Dr. Anand K Khakhar

Awards & Accolades

• Dr BC Roy Presidential National Award: This is the 'highest civilian award for medical professionals in India'. I received the award from the President of India, Mr Pranab Mukherjee in 2015 for my pioneering contribution towards development of liver transplantation in India.
• Tamil-Nadu State Governor's Medical Excellence Award: for my contributions towards making liver transplantation accessible to a larger population via several measures related to transplant awareness, cost reduction, improving organ availability, among other aspects.
• Best Transplant Program award from the Chief-Minister of Tamil-Nadu state: I received the award for consistently providing outcomes comparable to the best programs around the globe over a period of 5 years (averaging 90% one year graft and patient survival).
• Dynamic Indian of the Millennium Award from KG Medical Foundation: This is a foundation working towards development and improvement of healthcare and services in India. I was awarded in 2017 for initiating and developing a large number of liver transplant programs in approximately half the country over a period of 10 years.
• National Achievers Recognition Forum: An official agency of the government of India, awarded me for my achievements in furthering liver transplantation in India at an official ceremony held in New Delhi in August 2018.
• Dr ST Hemani Memorial Oration: delivered at Rajkot in 2019 on invitation from Indian Medical Association, Gujarat.
• International Scholarship: I was awarded the SIU/CUA (Societe Internationale d' Urologie / Canadian Urological Association) scholarship for one year which I used to undergo an ASTS accredited Renal Transplantation fellowship at the University of Western Ontario in London Ontario. The SIU/CUA has only 3 such scholarships each year to be distributed across the globe.
• Indian National Scholarship: I was awarded the National Merit Scholarship for the performance in the secondary school examinations.

Clinical Experience in Surgery & Transplantation

India (2007 - 2020)

• I resigned my job at Columbia University, New York in December 2006 and returned to Chennai. Here I founded a 'Centre for Liver Disease & Transplantation' at Apollo Hospitals, Chennai in January 2007. This was the first liver transplantation program in Chennai and essentially Southern India. I build the 'multi-disciplinary transplant team' from scratch. This was a herculean task that led to the first successful liver transplant program in Tamil-Nadu and grew to become the largest in South India over the next 5 years.
• I focused on creating a system of an 'in house OPO' (Organ Procurement Organization) at Apollo Hospitals, which is a large conglomerate of health-care facilities spread across southern India. This endeavor was subsequently taken over by the state government and took the shape of a state wide OPO called 'Transtan' and became an inspiration for the federal government to create a system of national and state level OPOs that are now called NOTTO (National Organ & Tissue Transplant Organisation) and SOTTO (State Organ & Tissue Transplant Organisation).
• Over the last 12 years we have done more than 1100 liver transplantations including more than 400 living donor liver transplants at our centers. I personally and independently do both living donor hepatectomy as well as living donor liver transplantation for both adult and pediatric recipients with junior colleagues and fellows. Of-course I do the regular cadaver liver transplants as well.

Liver Transplantation at various Centers

• After three years at Chennai and more than 100 liver transplantations with about 90% success, I was encouraged by the Apollo Hospitals system to recreate similar programs in their other hospitals in Chennai as well as those at Bangalore, Hyderabad, Kolkata and Ahmedabad. It was a unique opportunity that we addressed by recruiting ASTS fellowship trained surgeons of Indian origin and by training fellows in our programs over the next 5 years. We similarly developed complementary department colleagues in Hepatology, Gastroenterology, Anesthesia and Critical care within our group and set up programs on similar design.
• We set up programs that offered 'comprehensive transplant services' including medical management of liver failure, living donor and cadaver donor liver transplantation and transplantation for pediatrics and adults.

