Consensus on Immunosuppression in Liver Transplant Recipients
🗓️ 20 Nov 2025🕒 11:30 - 17:30 📍Hall B
Theme - Consensus on Immunosuppression in Liver Transplant Recipients
Objectives -
Aim to standardize care, reduce toxicity, improve graft longevity, and create a roadmap for implementation and measurable impact across diverse transplant programs.
Theme - In-depth hands-on experience on TEE Simulators focused for liver transplant anesthesia by expert national and international faculty. The event is designed for both anesthesiologists and surgeons to enhance patient outcomes and care.
Objectives -
What the workshop offers: Workshop presents a skill enhancement podium for anesthesiologists in liver transplant anesthesia through focused PBL in TEE By attending the workshop, the participants will be better oriented to manage complexities during liver transplant cases
Focussed Group Discussion - Alcohol use disorder in liver disease
🗓️ 21 Nov 2025🕒 08:00 - 08:45📍Hall C
Theme - Focussed Group Discussion
1. Anti craving drugs: do they really work? 2. Role of Counselling for reducing heavy drinking. 3. Managing withdrawal syndrome(s) in admitted patients. 4. Role of Thiamine in patients with AUD. 5. Nutritional assessment and management .
The Robotic Surgery Workshop is a hands-on training program designed to introduce and enhance surgical expertise in minimally invasive liver resections and donor surgeries using robotic platforms.
Welcome Address & Registration
08:00 - 08:15
Robotic Surgery Setup: Platform Overview, Instrumentation, and Team Coordination
Theme - Balancing Risks and Benefits in Pediatric Metabolic Disorders
Objectives -
1. Explore the concept and rationale of preventive liver transplantation (before overt liver failure or irreversible complications) 2. Discuss disease-specific indications: Crigler–Najjar syndrome type 1 (CN1), primary hyperoxaluria, and urea cycle disorders (UCD) 3. Explore the role of specific genetic factors (e.g., DCD2 gene, NSC variants, NBAS gene) in transplant decision-making
Disease-Specific Rationale: CN1, primary hyperoxaluria, and UCD – When to consider early/preventive transplant
Theme - From Dietary Management to Transplantation Decisions
Objectives -
1. Provide an overview of liver transplantation in amino acid disorders and organic acidemias (MMA, PA, MSUD, UCD) 2. Highlight real-world experience through case discussion 3. Deciding the timing of transplant -failure of dietary management 4. Understand long-term outcomes and follow-up challenges in these patients
Indications for liver transplantation in Amino acid and Organic acid disorders; Pathophysiology and Rationale
Real-world case: Diagnostic journey, metabolic crisis management, and transplant decision
Sub Topics: 1) Management of metabolic crisis 2) When is dietary management sufficient? 3) When should liver transplantation be considered? 4) Pros, cons, and ethical dilemmas
Theme - Balancing Dietary Therapy, Growth, and Transplant Timing
Objectives -
1. Provide an overview of liver transplantation in carbohydrate metabolism disorders 2. Explore case-based dilemmas where extrahepatic involvement (e.g., cardiac disease) or growth failure drives decision-making 3. Discuss failure of dietary management and timing of liver transplantation 4. Discuss strategies for optimizing long-term outcomes after transplant
Indications for liver transplantation in disorders of carbohydrate metabolism (e.g., GSD, galactosemia, hereditary fructose intolerance)
Cardiac involvement in GSD and its Implications for transplantation
10:17 - 10:24 Didactic talk
Journey of a real world case
Sub Topics: 1) Dietary Management - When is strict dietary management sufficient? when do you call "failure of dietary management" 2) Growth failure as a sole indication 3) Assessment of extrahepatic disease in transplant candidates (Renal, Muscular) 4) Oncovigilance & role of SGLT2- inhibitors
The Robotic Surgery Workshop is a hands-on training program designed to introduce and enhance surgical expertise in minimally invasive liver resections and donor surgeries using robotic platforms
Case-Based Panel Discussion: Intermediate HCC/ advanced HCC: Immunotherapy for downstaging before Liver Transplantation
Sub topics:
1. Current criteria for considering immunotherapy for downstaging in before Liver Transplantation?
2. Patients selection- how do you select patients who are most likely to respond to immunotherapy-based downstaging? What factors (tumor burden, AFP levels, MVI status, PS ) guide your decision-making?
