surgeries 42 47 Major Hepatectomy 25 27 Hepaticojejunostomy 14 14 43

Services 2016 2017 Choledochol Cyst Excision 10 7 Minor Hepetectomy 9 7 Extended Cholecystectomy 18 14 Frey's Procedure 4 6 Necrosectomy Open 6 7 Pancreaticoduodenectomy 35 37 Hilar cholangiocarcinoma resection 4 6 Total 630 640 New Services and Facilities Started Liver transplant program at Swai Man Singh Medical College Jaipur. It was a big challenge for the team, to perform such an high end operation in a public sector hospital. This was successfully accomplished with three transplants being performed. Department has taken more challenging and high risk cases such as successfully transplanting five month old baby with fulminant liver failure, low GRWR, Hepato Pancteatico Duodenectomy for Gallbladder Cancer, Vascular resection for Hilar-Cholangio Cancer / Pancreatic Cancer. Course Offered The M.Ch course pioneered by the department has become one of the most sought after course for superspeciality training in the country, showing the credibility of the department. In the nationwide NEET exam conducted this year, candidate who opted for the course were the top rankers and the seats were filled by rank 24. Course Candidates Admitted M.Ch. HPB Surgery 3 44

Department’s Achievements  Department of HPB Surgery and Liver Transplantation is being increasingly recognized in both patient and medical circles as a destination for high quality patient care and academics.  The liver transplant program has grown in strength with around hundred transplants are being performed every year for 3 consecutive years. The preioperative survival of patients is more than 90% which is comparable to best centers in the world.  The outcome of live liver donors has been outstanding with major complications rate less than 4% , among the best in the world.  About 20% of transplant performed are emergency transplant for patients with acute or acute on chronic liver failure which is a rarity in any new program and big achievement for the team.  Pediatric liver transplant program has been successfully established with more than 40 children have ben transplanted. Nearly half of these children needed emergency transplant for acute liver failure which is a big challenge for any team.  Department has keen interest in developing deceased donor liver transplant (DDLT ) program and has performed highest number of DDLT in North India. We have set new trends in the country by transporting organs from distant cites such as Jaipur, Indore, Lucknow, Chandigargh and successfully transplanting. We have trained teams from other institutes like SMS Jaipur, JIPMER Pondicherry, IGIMS Patna and SGPGI Lucknow. We have successfully started liver transplant program at SMS Jaipur this year thus setting a new trend in the country which will open doors for other public sector hospitals to positively think about starting transplant program.  The clinical and research work done in the department has been published in high impact factor journals. The department had one of the highest numbers of abstracts in IASG, Puduchery and a randomized controlled trial carries out in department on technique of back table perfusion was awarded as best paper in oral presentation and was further accepted for publication MELD Score of adult patients who underwent transplant in Transplantation. Year wise number of live donor (LDLT) and dead donor Post transplant survival (DDLT) liver transplant 45

The residents are actively involved in academic research and promoted to present their research work in various international and national conference. The below mentioned list provides the details of research work presented during academic year 2017. Scientific Presentation in international conference  Pediatrics living donor liver transplantation for acute liver failure: Single center experience (Oral presentation at International liver transplantation society (ILTS)-2017 conference at Prague)was presented by Dr. Rommel.  Volumetric analysis of liver regeneration in living donor. (Poster presentation at International liver transplantation society (ILTS)-2017 conference at Prague)was presented by Dr. Nihar.  Prevalence of acquired or inherited pro coagulant state in patient with extra hepatic portal vein obstructions(Oral presentation at IHPBA Bangalore 2017) was presented by Dr. Vaibhaw. Scientific Presentation at national conference  Dual (arterial portal) versus only portal perfusion in living donor liver transplantation: Randomized control trial. (Oral award winning presentation at IASG-2017, Pondicherry), was presented by Dr. Rommel.  Diffusion weighted MRI and NLR accurately predicts infection in suspected infected pancreatic necrosis-award oral paper presentation at IASG-2017, was presented by Dr. Rommel.  Liver donor liver transplantation for acute liver failure: Outcome analysis (Oral presentation at IASG-2017(Pondicherry), was presented by Dr. Ankur.  Short term patency of neo middle hepatic vein in right lobe living donor liver transplantation (Oral presentation at IASG-2017, Pondicherry), was presented by Dr. Ankur.  Surgical management of hilar cholangiocarcinoma: case series from tertiary care hospital (Oral presentation at IASG-2017, Pondicherry), was presented by Dr. Kumaraswamy.  Deceased donor liver transplantation: Perspective from public sector hospital in India (Poster presentation at IASG-2017, Pondicherry), was presented by Dr. Kumaraswamy.  Live donor liver transplantation for acute liver failure in children: Single centre experience (Poster presentation at IASG-2017, Pondicherry), was presenterd by Dr. Rommel. Visitors in Department  Professor V K Kapoor, SGPGI Lucknow.  Professor Nigel Heaton, Kings College Hospital, London. Staff Faculty Designation Prof. TK Chattopadhyay Senior Consultant Prof. Viniyendra Pamecha Professor and Head of department 46

Dr. Senthil Kumar Additional Professor Dr. Shridhar V Sasturkar Assistant Professor Dr. Piyush Kumar Sinha Assistant Professor Dr. Ragini Kilambi Assistant Professor Dr. Nilesh Sadashiv Patil Assistant Professor Senior Residents Dr. Ankurkumar Kanjibhai Vagadiya, Dr. Imtiakum Jamir, Dr. Kumaraswamy.P, Dr. Shashwat Sarin, Dr. Devi Singh Dhankhar, Dr. Bramhadatta Pattnaik, Dr. Sahil Gupta, Dr. Vivek R, Dr. Venkatesh BS Nurses Mr. Sanjay Joshi, Ms. Amom Beda Devi, Ms. T.Prameshwari Devi, Ms. Debola Devi, Mr. Sandeep Jhajhariya, Mrs. Thailuna, Ms. Smitha Thomas, Ms. Hatneichin Cecilia Touthang, Mr. Mohan Sharma, Ms. Omila, Ms Jisha, Ms Sandhya NM, Ms. Manju, Ms Sarita Devi, Ms Adanai KW, Ms Anix P, Ms Neha B Technical Staff Mrs. Vibhuti Sharma, Mr. Kuldeep Varshney, Mr. Sunil Kumar, Mr. Neeraj Kaushik, Mr. Ravi Chauhan, Mr. Pushpendra Kumar, Mr. Kamaljit Singh, Mr. Mahesh Pal Singh, Mr. Jitender Kumar, Mr. Shailender Singh, Mr. Mahipal Yadav 47