Pancreas Transplantation

• India is the diabetes capital of the world and diabetic nephropathy is a huge problem in our country.
• We started the first simultaneous Pancreas & Kidney transplant (SPK) program in 2013 and extended to Pancreas Transplant Alone (PTA) for select indications. We have done about 35 SPKs and two PTAs so far with good outcomes.
• An institutional based study of post-operative surgical complications of live related renal transplant recipients. Saanish S, Venkatraman V, Sivaraman PB, Khakhar AK. April 2013. Indian Journal of Transplantation. 2013.03.003
• Extended Hepataectomy after Sequential Trans Arterial Chemoembolization and Portal Vein Embolization: Initial Experience. Ramamurthy A, Vibhute B, Shrimal A, Anand Khakhar. Indian Journal of Surgical Gastroenterology, Oct 2012:50
• Cadaver donor: Identification, motivation and maintenance. Anand Khakhar, Anand R, Gopasetty M. Indian Journal of Transplantation. S2212-0017(11)60069- 5
• Invasive fungal infections in liver transplant recipients: an institutional profile. Ramamurthy A, Murali N, Vibhute B, Khakhar AK. March 2011. 51 DOI: 10.1016/Indian Journal of Transplantation. S2212-0017(11)60134-2.
• The association between central venous pressure, pneumoperitoneum, and venous carbon dioxide embolism in laparoscopic hepatectomy. Shiva Jayaraman, Khakhar AK, H Yang, D Quan. Surgical Endoscopy 23(10):2369-73. April 2009
• Recurrent hepatocellular carcinoma after transplantation: Use of a pathological score on explanted livers to predict recurrence. Parfitt JR, Marotta P, Alghamdi M, Wall W, Khakhar AK et al. Liver Transplantation 13(4):543-51. April 2007
• Impact of venous drainage and reperfusion technique on reperfusion injury after orthotopic liver transplantation. McAlister Vivian, Quan D, Solano E, Khakhar AK et al. Transplantation 78:366-367. July 2004
• Causes of death more than ten years after liver transplantation H Yang, N Mahy, Khakhar AK, Wall WJ. Liver Transplantation 53. June 2004.
• Liver transplantation for hepatocellular carcinoma: Survival analysis based on tumour characteristics. Solano Ed, Khakhar AK, Stell D, Wall WJ. Liver Transplantation Vol 9. June 2003
• Catastrophic microangiopathy induced by high titres factor VIII inhibitor after liver transplantation for Hemophilia A with cirrhosis. Khakhar AK, Chan NG, Allan DS, Chakrabarti S, McAlister VC. Haemophilia. 2005 Nov;11(6):623-8.
• Retrograde reperfusion versus conventional orthograde technique in orthotopic liver transplantation. AK Khakhar, VC McAlister, D Quan, E Solano, H Yang, JN Mahy, WJ Wall. Journal of Gastroenterology and Hepatology (2004) 19(Suppl.) A 681.
• Thrombotic thrombocytopenia after liver transplantation for hemophilia A and hepatitis C: role of antibodies to factor VIII. AK Khakhar, D Quan, E Solano, H Yang, JN Mahy, WJ Wall, and VC McAlister. Journal of Gastroenterology and Hepatology (2004) 19(Suppl.) A 808.
• Survival after liver transplantation for hepatocellular carcinoma. Khakhar A, Solano E, Stell D, Bloch M, Dale C, Burns P, Ghent C, Quan D, McAlister V, Marotta P, Wall WJ. Transplant Proc. 2003 Nov;35(7):2438-41.
• Retransplantation for recurrent hepatitis C: the argument against. Wall WJ, Khakhar A. Liver Transpl. 2003 Nov;9(11): S73-8.
• The impact of allograft nephrectomy on percent panel reactive antibody and clinical outcome. Khakhar AK, Shahinian VB, House AA, Muirhead N, Hollomby DJ, Leckie SH, McAlister VC, Chin JL, Jevnikar AM, Luke PP. Transplant Proc. 2003 Mar; 35(2):862-3.
• Liver transplantation for primary sclerosing cholangitis. Solano E, Khakhar A, Bloch M, Quan D, McAlister V, Ghent C, Wall W, Marotta P. Transplant Proc. 2003 Nov;35(7):2431-4.
• Epstein-Barr virus seronegativity is a risk factor for late-onset posttransplant lymphoroliferative disorder in adult renal allograft recipients. Shahinian VB, Muirhead N, Jevnikar AM, Leckie SH, Khakhar AK, Luke PP, Rizkalla KS, Hollomby DJ, House AA. Transplantation. 2003 Mar 27;75(6):851-6.
• Laparoscopic versus open partial nephrectomy. Beasley KA, Al Omar M, Shaikh A, Bochinski D, Khakhar A, Izawa JI, Welch RO, Chin JL, Kapoor A, Luke PP. Urology. 2004 Sep;64(3):458-61.
• Prospective evaluation of the role of quantitative Doppler Ultrasound in surveillance in Liver Transplantation. Stell D, Downey D, Marotta P, Solano E, Khakhar A, Quan D, Ghent C, McAlister V, Wall W. Liver Transpl. 2004 Sep;10(9):1183-8.
• Allograft nephrectomy: Implications on %PRA and clinical outcomes (A) A Khakhar, V Shahinnian, AA House, N Muirhead, D Hollomby, V McAlister, J Chin, S Leckie, A Jevnikar, P Luke. Can J Urol. 2002 Jun;9(3):1520.
• Laparoscopic vs Open partial Nephrectomy. (A) DJ Bochinski, AK Khakhar, A Obeid, JL Chin, A Kapoor, PP Luke. Can J Urol. 2002 Jun;9(3):1509
• Outcome of Laparoscopic versus Open Partial Nephrectomy.(A) K Beasley, D Bochinski, A Khakhar, J Izawa, J Chin, A Kapoor and P Luke. J Endourol. 2003 Nov;17 Supp 1.

