Qualification: 
MS, DNB
rcnmenon@aims.amrita.edu

Dr. Ramachandran Menon currently serves as Associate Professor at the Department of Gastrointestinal Surgery, School of Medicine, Kochi.

Qualification: MS (General Surgery), DNB (General Surgery), DNB (Surgical Gastro), Fellow- Minimal access surgeons of India. Senior Clinical Fellowship in Multi-Organ Transplant surgery – Addenbrookes Hospitals - Cambridge UK) 

Publications

Publication Type: Journal Article

Year of Publication Title

2019

J. Shaji Mathew, Kumar, K. Y. Santosh, Nair, K., Amma, B. Sivasankar, Krishnakumar, L., Dinesh Balakrishnan, Gopalakrishnan, U., Ramachandran Narayana Menon, Sunny, A., Dhar, P., Vayoth, S. Othiyil, and Surendran, S., “Antegrade Hepatic Artery and Portal Vein Perfusion Versus Portal Vein Perfusion Alone in live Donor Liver Transplantation: A Randomized Trial”, Liver Transpl, 2019.[Abstract]


BACKGROUND: Traditionally, deceased donor liver grafts receive dual perfusion through the portal vein and the hepatic artery(HA) either in-situ or on the back-table. Hepatic artery perfusion is avoided in live donor liver grafts for fear of damage to the intima and consequent risk of hepatic artery thrombosis(HAT). However, biliary vasculature is predominantly derived from the HA. We hypothesized that antegrade perfusion of the HA in addition to the portal vein on the back table could reduce the incidence of post-operative biliary complications.

METHODS: Consecutive adult patients undergoing live donor liver transplants (LDLT) were randomized after donor hepatectomy to receive graft perfusion of HTK (Histidine-tryptophan-ketoglutarate) solution either via both the hepatic artery and portal vein (dual perfusion group,n=62) or only through the portal vein (standard perfusion group,n=62). The primary endpoints were the occurrence of biliary complications (biliary leak/stricture). Secondary endpoints included hepatic artery thrombosis and patient survival.

RESULTS: The incidence of biliary stricture was significantly lower in the dual perfusion group 6.5% vs.19.4%[OR 0.29, 95%CI(0.09-0.95);P=0.04]. There was no significant reduction in the incidence of HAT, bile leak or hospital stay between the two groups. Three year patient and graft survival was significantly higher among patients who received dual perfusion compared to standard perfusion[P=0.004, P=0.003]. On multivariate analysis non perfusion of the hepatic artery and preceding bile leak were found to be risk factors for the development of biliary stricture(P=0.04 & P<0.001).

CONCLUSIONS: Dual perfusion of live donor liver grafts through both hepatic artery and portal vein on the back-table may protect against the development of biliary stricture. This could translate to improved patient survival in the short-term. This article is protected by copyright. All rights reserved.

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2019

J. Shaji Mathew, Menon, V. P., Menon, V. P., Mallick, S., Amma, B. Sivasankar, Dinesh Balakrishnan, Gopalakrishnan, U., Ramachandran Narayana Menon, Athira, P. P., Jagan, O. A., and Surendran, S., “Dengue virus transmission from live donor liver graft.”, Am J Transplant, 2019.[Abstract]


Arboviral transmission through transplanted organs is rare. We report a highly probable case of dengue viral transmission during live donor liver transplantation. Fever with severe thrombocytopenia was observed in the donor and recipient within 6 and 9 days after transplantation, respectively. Dengue diagnosis was confirmed by testing blood and explant tissue from donor and recipient using dengue specific NAT (nucleic acid testing) and serology. Serology indicated the donor to have secondary dengue infection that ran a mild course. However, the dengue illness in the recipient was severe and deteriorated rapidly, eventually proving fatal. The recipient's explant liver tissue tested negative for viral RNA indicative of a pre-transplant naïve status. The prM-Envelope gene sequence analysis of the donor and recipient viral RNA identified similar serotype (DENV1) with almost 100% sequence identity in the envelope region. Molecular phylogenetic analysis of donor and recipient viral envelope sequences with regional and local dengue strains further confirmed their molecular similarity, suggesting a probable donor to recipient transmission via organ transplantation. Screening of living donors for dengue virus may be considered in endemic regions. This article is protected by copyright. All rights reserved.