Academic and Research Achievements of Faculty Dr. Viniyendra Pamecha Dr. Pamecha is Professor and Head. He joined ILBS in 2010. He has established the liver transplant program at ILBS making it high volume center with results comparable to best international centers. He has performed many complex liver and pancreatic resections. Under his leadership liver transplant program at SMS jaipur has been started. His research work is published in leading journals of the specialty and has been presented in many National and International congresses. He is dedicated to development of deceased donor liver transplant and training of young surgeons in the specialty. His research areas include liver regeneration, portal hemodynamics and immune regulation in solid organ transplantation. Before joining ILBS he has worked in London UK, from 2003 to 2010, initially at the renowned Liver Unit of King’s College Hospital (2003 - 2005) and subsequently at Sheila Sherlock Liver Centre, Royal Free Hospital (2005 - 2010). He was awarded Fellowships in Multi organ Retrieval, Liver Transplantation and Hepato Pancreatico Biliary Surgery by the European Board of Surgery in 2009. He received the prestigious FRCS in Hepato Pancreatico Biliary Surgery in 2010.  Total Number of publications 49  Total Number of publications in 2017 13  Total No. of Projects 10 List of Projects  To study the impact of bone marrow derived stem and progenitor cells in regeneration of transplanted liver.  Comparison of proliferative and dierential potential of adipose tissue derived Mesenchymal stem cells in cirrhotics and normal individuals- pilot study.  Regulatory T cells in Living Donor Liver Transplantation: Characterization and Functionality (Pilot Study)”.  To study the correlation between labarotory parameters and post-operative course after living donor liver transplantation.  Single venous outow reconstruction in LDLT using right lobe graft.  Validation of definition of early graft dysfunction in LDLT.  CT Volumetry in donor compared to recipient at 1 week post living donor liver transplantation and affecting factors. Award  Visiting Professor – Indira Gandhi Institute of Medical Sciences, Patna. Invited Speaker  Small for Size – How much? Annual Conference – Indian Society of Surgical Gasterenterology, Pondechery.  Marginal deceased liver donor – How far we can go? Annual Conference - Indian 48

Society of Organ Transplantation, Indore.  Selection and Optimization for Live donor liver transplantation. Annual Conference - Indian Association for Study of Liver Disease, New Delhi.  Live donor liver transplantation – Beyond conventional criteria for HCC and Alcoholic hepatitis. Annual Conference – Indian Society of Gastroenterology, Bhuneshwar.  Master Video – Donor Hepatectomy - Kerala Chapter of Indian Association of Surgical Gasterenterology, Kattayam.  Resection for Large HCC - Kerala Chapter of Indian Association of Surgical Gasterenterology, Kattayam.  Liver Regeneration after Partial Hepatectomy – Indo French Symphosium, ILBS.  Portal Vein Embolisation Vs ALLPS – Moderated Debate Annual Conference – Indian Chapter of International Hepato Pancreatico Biliary Association.  Liver Transplantation for Alcoholic Liver disease - Center for Liver and Biliary Sciences Conference, New Delhi.  Small for Size Syndrome; Diagnosis and Management - Transplant Hepatology Course, Medanta Hospital New Delhi.  Resection for HCC at FALS 2017 - Sir Ganga Ram Hospital, New Delh. Dr. T. K. Chattopadhyay Dr. TK Chattopadhyay was head of the department of GI Surgery, AIIMS. He has interest in the diseases of the oesophagus, portal hypertension, ulcerative colitis, pancreatic cancer, disease of the liver and biliary tract to name a few. He was involved in the rst cadaveric liver transplantation at AIIMS and published nearly 200 research papers in various national and international journals. He has presented papers in various conferences in India and abroad. He is recipient of the prestigious S R Joglekar gold medal for the best paper published in the Indian Journal of surgery in 1985. He was chosen to deliver the prestigious Col. Pandalai oration in ASI 2010. He is the founding member of Indian Association of Surgical Gastroenterology. He went to become its secretary and president. He was also a visiting professor of School of medicine, Creighton University. After serving the AIIMS for nearly 40 years, he joined ILBS as Professor of HPB Surgery in 2010.  Total Number of publications 200 Dr. Senthil Kumar Dr. Senthil Kumar graduated from the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry. He completed his surgical residency in 1995 and was awarded the S.B Sen Gold medal for the best outgoing po-st graduate in the university, in general surgery. After completing three years of senior residency, he pursued higher surgical training in the UK. He was awarded the fellowship of the royal college of surgeons of Edinburgh in 1998. In the UK, after completing a research fellowship, he gained 49

experience in various sub specialties in surgery including colorectal, endocrine, vascular, upper GI, hepatopancreaticobiliary surgery and liver transplantation. He has worked in major Hepatobiliary and liver transplantation units in the UK including The Royal Free Hospi - tal, The Royal London Hospital and the Queen Elizabeth hospital, Birmingham. He obtained the certicate of completion of specialist training (CCT ) in 2011. He has in addition been trained in diagnostic and therapeutic Upper and Lower GI endoscopy, laparoscopy, emergency and trauma surgery. He has been an instructor in the Advanced Trauma Life Support course (ATLS) and the Care of the Critically Ill Surgical Patient course (CCrISP), in the UK. His current areas of interests include living donor liver transplantation, multi-organ retrieval and the management of primary liver malignancies. He joined the Department of HPB Surgery and Liver Transplantation at ILBS in 2013.  Total Number of publications 45  Total Number of publications in 2017 2 Invited Speaker  26/01/2017: Critical care in liver disease, ILBS, Delhi. Delivered a talk: Äbdominal compartment syndrome”.  28/01/2017: IHPBA 2017, Bangalore. Deliverd a talk: “Liver transplantation in Colorectal liver metastasis”.  17/03/2017: ASGKON GASTRIA 2017, Kumarakom, Kerala. Delivered a lecture: “Hilar block- preoperative optimisation”.  08/04/2017: CME on NASH, Mumbai. Delivered a lecture: “Donor selection in living donor liver transplantation”.  08/08/2017: Sixth Ramalingaswamy memorial oration day, ILBS, Delhi. Delivered a talk: “Noninvasive diagnosis of acute cellular rejection in liver transplantation”.  24/11/2017: Indo-French surgical workshop, AIIMS, Bhopal. Participated as a faculty and also delivered a lecture: “Overview of liver transplantation”. Dr. Shridhar V. Sasturkar Dr Shridhar Vasantrao Sasturkar did his general surgery training from S.C.B. Medical College. Cuttack. He pursued his specialty training in H.P.B surgery and Liver Transplantation from ILBS New Delhi. His area of interest includes liver transplantation and H.P.B malignancy. His keen interest in academics and research is well evident by various national and international presentations made in past years. His area of interest includes Liver regeneration and portal hemodynamics in living donor liver transplantation.  Total Number of publications 17  Total Number of publications in 2017 6 50