Intestinal & Multi-Visceral Transplantation

• India did not have a single developed program for Intestinal and Multi-Visceral transplantations. We started with intestinal rehabilitation and nutritional augmentation program that progressed to intestinal and multi-visceral transplantation at our hospital and have conducted combined liver and intestinal transplantation successfully as well as isolated intestinal transplantation at our unit although the numbers are small.

Affordable Health-care

• India did not have a single developed program for Intestinal and Multi-Visceral transplantations. We started with intestinal rehabilitation and nutritional augmentation program that progressed to intestinal and multi-visceral transplantation at our hospital and have conducted combined liver and intestinal transplantation successfully as well as isolated intestinal transplantation at our unit although the numbers are small.

USA & Canada (2001-2007)

• I joined the division of transplantation at the Columbia Presbyterian hospital in New York city as a Instructor in Clinical Surgery in August 2005. I here work with well known transplant surgeons like Dr Jean Emond who is among the pioneers in Pediatric liver transplantation and Dr Lloyd Ratner who is credited with doing the world's first laparoscopic donor nephrectomy. The novel procedures performed here include ABO incompatible and positive crossmatch living donor kidney transplantation, I am now comfortable managing the pre-operative preparation and post-operative management of these immunologically high risk living donor transplantations. I also perform laparoscopic donor nephrectomy here. The program at Columbia Presbyterian hospital was also very aggressive in utilization of extended criteria cadaveric donor organs for liver transplantation.
• From July 2004 to July 2005, I was working at the TE Starzl Institute of Transplantation at the University of Pittsburgh for an advanced Clinical Fellowship in Multi-Organ Transplantation. Here I trained in Pancreas Transplantation, Living Donor Liver Transplantation and Hepatobiliary surgery. UPMC was among the most aggressive users of marginal grafts. I completed the ASTS certification requirements for Pancreas transplantation. I gained tremendously in my clinical acumen including operative experience in liver and pancreas transplantation including the retrieval and utilization of organs from nonheart beating cadaver donors. I also was involved in multi-visceral transplants. I had some memorable interactions with Dr Starzl himself, Dr Fung, Dr Marcos and Dr Wallis Marsh. I also spend dedicated time on the hepatibiliary cancer service with Dr David Geller.
• From July 2002 to July 04. I was a Clinical Fellow, Liver Transplantation at the University of Western Ontario. My work includes donor hepatectomy, multivisceral cadaveric organ retrieval, and assisting and performing Liver Transplantation under supervision. I was also in charge of care of inpatients on the transplant floor and the ICU. I was involved with the pre-operative, peri-operative, and postoperative follow-up care of transplant patients in the clinic. I participated in the Hepatobiliary surgery performed by the liver transplant team. I achieved the ASTS requirements for certification in Liver and Kidney transplantation during my tenure.
• From August 2001 to July 2002, I was working as a Clinical Fellow, Renal Transplantation, at the Department of Urology, University of Western Ontario, London ON, Canada. I received the prestigious SIU/CUA (Societe' de Urologie' and Canadian Urological Association) scholarship to carry out that academic venture. My work included active participation in Donor retrieval (multiorgan and kidneys) and performing renal transplantations under supervision. I was also responsible for the preoperative evaluations and postoperative care of transplant recipients and living donors. I actively participated in laparoscopic donor nephrectomy and laparoscopic and radical nephrectomy.