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2017

R. Babu, Sethi, P., Surendran, S., Dhar, P., Gopalakrishnan, U., Dinesh Balakrishnan, Ramachandran Narayana Menon, Thankamonyamma, B. Sivasankar, Vayoth, S. Othiyil, and Thillai, M., “A New Score to Predict Recipient Mortality from Preoperative Donor and Recipient Characteristics in Living Donor Liver Transplantation (DORMAT Score).”, Ann Transplant, vol. 22, pp. 499-506, 2017.[Abstract]


<p>BACKGROUND Recipient outcomes in adult living donor liver transplantation depend on various characteristics in both recipient and donor. We aimed to derive a score based upon preoperative characteristics in donor and recipient that could predict the recipient mortality in adult living donor liver transplantation. MATERIAL AND METHODS Retrospective data of 100 living donor liver transplantation recipients and their respective donors were analyzed for preoperative factors that correlated with recipient mortality. Statistically significant factors were weighted appropriately to derive a regression equation to obtain a donor-to-recipient match (DORMAT) score. This score was applied to 71 patients prospectively and their outcome was analyzed. RESULTS Donor-recipient match (DORMAT) score, derived using regression analysis of the significant variables was [0.002 (Recipient age) + 0.013 (Recipient BMI) + 0.055 (SBP) + 0.344 (HRS) + 0.022 (Pre-op culture positivity) + 0.01 (Donor age) - 0.639]×100. DORMAT score, when validated to a prospective cohort of 71 adult-to-adult LDLT patients, had a C-statistic (area under ROC curve) of 0.712. The mortality rate was seen to increase with increasing DORMAT score. CONCLUSIONS DORMAT score is a useful clinical decision-making tool to predict recipient mortality in adult living donor liver transplantation.</p>

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2017

B. Chandran, Bharathan, V. Kumar, Mathew, J. Shaji, Amma, B. Sivasankar, Gopalakrishnan, U., Dinesh Balakrishnan, Ramachandran Narayana Menon, Dhar, P., Vayoth, S. Othiyil, and Surendran, S., “Quality of life of liver donors following donor hepatectomy.”, Indian J Gastroenterol, vol. 36, no. 2, pp. 92-98, 2017.[Abstract]


<p><b>BACKGROUND: </b>Although morbidity following living liver donation is well characterized, there is sparse data regarding health-related quality of life (HRQOL) of donors.</p><p><b>METHODS: </b>HRQOL of 200 consecutive live liver donors from 2011-2014 performed at an Indian center were prospectively collected using the SF-36 version 2, 1 year after surgery. The effect of donor demographics, operative details, post-operative complications (Clavien-Dindo and 50-50 criteria), and recipient mortality on the quality-of-life (QOL) scoring was analyzed.</p><p><b>RESULTS: </b>Among 200 donors (female/male=141:59), 77 (38.5%) had complications (14.5%, 16.5%, 4.5%, and 3.5%, Clavien-Dindo grades I-IV, respectively). The physical composite score (PCS) of donors 1 year after surgery was less than ideal (48.75±9.5) while the mental composite score (MCS) was good (53.37±6.16). Recipient death was the only factor that showed a statistically significant correlation with both PCS (p<0.001) and MCS (p=0.05). Age above 50 years (p<0.001), increasing body mass index (BMI) (p=0.026), and hospital stay more than 14 days ( p= 0.042) negatively affected the physical scores while emergency surgery (p<0.001) resulted in lower mental scores. Gender, postoperative complications, type of graft, or fulfillment of 50-50 criteria did not influence HRQOL. On asking the hypothetical question whether the donors would be willing to donate again, 99% reiterated there will be no change in their decision.</p><p><b>CONCLUSION: </b>Recipient death, donation in emergency setting, age above 50, higher BMI, and prolonged hospital stay are factors that lead to impaired HRQOL following live liver donation. Despite this, 99% donors did not repent the decision to donate.</p>

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