Dr. Piyush Kumar Sinha Dr. Piyush Kumar Sinha did his general surgery training from Post Graduate Institute of Medical Education and Research, Chandigarh and completed his MCh HPB Surgeryt training from ILBS, New Delhi. He joined the Institute as Assistant Professor in 2014. His areas of interest are Liver Transplantation and HPB malignancy.  Total Number of publications 9  Total Number of publications in 2017 5 Dr. Ragini Kilambi` Dr. Ragini Kilambi did her MS (General Surgery) and then MCh in Gastrointestinal Surgery and Liver Transplantation from the All India Institute of Medical Sciences, New Delhi. She also trained briey in gastrointestinal and HPB surgery from SGPGI, Lucknow. After completing her MCh, she continued to pursue her keen interest in research and academics by working as a senior research associate in the department of Gastrointestinal Surgery at AIIMS. During her residency, she has been trained in the fields of laparoscopic and open hepatobiliary, pancreatic and luminal surgery. She has an active interest in research and academics and has a number of publications in various national and international journals and textbooks to her credit. She has also presented papers and posters in various national and international conferences and won awards for the same. Her areas of interest include advanced laparoscopy, hepatobiliary and pancreatic cancers, and acute and chronic pancreatitis.  Total Number of publications 13  Total Number of publications in 2017 5 Dr. Nilesh S Patil Dr Nilesh Patil did his MS in general surgery from Bangalore medical College and then completed MCh in Surgical Gastroenterology from G. B. Pant Institute of Postgraduate Institute of Medical Education and Research, New Delhi. He received training in complex gastrointestinal and minima l invasive surgeries. He was actively involved in research and academic work. Apart from being dextrous in performing difficult surgeries, he also published many papers in international and national journals. He pursued his specialty training in Liver transplant and Hepato-Pancreato-Biliary Surgery from CLBS, Apollo Hospital, New Delhi. Before joining ILBS, he worked as an assistant professor in the department of Surgical Gastroenterology at SRMS, Bareilly. He has presented papers and posters in various conferences and authored many chapters in textbooks of G I surgery. His areas of interest are liver transplantation and HPB malignancy.  Total Number of publications 9  Total Number of publications in 2017 2 51

Anaesthesia and Critical Care Medicine 52

Anaesthesia and Anaesthesia and Critical Care Medicine Critical Care Medicine Department of Anaesthesia at Institute of Liver and Biliary Sciences provides perioperative anaesthesia care for surgical and interventional procedures in the setting of operation theatres as well as in day care endoscopy and radiological procedures. The department is also actively involved in postoperative care of high risk surgical patients admitted to surgical and transplant intensive care units and also provides round the clock acute pain services for management of postoperative pain for patients discharged to surgical wards after their surgery. Besides providing the the clinical services, the department of is also actively engaged in teaching and research activities. It has an active teaching program under which students are admitted to MCI recognised post-doctoral courses including DM and PDCC in transplant anaesthesia and critical care. The Department takes pride in its alumni who are all well placed and have been occupying positions of repute all over the world. The department since last 5 years have been successfully conducting a one day symposium for clinicians involved in conduct of anaesthesia and perioperative critical care for solid organ transplant recipients by the name of TRANCRIT which has become a much awaited event of the speciality. The critical care division along with the hepatology department conducted the 1st National conference on critical care and Infection in Liver diseases which was a 3 day event with 6 parallel conference workshops. The conference was a huge success including nursing college which had an overwhelming response for their critical care workshop. The Liver coma ICU and HDU was shifted to the newly constructed Phase 2 of ILBS and made fully functional. The number of ICU beds now stands at 28 including four isolation rooms, while the number of HDU beds is now 16, including 2 isolation rooms. The ICU has acquired 53

state of the art ventilators, non invasive cardiac monitoring devices and other equipments as per guidelines to provide the best patient care. Separate counselling room has been made so ensure privacy and facilitate video-conferencing. Services Rendered Services 2016 2017 Liver Transplant 92 88 Kidney Transplant 40 38 GI and Urology Surgeries 1216 916 Endoscopy Procedures 11175 26420 Radiology Suite Procedures 1148 915 Miscellaneous 1337 485 Liver Coma ICU 1077 899 HDU 1054 1472 Liver Transplant ICU 174 191 Surgical ICU 903 853 Educational Activities 6th Transplant Anaesthesia and Critical Care Symposium, TRANCRIT 2017,Date: 12th May 2017 1st National conference on Critical Care and Infection in Liver diseases, Date 24-26th January 2017. Courses Offered Course Candidates Admitted Candidates Passed DM Organ Transplant Dr Neha Tandon Dr. Kelika Prakash Anaesthesia and Critical Care Dr. Sumit Gupta, Dr. Kishore Dr. Atchaya Arun PDCC Liver transplant Kumar Dr. Udit Dhingra, Dr. Harshita Om Prakash Anaesthesia and Critical Care Dr. Ankur Sharma Singh, Dr Tanvi Meshram, Dr. Geeta Rajput Dr. and PDCC Critical Care (Liver Dr. Md. Qurram Parvez Vibha Goel, Dr. Sudhir Kumar Bisherwal, Dr. Shilpa ICU) Tiwari, Dr. Shailesh Kumar Sahu Department’s Achievements The department successfully conducted 6th Edition of TRANCRIT 2017. Candidates enrolled in the DM Organ Transplant Anaesthesia and Critical Care have successfully completed the course. The students who have successfully completed the academic programs from the Department of Anaesthesia have been successfully recruited to various centers of repute both nationally and internationally. 54

Visiting Faculty To The Department In 2017 Name Institution Dr Suman Lata JIPMER Puducherry Dr Kunal Singh IGIMS, Patna Dr. Nidhi Arun IGIMS, Patna Dr Shashank Dhiraj IGIMS, Patna Staff Faculty Designation Prof. Chandra Kant Pandey Senior Professor and Head Prof. M.K. Arora Professor Dr. Manish Tandon Associate Professor Dr. Lalita Gouri Mitra Associate Professor Dr. Vandana Saluja Assistant Professor Dr. Prashant Mohan Agarwal Assistant Professor Dr. Kelika Prakash Assistant Professor Dr. Rafat Shamim Assistant Professor Dr. Gaurav Sindhwani Assistant Professor Dr. Neha Garg Assistant Professor Senior Residents Dr Kartik P, Dr. Nanda Kumar, Dr. Neha Tandon, Dr. Atchay Arun Kumar, Dr. Kishore, Dr. Sumit Gupta, Dr. Parvez Qurram, Dr. Harshita Om Prakash Singh, Dr. Tanvi Meshram, Dr. Udit Dhingra, Dr. Geeta Rajput, Dr. Vibha Goel, Dr. Sudhir Kumar Bisherwal, Dr. Shilpa Tiwari, Dr. Shailesh Kumar Sahu, Dr. Gopinath R, Dr. Feroze Sathpathy Technical Staff Md. Shakil Hashmi, Md. Parvez Ahmad, Ms. Geeta Verma, Mr. Ramesh Chandra, Mr. Arun Kumar, Mr. Praveen Kumar, Mr. Bhupender Singh, Mr. Raju Yadav 55