India before Transplantation Training (Before 2001)

• I completed a residency in General Surgery, from July 1992 to March 1997, and I passed my General surgery Boards in Nov 1996. During my residency, I assisted and performed major and minor surgical procedures and was involved in preoperative, post operative and intensive care of indoor and outdoor patients. My work also includes regular teaching programme especially for under graduates and medical students.
• Following board certification in general surgery, I underwent a second residency in Urology from Jan 1998 ' March 2001. I was a resident in Urology, at Apollo Hospitals, Chennai, India. The Urology residency program at Apollo Hospital is accredited by the National Board of Medical Examinations, New-Delhi. Here I participated in open Urological Surgery, Endo-urology and Kidney Transplantation. I assisted and performed undersupervision and open and endoscopic surgeries for renal and ureteric stones, prostatic and bladder surgery and renal transplantation. I also shared 1 in 5 on call rota. It has the largest cadaver renal transplant program in India and a very busy living donor renal transplant program.
• I was appointed as a Junior Lecturer in the Department of Urology and Renal Transplantation at the Institute of Kidney Diseases & Research Centre, Ahmedabad. I performed procedures like PCNL, URS, TURP, TURBT and open stone surgery, reconstructive urology including use of bowel in urology and renal transplantation. I was also involved in teaching post graduate students during this short tenure.

Publications

• Initial Poor Function and Primary Nonfunction in Deceased-Donor Orthotopic Liver Transplantation Maintaining Short Cold Ischemic Time: What Is the Influence of Poor Donor Maintenance? Notes From a Single Indian Center. Aug 2016. Progress in transplantation. Das S, Swain SK, Adala PK, Balasubramaniam R, Gopakumar CV, Zirpe D, Anand Khakhar, Vaidya A, Ramamurthy A. (E-Pub ahead of print)
• In situ split liver transplant for two adult recipients: A single centres initial experience. Karthik Mathivanan, Anand Ramamurthy, Prashant Rao, Anand Khakhar. Indian Journal of Transplantation.2014.12.012
• Simultaneous kidney'pancreas transplant for type ? diabetes mellitus with endstage renal disease. Mathivanan K, Gopasetty M, Vibhute B, Anand Khakhar. Indian Journal of Transplantation.2014.12.008
• Multivisceral transplant: First of its kind in India. Gopasetty M, Khakhar AK et al. Indian Journal of Transplantation. 2014.12.011
• Quantiferon TB Test ' Does It Have a Role in Identifying Patients at Risk for Reactivation of Tuberculosis in Liver Transplant Recipients: A Study from an Endemic Country. Article ' Dec 2014
• Effectiveness of Protocol Doppler Ultrasonography in Salvaging Grafts in Post Orthotopic Liver Transplant Patients Journal of Clinical and Experimental Hepatology 4:S92-S93 March 2014.
• Deceased Donor Liver Transplantation in India: Current Challenges and Solutions. Anand R, Gopasetty M, Varma M, Khakhar AK. Liver Transplantation 19(S1):86-334 react-text: 52,53 June 2013.

Research & Grants :

• I worked on a project for developing a safe and efficacious surgical technique for Laparoscopic Hepatectomy in a porcine model. This was aimed at developing an animal model and technique for performing laparoscopic liver procurement for Living donor liver transplantation. We received a competitive grant of $ 15,000 by the Lawson Health Research Institute, University of Western Ontario for the project.
• I worked on a project for developing a safe and efficacious surgical technique for Laparoscopic Hepatectomy in a porcine model. This was aimed at developing an animal model and technique for performing laparoscopic liver procurement for Living donor liver transplantation. We received a competitive grant of $ 15,000 by the Lawson Health Research Institute, University of Western Ontario for the project.
• Dissertation: Changing bacterial flora over burns wounds. Accepted by Saurastra University, Rajkot, Gujarat, India during the residency training in General Surgery.

Membership to Professional organizations:

• ACS: American College of Surgeons
• American Society of Transplantation Surgeons
• Canadian Society of Transplantation.
• International Liver Transplantation Society
• The Transplantation Society.
• Indian Society of Organ Transplantation.
• Liver Transplantation Society of India (Founding Member).
• Urological Society of India.
• Association of Surgeons of India.