3. What are the major immune-related adverse events (irAEs) associated with immunotherapy in the pre-Liver Transplantation setting? Especially focus on liver injury related to immunotherapy
4. Success rates of downstaging with immunotherapy Immunotherapy impact on Post Liver Transplantation outcomes and recurrence rate
5. Is there any role of combining Immunotherapy with loco regional therapy in downstaging of HCC for Liver Transplantation 6. Role of Dual IO, Is it better than single
Theme - The Challenge of Transplant Timing and Outcomes
Objectives -
1. Provide an overview of mitochondrial hepatopathy (mitochondrial gene disorder particularly MtDNA depletion syndromes POLG, MPV 17, DGUOK etc ) and fatty acid oxidation defects as indications for liver transplantation 2. When (or whether) to transplant, given systemic involvement and uncertain benefit 3. Explore the living related donor dilemma in genetically inherited disorders 4. Understand long-term outcomes — does transplantation halt progression or shift the disease course?
Overview: Spectrum of mitochondrial hepatopathy and fatty acid oxidation defects; pathophysiology and challenges in liver transplantation
Sub Topics: 1) How do multisystem involvement & extrahepatic manifestation influence transplant candidacy 2) Optimal timing for referral & listing for liver transplantation (especially in context of evolving neurological symptoms and risk of irrerevisible neurodegeneration) 3) Peri Operative consideration, anaesthetic risk, postoperative complication and infection risk, unique to these patients 4) Optimal immunosupression and concern over mitotoxic agents.
Theme - The Key to key-hole surgery: The Ying and Yang of Minimal Invasive/Robotic Surgery
Objectives -
1. Understand the learning curve vis a vis technology 2. Requirements of Setting up of the minimally invasive/Robotic unit and Mentorship 3. Understanding the difference between misadventure versus retreat 4. Understand the importance and relevance of laparoscopic surgery
Minimally Invasive Donor Surgery: The learning curve and beyond
1. Define ACLF using current classifications (EASL vs APASL). 2. Explore immunologic and clinical course of ACLF patients. 3. Evaluate the role of extracorporeal therapies in improving outcomes.
Theme - From Biliary Diversion to Transplant: Evolving Treatment Paradigms
Objectives -
• Provide an overview of familial intrahepatic cholestasis (PFIC) and Alagille syndrome (ALGS), including recent advances in understanding • Explore the living related donor dilemma in PFIC and ALGS separately • Debate biliary diversion (internal vs. external) versus transplant as therapeutic strategies • Review new medical therapies (IBAT inhibitors) and their potential to shift the treatment algorithm
Overview & What’s New: Genetics, natural history, and evolving indications for intervention in PFIC and ALGS
Sub Topic 1) Mutation specific prognosis and individualized transplant timing 2) Risk of heterozygous carriers as donors - Living related donor dilemma 3) ALGS: cardiac/vascular comorbidities in recipients and donor selection 4) Role of diversion procedures in pruritus relief, progression prevention, and how they compare with Liver Transplantation
The Endohepatology Workshop at LTSICON 2025 offers a focused, hands-on experience in advanced endoscopic procedures relevant to hepatology and liver transplantation
Theme - ACLF & Liver Transplantation: Who Makes the Cut?
Objectives -
1. Identify which ACLF patients benefit from liver transplantation. 2. Explore diagnostic dilemmas and management strategies in diabetic ACLF cases. 3. Engage in interactive, case-based learning on ACLF treatment pathways.