Academic and Research Achievements of Faculty Dr. Chandra Kant Pandey Dr. C K. Pandey graduated and postgraduated from Moti Lal Nehru Medical College Allahabad. Before joining Institute of Liver and Biliary Sciences, New Delhi, he worked as Additional Professor Anaesthesiology at Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow and Senior Consultant Sahara Hospital Lucknow. Presently he is working as Senior Professor of Anaesthesiology at ILBS. He conceptualized and spearheaded a DM in Organ Transplant Anaesthesia and Critical Care This course is the first and only MCI recognized course in the subject so far. While holding various academic positions and working on liver related aspects of anaesthesia he has written a book entitled “Hepatic and Biliary Diseases: Anaesthesiologists’ Perspective” (the first book on the subject by an Indian author in the country). The book is a comprehensive review on th e anatomy, physiology and relevant anaesthetic pharmacology of the liver as well the anaesthetic management of patients of liver disease posted for transplant and non-transplant surgery. He is actively involved to establish Liver Transplant Programme at SMS Medical College Jaipur and Indira Gandhi Institute of Medical Sciences, Patna.  Total Number of publications 90  Total Number of publications in 2017 6 Conferences attended  Chaired session on “Recent advances in paediatric anaesthesiology” during RAPACON 2017 on 4th February 2017 at Noida.  Delivered lecture on “Approach to a case with liver dysfunction” in Central Zone (ISA)- PG Assembly From 1st – 5th March, 2017 at Lucknow.  Delivered lecture on “Approach to a case of obstructive jaundice posted for Abdominal Surgery” in Central Zone (ISA)-PG Assembly From 1st – 5th March, 2017 at Lucknow.  Delivered lecture on “An approach to a case of obstructive jaundice” 5th PG Assembly SGPGIMS Lucknow from 17thMarch to 19th March 2017.  Delivered lecture on “Lactate and liver Disease” in Fast Tracking in Liver Transplantation at Max Super Speciality Hospital Saket, New Delhi on 22nd April 2017.  Delivered a lecture on “Lactic Acidosis and its implications in anaesthesia” ISACON Central Zone at KGMU Lucknow on September 2, 2017.  Judged competitive paper session at KGMU Lucknow, ISACON Central Zone Sep 2, 2017.  Delivered a lecture on “Preoperative concerns and optimization of adult with organ transplant undergoing non-transplant surgery” RSACPCON at Kanpur September 17, 2017.  Delivered a lecture on “Challenges in anaesthesia for non-transplant surgery in chronic liver disease” ISACON Pudducherry State Conference at Pondicherry 24th September, 2017.  Delivered a lecture on “Preoperative management of acute liver failure” during UTAC, Kochi October 2, 2017. 56

 Chaired session “Fluids and products during transplant” during UTAC, Kochi October 2, 2017.  Panellist for “Acute on Chronic Liver Failure” during UTAC, Kochi October 2, 2017.  Panellist for “Nightmare during transplant surgery” “Porto-pulmonary Hypertension” during UTAC, Kochi October 2, 2017.  Delivered lecture on “Management of Upper Gastrointestinal Bleed in ICU” during EZCCCON at Ranchi, October 28-29, 2017 Dr. M.K. Arora Dr Arora recently joined the department. He was earlier the Professor and Head, Department of Anesthesiology at AIIMS , New Delhi. He has nearly 40 year experience in speciality of Anesthesiology , with an advanced training in Anaesthesia at McGill University Health Centre, Montreal, Canada where he got special training in Anaesthesia for Liver Transplantation. His research interests include critical care , regional anesthesia and pediatric anesthesia . He has administrative experience as Head of department having more than 35 Faculty members and large number of residents under his supervision.  Total Number of publications 70  Total Number of publications in 2017 12 Dr. Manish Tandon Dr. Manish Tandon did Post graduation in Anaesthesia (M.D) in 2003, following which he did 3years. of Senior Residency from SGPGIMS Lucknow which included 1 year of Post Doctoral certication course in Cardiac Anaesthesia in the year 2006. He practiced cardiac Anaesthesia uptill 2011 Nov, when he joined ILBS Hospital as Assistant Professor. He is presently working at ILBS as Associate Professor in Anaesthesia and practices preoperative Anaesthesia and Critical Care for patients of Liver and Kidney transplant and for other major and minor GI and Urology surgeries. He is actively involved in the academic and clinical research activities of the department.  Total Number of publications 30  Total Number of publications in 2017 4  Total No. of Projects 5 List of Projects  Effect of addition of Sub-anaesthetic dose of Ketamine on Gagging during propofol based sedation for Upper GI endoscopy; a prospective randomized double blind study  Hemodynamic Behaviour after LT; A surrogate marker for liver function.  Assessment of Tapentadole as an adjunct for postoperative pain relief in patients undergoing open abdominal surgery.  Validation and comparison of new Objective Pain Score. 57

 Effect of the side of nostril on the success rate of nasogastric tube insertion  Study of Thickness of Tongue by ultrasound and its relation with severity of disease in patients with cirrhosis of liver: Start Date 11th July 2017. Conferences attended  DVT in ICU: Clinical relevance: ISCCM2017  Anaesthesia For Liver Transplant Surgery: GB Pant Hospital PG Assembly 2017  Bridging Therapy in Acute Liver Failure: CALT 2017 at Medanta Hospital Dr. Lalita Gouri Mitra Dr. Lalita did her postgraduation from Tata Memorial Hospital Mumbai followed by her senior residency at GTBH New Delhi before joining as a teaching faculty at Calcutta medical College, Kolkata in 2004. She has been trained in Australia as an Anesthesia fellow and worked there as a sta specialist as well before joining ILBS in 2013. She has keen interest in critical care and anaesthesia for trauma and paediatrics. She is a certied ATLS provider.  Total Number of publications 2 Conferences attended  Liver Clinics 2017 Chennai  Criticon 2017 Kochi  DCCS 2017 New Delhi  Accordian 2017 New Delhi Award  Chairman award Delhi Critical Care Symposium by ISCCM 2017 Dr. Vandana Saluja Dr. Vandana graduated from Dr.D.Y. Patil medical college, Mumbai and postgraduated from GMC, Aurangabad. She did her post doctoral in liver transplant anaesthesia from ILBS in year 2013. She has keen interest in practice of critical care medicine.  Total Number of publications 9  Total Number of publications in 2017 1  Total Number of projects 2 List of Projects  Validity of Thromboelastogram TEG to predict bleeding after central venous cannulation in liver disease and correlation with lab parameters.  Inferior vena cava distensibility in liver disease: Comparison of hemodynamically stable and unstable patients. Conferences attended  Delivered a talk on “Hyponatremia in cirrhosis: Implication for perioperative uid management and outcome at Trancrit 2017. 58

Dr. Prashant Mohan Agarwal Dr. Prashant Mohan Agarwal has done his MBBS from Madras Medical College, Chennai in 2006 . He has done MD Anesthesiology and Critical Care from N. H. L Municipal Medical College, Ahemdabad in 2010. He has done his senior residency from SGPGIMS , LKO in Anesthesia and Critical Care from 2010 to 2013. Dr. Prashant has worked as attending consultant in critical care medicine at MEDANTA THE MEDICITY, Gurugram. He is working as Assistant Professor in Critical Care Medicine at ILBS since 2014. Currently, he is working in the field of critical care in patients with liver disease. His areas of interest are use of USG in critcal care, mechanical ventilation in ARDS, hemodynamic monitoring.  Total Number of publications 1 Dr. Kelika Prakash Dr Kelika Prakash completed her MBBS from Maulana Azad Medical College in 2009 and M.D in anaesthesiology from B.J. Govt Medical college in 2012. She worked as a senior resident in AIIMS, New Delhi before joining ILBS to pursue her DM in transplant Anaesthesiology abd Critical Care in 2014. After passing her DM in 2017, she joined this department as Assistant Professor in August 2017. Her interests include studying the molecular effects of anaesthetic drugs and PONV.  Total Number of publications 6  Total Number of publications in 2017 4  Total Number of projects 1 List of Projects  Evaluating the role of circulating cell free nucleic acids (cf-NA) as a potential marker of organ related injury in patients undergoing prolonged anesthesia. Award  Second Prize in TRANCRIT 2017. Dr. Rafat Shamim Dr Rafat Shamim has done his MBBS from GSVM Medical college, Kanpur and MD in Anaesthesia from SGPGIMS, Lucknow in 2014. Later he did PDCC in Organ Transplant Anaesthesia from SGPGIMS, Lucknow in 2015. He completed his senior residency from SGPGIMS, Lucknow. He has active interest in the study of pain management, hemodynamic monitoring and coagulopathy in liver transplant.  Total Number of publications 15  Total Number of publications in 2017 6 59

DR. GAURAV SINDHWANI Completed postgraduation in Anaesthesia from J.N medical college, Belgaum in 2014 . After that I worked as a senior resident for two years in department of anaesthesia, PGIMER Chandigarh. Than I did PDCC in organ transplant anaesthesia from SGPGI, Lucknow in 2017. My area of interest includes patients undergoing liver and kidney transplant and t h e management of post-operative pain.  Total Number of publications 8  Total Number of publications in 2017 8 Conferences attended  Presented a poster in TRANSCRIT 2017 on bilateral quadratus lumborum block in a patient undergoing laparoscopic donor nephrectomy. List of Projects  Efficacy of ultrasound guided quadratus lumborum block as postoperative analgesia in patients undergoing renal transplantation – a randomize double blind clinical study  Comparison of efficacy of ultrasound guided continuous quadratus lumborum block versus continuous epidural block for post operative analgesia in patients undergoing laparoscopic nephrectomy – A prospective randomize clinical study. Dr. Neha Garg Dr Neha Garg have joined assistant professor in the department of anaesthesia at ILBS in October 2017. Dr Garg has done medical training (MBBS) from UCMS, Delhi and internship from Guru Teg Bahadur Hospital, Delhi (2004-2009). She has completed MD from PGIMER, Chandigarh and later Senior residency from AIIMS, New Delhi in 2017. Her area of interests include transplant, pain and regional anaesthesia.  Total Number of publications 7  Total Number of publications in 2017 5  Total number of projects 1 List of Projects  Comparison of Small Dose Ketamine and Dexmedetomidine Infusion. Conferences attended  ACLS/ BLS – JANUARY 2017. 60

61

Nephrology 62

Nephrology Nephrology The department of nephrology provides medical care to the patients who suffer from the disorders of kidney. It includes patient on chronic dialysis therapy or those who suffer from acute kidney failure. In addition, we provide renal replacement to the critically sick patients in the medical and surgical ICU’s. We have an 20-bedded inpatient nephrology ward with dedicated nephrology nurses. Our outpatient dialysis unit is well equipped with state of the art dialysis machines and reverses osmosis water purification system. The faculty is capable of performing all nephrology procedures including native and transplant kidney biopsies, temporary and permanent dialysis catheter and peritoneal dialysis catheters. The department runs a busy nephrology and transplant clinic for nephrology care. In addition, we have a dedicated Liver-Kidney clinic, perhaps the only one of its kind in the country for patients with combined liver and kidney diseases. We have a rapidly growing kidney transplant program and have performed 158 kidney transplants including living donor, cadaveric and renal transplant in HIV positive patients. We recently started performing the kidney swap for blood group incompatible patients. We have regularly presented papers,abstracts and posters in major international and national nephrology conferences. The department of Nephrology regularly organizes free kidney camp every year in the month of March to celebrate world kidney day. The department also takes prides in spreading about the awareness of kidney disease by media by regularly delivering lectures on Delhi Doordarshan. 63

Services Rendered Name 2016 2017 New Patients attended in Nephrology OPD 2366 2076 Admissions in Nephrology 800 729 Kidney Transplant 60 38 Kidney Biopsy 94 56 Permacath instertion 83 134 HD sessions (dialysis unit) 9182 9003 ICU dialysis 1833 1701 CRRT 277 283 New Services and Facilities Ten bedded nephrology ward in Phase 2. Educational Activities Details of the Educational activities (CME/Conf/workshop) hosted by the department in 2017 under following headings Name of the activity: World Kidney day celebration Date: March 9, 2017 Description: Public awareness lecture on kidney health and disease was conducted along with cultural program by the staff of the department and free kidney health check up camp was organized. Course Offered Course DNB Nephrology superspecialty course (3 years) Staff Faculty Designation Dr. R P Mathur Senior Consultant Dr. Ashish Kataria Assistant Professor Dr. Venkata Siva Tez Assistant Professor Residents Dr. Dibya Jyoti Kalita, Dr. Anuradha singh, Dr. Abhishek, Dr. Ajit, Dr. Jugal, Dr. Anmol, Dr. Neha, Dr. Chandan Nursing Staff Mariamma Thomas, Shiju Jose, Sandeep Nunia, Ching, Hoihkim Leichumbam, Somala Devi, , Gangmei, Yogendra Nunia, Divya S Nair, Beda Devi, Abin Shinil, Sher Singh, Bhupende Sulakshana, Zou, Vasudev, Pradeep Sanjay, Brij Kishore, Ved Prakash, Abdul, Rita Devi, K Nivedita , B Lolia, Jaison Abraham, Chandra Mohan 64

Academic and Research Achievements of Faculty Dr. R.P. Mathur Dr. R.P. Mathur is Sr. Consultant and Head, Dept. of Nephrology and, Transplant Medicine at Institute of Liver and Biliary Sciences, New, Delhi. He is an aluminus of AIIMS from where he did DM, Nephrology. He has 31 years of experience in the field of, Nephrology with a brilliant academic record. He is the recipient of, Fellowship of Indian College of Physicians, Fellowship of Indian, Society of Nephrology. The title “ISN Scholar” was conferred upon, him by International Society of Nephrology after Fellowship in, Clinical Nephrology at Manchester Royal Infirmary, UK. Dr Mathur has been DNB Teacher and Examiner and has served on important positions in, the Zonal Chapters of Indian Society of Nephrology and Association of Physicians of India., Presently he is Vice President of Indian. Society of Nephrology (NZ Chapter) His areas of special interest are prevention and retardation of progression of Chronic Kidney Disease and improvement of kidney transplant outcome. He has published research papers in various national and International journals and has contributed chapters on Nephrology in various books. Dr. Akash Kataria Dr Ashish Kataria did his MBBS from the All India Institute of Medical, Sciences (AIIMS), New Delhi. He did his residency in Internal Medicine, from the Hofstra NSLIJ School of Medicine, NY, USA and Nephrology, fellowship from the same institution. He further completed, fellowship in Renal transplantation from the Medical College of, Wisconsin, Milwaukee, WI, USA. He is a designated Hypertension, Specialist by the American Society of Hypertension (USA)., During his Nephrology Fellowship, he was awarded the first ever, Alison Norris Nephrology Fellow Award by the New York Society of, Nephrology (NYSN) for his research in nephrology. He is board certified in Nephrology and, Internal Medicine from the American Board of Internal Medicine (ABIM, USA).  Total Number of publications 10  Total Number of publications in 2017 2 Dr. Venkata Siva Tez Dr P Venkata Siva Tez is a nephrologist with experience in teaching and practice of clinical nephrology, dialysis and renal transplantation. He graduated from Osmania Medical College, Hyderabad (MBBS). He did his post graduation in Internal Medicine (MD) and specialised in nephrology (DM). He is specialty certified in nephrology and infectious disease by The Royal College Of Physicians UK. He recently joined Institute of Liver and Biliary Sciences as Assistant professor of nephrology. 65

Renal Transplant and Urology 66

Renal Transplant and Urology The Dept of Renal Transplant and Urology was established in June 2012. In a span of 5.5 years, it has developed into a state of the art urological centre offering renal transplant, laparoscopy and endourology services. With the joining of new faculty members, the department has been further strengthened and is now aiming to cater to the increased volume of patients. Providing the full spectrum of urological care with expertise using the latest cutting edge technology at an affordable cost and with short waiting times are the hallmarks of the department. The department contains all the latest equipment viz ESWL machine, 100 watt holmium laser, Flex x 2 flexible Ureteroscope, Semirigid Ureteroscopes, Olympus bipolar generator and Urodynamic Laboratory. Services Rendered Services No. Services No. DJ stent change/remova 158 Transurethral resection of bladder tumor 7 AV fistula 108 CAPD catheter removal 1 RIRS (Retrograde Intrarenal Surgery) 41 Laparoscopic simple nephrectomy 7 RSL (ureterorenoscopic lithotripsy) 58 Laparoscopic partial nephrectomy 1 PCNL (percutaneous nephrolithotripsy 19 Open partial nephrectomy 1 PCN (Percutaneousnephrostomy) 18 Laparoscopic radical nephrectomy 2 Orchidectomy 5 Open radical nephrectomy 2 High inguinal orchidectomy 1 Perineal urethrostomy 2 Suprapubic cystostomy 4 Urethroplasty 3 Circumcision 1 Laparoscopic pyeloplasty 5 Dorsal slit 2 Frenuloplasty 1 Bladder neck incision 1 Cystoscopy 15 OpticaL internal urethrotomy 12 Cystolithotripsy 2 Urethral dilatation 4 Endoscopic incision for ureteric stricture 1 67

Live donor laparoscopic nephrectomy 35 Uroflometry 477 Bilateral cadaver nephrectomy 1 Urodynamic study 20 Renal transplant 38 Transrectal ultrasound guided prostate biopsy 8 Departments Achievements This year saw the completing more than 100 successful kidney transplants. The new developments in the department include starting of ABOi kidney transplants. This is an important boon for the patients who do not have blood group compatible donors in their families. The success of transplants across the blood group barrier in a government set- up is a ray of hope for middle class Indian families, as this procedure is very expensive in private hospitals. Further the department also has started receiving kidneys from outstation (Lucknow). Even after prolonged hours of ischemia, we could achieve a successful outcome comparable to in-house retrievals. The ILBS urology students have been selected for prestigious MCh Urology programmes at various National Institutes. Academic and Research Achievements of Faculty Dr. (Maj Gen) D V Singh Dr. (Maj Gen) D V Singh is an alumnus of Maulana Azad Medical College and Armed Forces Medical College. He did super specialisation in urology with an M.Ch. (Urology) from the prestigious All India Institute of Medical Sciences (AIIMS), New Delhi. He was commissioned into the Indian Army and while in Armed Forces Medical Services (AFMS) and served in various appointments as a Medical Officer, General Surgeon and Urologist. He started a successful Live Related Donor Renal Transplantation Program at the Armed Forces Medical College and the associated Command Hospital, Pune as Professor and Head of Urology in 2007. He was credited with the development of a successful Laparoscopic Donor Nephrectomy Program since 2009 and gave impetus to the Deceased Donor Renal Transplantation and Minimally Invasive Urology Programs since 2010 at the Army Hospital Research and Referral, Delhi. For the outstanding achievements he has been awarded the “Chief of the Army Staff (COAS) Commendation” twice. Dr. Ahmed Kamaal Dr. Ahmed Kamaal completed MS general surgery from JJM Medical college in 2007. Then he pursued DNB Urology from Apollo Hospital, New Delhi. Because of special interest in Renal Transplant, he joined fellowship program at Medanta the Medicity Gurgaon in 2014 and continued there as associate consultant in urology and renal transplant till he joined ILBS in July 2017. Conferences attended Graft PCNL- point of technique in North Zone USI conference. 68

Dr. Anil Sharma Dr. Anil Sharma completed his M.Ch in Urology and Renal Transplant from Government Medical College, Calicut, Kerala in 2014. Also cleared DNB Urology in October 2015. Joined BSA medical college and hospital ,Rohini, New Delhi. Subsequently did his fellowship in Renal Transplant in June 2017from Medanta, the medicity. Acquired skills in Laparoscopic donor nephrectomy and recipient surgery during his fellowship and joined Medanta as Associate consultant Renal Transplant and Urology before joining ILBS as consultant Renal transplant. Conferences attended  Video presentation- difficulties in renal access during laparoscopic donor nephrectomy in Agra urological club best video session in NZUSICON conducted in Meerut in November 2017.  Paper presentation ONCOCON DELHI 2017-Persistently raised psa and negative biopsy.  Panelist ONCOCON DELHI 2017- Interesting case discussions presentations. Dr. Vijay Kumar Sarma Madduri Dr. Vijay completed his MBBS and MS from All India Institute of Medical Sciences (AIIMS) New Delhi, the top ranked medical college of the country. He Completed MCh in Urology and Renal Transplant from Institute of Postgraduate Medical Education and Research (IPGMER) Kolkata. He worked for 1 year as Consultant in Urology and Renal transplant at Global Hospitals Hyderabad where he obtained valuable experience in deceased donor renal transplants. Subsequently he joined ILBS. His areas of interest are laparoscopic urology, renal transplant, RIRS and endourology. He is member of committee tasked by the Urological society of india to frame national guidelines on Urinary incontinence. Total number of publications 5 Conferences attended  A comparative study of monopolar and bipolar transurethral resection of prostate for benign prostatic hyperplasia. Poster, USICON, Hyderabad.  Laparoscopic partial nephrectomy without using intraoperative ultrasound guidance: a feasibility study. Video presentation, USICON, Hyderabad. 69

Medical Oncology, Radiation Oncology and Nuclear Medicine 70

Medical Oncology, Radiation Oncology and Medical Oncology, Radiation Nuclear Medicine Oncology and Nuclear Medicine The oncology services at ILBS provide an evidence-based multidisciplinary diagnostic and therapeutic applications to patients with cancer. The emphasis is on gastrointestinal/ hepatopancreaticobiliary malignancies and other related tumors like neuroendocrine tumors, GIST, and GI lymphoma. Consultation and treatment for other malignancies like urogenital, lung, lymphoma, leukemia, head and neck, breast, gynaecological and brain tumors is also available. While the treatment strategy is scientific and evidence-based, it is also individualized considering patient’s social and economic profiles. Palliative care is an essential component along-with the cancer-directed therapy. In view of the increasing number of cancer patients in ILBS, hospital based cancer registry has been initiated under the National Centre for Disease Informatics and Research, ICMR. Medical Oncology services include a 9-bedded chemotherapy daycare and a 3-bedded inpatient ward. The department provides screening, diagnosis and treatment for cancers affecting the digestive and other systems. The list of gastrointestinal cancers include liver, gall bladder, bile duct, pancreas, esophagus, stomach, colon, rectum, anal canal etc. Other malignancies like lymphoma, leukemia, sarcoma, lung, kidney, breast cancers etc are also under the purview of the department. Evidence-based chemotherapy protocols as per standard guidelines are followed. Chemotherapy is administered with good supportive treatment and a tender loving nursing care. Targeted molecular therapy is practiced as per scientific evidence. 71

Radiation Oncology services include a state-of-the-art linear accelerator for the evidence- based treatment of cancers with external radiotherapy. The department is completely equipped with 4-D CT simulator, TPS, and mould room. Provisions for advanced technologies with IGRT, SBRT, IMRT, and 3-DCRT are available. Management of all cancers requiring radiotherapy is under the scope of the department. Advanced treatment with SBRT for hepatopancreaticobiliary cancers is a special area of expertise at ILBS. Focused radiation delivery to the tumor target with sparing of normal tissues is the intent of radiotherapy for providing best outcome and quality of life to the cancer patients. The department is also going to procure brachytherapy in near future. Nuclear Medicine department has been recently established. With advancements in technology and research, management of various cancers are being increasingly directed at the molecular and cellular levels in the form of targeted therapies. The assessment of disease status and response rates are increasingly being relied upon functional and metabolic signatures over and above the morphological changes. The need for a more precise diagnosis/prognostication of diseases and personalized medicine has moved the entire world like never seen before. And ILBS is no exception. As a result, ILBS has established a dedicated Nuclear Medicine Department with a state-of-the-art 128-slice time-of-flight PET-CT. The uniqueness of PET-CT lies on its ability to noninvasively assess diseases at the metabolic and molecular levels. Moreover, the institute is procuring a 16-slice state-of-the- art SPECT-CT machine. In addition, the department would also be equipped with a 4-bedded high dose Nuclear Medicine therapy ward for Peptide Receptor Radionuclide Therapy (PRRT) and other high dose Nuclear Medicine therapies. Subsequently, the institute is committed to deliver the services of a full-edged Nuclear Medicine Department to the public for better diagnosis/ prognostication of diseases and personalized medicine, both for clinical and academic research purposes. Services Rendered Services 2016 2017 OPD 2233 2151 Chemotherapy Daycare 893 963 IPD 215 175 Course Offered  Post Doctoral Certificate Course in HPB/GI Oncology (No. of seats: 2) 72

Department’s Achievements Research activities in the dept  Multi-institutional clinical trial: Comparison of Chemotherapy or Chemoradiotherapy in Adjuvant Treatment of non-pancreatic Peri Ampullary Carcinoma - A Randomize d Controlled Trial: CAPR study. Received ethical clearance.  International clinical trial: Perioperative Chemotherapy Prior to and After Reoperation for Incidental Gallbladder Cancer – An International, Randomized Phase III Trial. Applied for ethical clearance.  Inter departmental project: Genome wise association study for evaluating the genetic/ epigenetic landscape of cholelithiasis and gall bladder cancer . Applied for ethical clearance.  Intra departmental project: An Open Label Randomized Controlled Trial to compare Metronomic Chemotherapy with Best Supportive Care Versus Best Supportive Care alone in pancreatobiliary cancers. Applied for ethical clearance.  Hospital Based Cancer Registries: Data Management Software under National Centre for Disease Informatics and Research, Bengaluru. Visiting Faculty To The Department In 2017 Name Institution Dr Kumar Alagappan MD Anderson Cancer Centre, USA Prof. Milind Javle MD Anderson Cancer Centre, USA Emory Liver and Pancreas Center, Division of Surgical Oncology Dr Shishir K. Maithel Winship Cancer Institute Atlanta, USA Dr Ranjit K Sahoo AIIMS, New Delhi 73

Staff Faculty Institution Prof Hanuman Prasad Yadav Professor (Radiation Oncology) Dr. Saphalta Baghmar Assistant Professor (Medical Oncology) Dr. Puja Sahai Assistant Professor (Radiaton Oncology) Dr. Namita Sharma Assistant Professor (Medical Oncology) Dr Bangkim Chandra Khangembam Assistant Professor (Nuclear Medicine) Junior Residents Dr Rajesh Singla, Dr Vikrant Singh Technical Staff Mr. Rose Kamal, Mr. Deepak Thaper, Mr. Manik Sharma, Mr. Prabir Banik, Mr. Kartik Saroha Nurses Ms. Shakeela, Ms. Bincy, Mr. Vishnu Academic and Research Achievements of Faculty Dr. Hanuman Prasad Yadav Dr. Hanuman Prasad Yadav completed his MBBS and MD from SMS Medical College, Jaipur, Rajasthan University in 1981 and 1986, respectively. He has worked in Sawai Mansingh Hospital and Medical College, Mahatma Gandhi Medical College and Hospital and Guru Gobind Singh Medical College and Hospital/ Baba Farid University of Health Sciences. He was the Nodal Ocer of Advanced Cancer Diagnostics and Treatment Centre, Bathinda, Punjab. He has developed comprehensive cancer treatment centre in GGS Medical College, Faridkot and Bathinda . He has joined ILBS in 2016 as Professor, Radiation Oncology. 74

 Total Number of publications 11  Total Number of publications in 2017 1 Conferences attended  Chairperson at CRAB-E-CON, Sep 2017, Jammu.  Chairperson at Indian Cancer Congress, Nov 2017, Bengaluru.  Lifetime achievement award at NZAROI conference 2017. Dr. Saphalta Baghmar Dr. Saphalta Completed her MBBS from Mahatma Gandhi Medical College, Indore and MD medicine from Shyam Shah Medical College, Rewa. She did her DM from All India Institute of Medical Sciences in 2014. Her area of interest is GI oncology, Gynaeconcolgy and intented to study research based on preventive oncology. She is actively working with an NGO, Cancer Care India, which is spreading cancer awareness all over India. Giving lectures about cancer awareness for the NGO.  Total Number of publications 9  Total number of projects 2 Dr. Puja Sahai Dr. Puja Sahai completed her MD from Maulana Azad Medical College. She has worked as a Senior Resident and Senior Research Associate at the All India Institute of Medical Sciences, New Delhi. She is the faculty-in-charge for Hospital Based Cancer Registry at ILBS. She is working actively towards establishing radiation oncology services at the institute. She is a team member for the installation and commissioning of state-of-the-art linear accelerator at ILBS. She strives to do institutional as well as multi-institutional collaborative research for innovating treatment strategies to further improve survival results and quality of life of cancer patients. She is currently a reviewer for: British Journal of Radiology, Brachythera p y , Journal of Cancer Research and Clinical Oncology, Journal of Gastrointestinal Cancer etc.  Total Number of publications 19  Total Number of publications in 2017 2  Total number of projects 2 Conferences attended  Panelist at Big Debates in Radiation Oncology, FMRI, Gurugram, Sep 2017.  Poster at Indian Cancer Congress, Bengaluru, Nov 2017. 75

Dr. Namita Sharma Dr Namita completed MBBS and MD (General Medicine) from Jawaharlal Nehru Medical College, Aligarh Muslim University (AMU) , Aligarh followed by DM (Medical Oncology) from Sher-i-Kashmir Institute of Medical Sciences (SKIMS) , Srinagar. Her areas of interests include GI cancers, pancreatic cancers and nutritional build up in cancer patients to improve patient outcomes.  Total Number of publications 3  Total Number of publications in 2017 1  Total number of projects 2 List of Projects  Eidemiological profile of patients registered in oncology OPD at ILBS, Delhi in 2017.  A prospective study of the impact of improvement in nutritional status on outcome and quality of life in patients with GI and hepatobiliary cancers on chemotherapy. Conferences attended  Indian Cancer Congress (ICC) 2017, Bengaluru : Prole of patients registered in oncology opd at ILBS, Delhi. Dr. Bangkim Chandra Khangembam Dr. Bangkim Chandra Khangembam did his MD in Nuclear Medicine from All India Institute of Medical Sciences, New Delhi. He worked as Assistant Professor at Dr. B. Borooah Cancer Institute, Guwahati (Regional Cancer Institute), a unit of Tata Memorial Centre, Mumbai. He started and established the first dedicated Nuclear Medicine department with radioiodine therapy facility for thyroid cancer in north-east India. He also designed the first and only high-dose Nuclear Medicine therapy ward (3-bedded) of north-east India and also took the forefront role in getting the said facility commissioned. He has experience in routine and research oriented Diagnostic Nuclear Medicine Imaging with SPECT-CT (Gamma Camera) and PET-CT, and Therapeutic Nuclear Medicine including radioiodine therapy, PRRT, bone pain palliation therapy, radiosynovectomy, MIBG therapy etc. He is also a Fellow of the Asian Nuclear Medicine Board (FANMB).  Total Number of publications 19 76

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Radiology and Interventional Radiology 78

Radiology and Interventional Radiology The department boasts of high-quality patient care with world class equipment and highly trained specialists. In addition, the department continues to play a key role in advancing the state of the art: invasive, image-guided vascular and non vascular interventional procedures as well as imaging technologies including CT (computed tomography), MRI (magnetic resonance imaging), X-Ray (radiography) and ultrasound. Hence there is ample opportunity for growth in clinico-radiological work, teaching and research activities. Sub- specialty niche work is a challenge in all sub-divisions of this field namely: clinical, teaching, research and administrative as well as financial and manpower related issues. The Department of Radiology and Interventional Radiology provides comprehensive imaging services under the banner of ILBS and is one of its kinds, in the country to be solely dedicated to the subspecialty of hepatobiliary radiology. Department of Radiology and Interventional Radiology employs more than 15-certified radiologists specializing in abdominal imaging and performs more than 100,000 imaging examinations annually at the hospital. We provide excellent-quality, radiation safe and cost effective care to patients through medical imaging. Mission  The department integrates imaging into research for further advancement of technology and improved clinical benefits.  Pass on the torch of knowledge and experience gained in the field of imaging through teaching programs.  Maintain highest quality of care in clinical work, procedures and teaching. 79

Future plans of the department We plan to further our department’s growth in the field of teaching and research programs as well as design a teleradiology centre for outreach to remote areas providing them with sub specialized standard of care in the existing specialty. Services Rendered Services 2016 2017 X –rays 28594 28867 Ultrasound 22444 26643 CT Scan 9541 10916 MRI 3487 3808 Conventional fluoroscopic guided Barium studies 64 94 DEXA scans 1810 1967 3 D volumetry Transplant Evaluation 500 800 Interventional Radiology Suites for  USG / CT guided FNAC and Biopsies  PCD (Percutaneous drainage)  PTBD and stenting  Radio Frequency Ablation (RFA)  Transjugular liver and kidney biopsy  Diagnostic angiography  GI bleed embolisation  Bronchial artery embolisation  Trans-arterial chemo embolization (TACE)  Trans-Jugular Intra-hepatic Porto-systemic Shunt (TIPS)  Balloon-occluded retrograde transvenous obliteration of varices (BRTO) 80

All of the diagnostic and interventional radiology services are supported by the latest hospital informatics and PACS capabilities. These technologies are a part of the Radiology Department’s commitment to offer the best care and technology for patients and fellow physicians. Services and Facilities X-ray Ultrasound CT Scans MRI Scans 3D reconstructions for liver anatomy and volume: This procedure was introduction in the mid- 1990s in Japan and is being practiced mostly in Asian subcontinent. It is a minimally invasive, highly effective treatment for gastric varices. It is an effective treatment option for portal- 81

systemic encephalopathy secondary extrahepatic portal-systemic shunts. Although, its use in India is not widely popular, ILBS is amongst the very few centers where the procedure is being frequently performed with excellent clinical outcomes. The multidisciplinary team at ILBS consisting of the Hepatologist and Interventional Radiologists is proud to have performed one of the highest number of BRTO procedures in the country. World class Myrian French liver volumetry software was incorporated into existing MDCT and MRCP scans, to provide MEVIS like in-house reformats for the liver transplant workup. On site training at Paris was also given to faculty regarding operations of the same. Liver volumetry software Myrian™ XP-Liver uses unique segmentation algorithms to isolate entire hepatic vascular systems, healthy parenchyma and lesions and calculate their volume with high precision. It generates highly accurate, dependable and reproducible measurements, as well as three-dimensional images which facilitate interdepartmental communication. This software has set new standards in decision-making for living donor liver transplant surgery and interventional radiology procedures. Per-cutaneous trans hepatic antegrade gastro/lienorenal shunt occlusion: Large spontaneous porto-systemic shunts in the setting of liver cirrhosis may sometimes lead to recurrent severe hepatic encephalopathy. Patients who do not respond to medical management require closure of these shunts. Patients with complex venous vascular anatomy may require percutaneous access of portal vein and further cannulation of the shunt and closure of the same. A rare and challenging procedure which our team has succesfully performed in few cases. TIPS shunt reduction: Hepatic encephalopathy is the most common complication seen in patients with TIPS. Those patients having recurrent severe hepatic encephalopathy require either closue or reduction of TIPS shunt. While closure of the shunt may lead to recurrence of the symptom (UGI bleed / Ascites), reduction of the shunt remains the most reasonable treatment. Although challenging task but our interventional team has done few of these procedures using novel parallel stent technique. Transjugular renal biopsy: Renal biopsy is one of the most important invstigation for a nephrologist to determine appropriate therapy. However percutaneous biopsy may be risky in patients with low platelet count and increased prothrombin time (specially in patients with liver cirrhosis) and in such cases biopsy may be safely performed via jugular. Educational Activities Name of the activity: Hepatobiliary and interventions CME (One day CME) Date of the activity: 18th November 2017 Short Term Training  PDCC in Hepato Biliary Interventional Radiology  PDCC in Abdominal Imaging Department’s Achievements Dr Prayas Vats: Course thesis completion- Differentiation of pseudo-tumoral inflammatory conditions versus malignant mass lesions of the pancreas on magnetic resonance imaging. Dr Jitender Singh: Course thesis completion- Study of pulmonary Complications in Liver cirrhosis : An imaging perspective. 82