Which ACLF Needs a Liver Transplant? Identifying key clinical and prognostic markers for transplant candidacy in ACLF
Theme - Peri-Transplant management of ACLF: Challenges and Holistic Strategies
Objectives -
1. Recognize challenges of ACLF in post-transplant patients. 2. Discuss holistic strategies for alcohol-related ACLF cases. 3. Analyze transplant and non-transplant outcomes and relapse prevention.
Challenges in Managing ACLF 3 Post-Transplant: Clinical course and complications in early post-Liver Transplantation period
12:50 - 13:00 Didactic Talk
Case-Based Panel Discussion: Alcohol-related ACLF: Holistic management (with or without transplant), and preventing relapses.
Sub topics
1) Alcohol use disorder : How severe the problem is in South Asia
2) Address the psychological and social impact of AUD
3) Strategies to prevent recidivism (medical/non-medical)
4) Discuss general care and role of liver transplant in Alcohol related ACLF patient
5) Discuss use of steroids and prevention of infections
Theme - SGLT2 Inhibitors: A Game Changer for Diabetes and Beyond?
Objectives -
1. To analyze the role of SGLT2i role in management of diabetes in non morbidly obese patients. 2. To understand if PPARs still have any role in management of MASH?
Debate: SGLT2i are the anti-diabetic medications of choice for MASLD without morbid obesity
Case based Panel Discussion: 50 year, diabetic male underwent Liver Transplantation for MASH related cirrhosis 2 years back, now presented with mild transaminitis and is diagnosed as recurrence of MASH
Sub-topics:
1. Prevalence of MASH- Recurrence/ De-Novo
2. Factors influencing recurrence- Pre op MASH, Metabolic risk factors, hyperlipidaemia, post op weight gain, immunosuppression
3. Strategies to prevent MASH post Liver Transplantation
4. Management – Life style/ immunosuppression/ medications
5. Role of bariatric Surgery post Liver Transplantation
Theme - Deciphering elusive portal hemodynamic and its management
Objectives -
1. Understanding the basic physiology and underlying principles. 2. Insight into the intraoperative portal flow management. 3. Scrutinizing the newer evidence.
Theme - Understanding immunization in “to be immunosuppressed
Objectives -
1. Evaluate the unique barriers to effective vaccination in India's pre- and post-liver transplant population. 2. Determine the optimal timing and schedule for essential and novel vaccines (e.g., COVID-19, Zoster, RSV) in LT candidates and recipients. 3. Address vaccine hesitancy and efficacy challenges rooted in financial, logistical, and immunological constraints.
Universal Hepatitis A Vaccination: Barriers to implementation in Indian practice
This workshop will focus on the principles, techniques and clinical applications of invasive hemodynamic monitoring during complex liver surgeries and transplant procedures. Participants will gain practical insights into arterial pressure monitoring, central venous pressure measurement, pulmonary artery catheterization and advanced cardiac output assessment.
Theme - Blending Surgical Precision with Digital Illustration.
Objectives -
1)To understand the role of surgical diagrams in enhancing comprehension and communication of complex liver transplant and HPB surgical procedures. 2)To acquire basic digital illustration skills using the Procreate app tailored to surgical anatomy and operative steps. 3)To develop the ability to create clear, accurate, and reproducible drawings of liver and HPB anatomy relevant to transplantation and major liver resections. 4)To learn the techniques for layering, annotation, and highlighting critical structures in digital diagrams to facilitate teaching, presentations, and operative planning. 5)Develop confidence in creating schematic drawings to enhance operative teaching and presentations.
Basics of using procreate app, layering, annotation Etc
17:45 - 18:00
Live Demonstration of drawing Liver Transplant & HPB Surgical Anatomy
18:00 - 18:15
Demonstration of diagrams drawn for operative planning in past years
Theme - Clostridioides difficile infection and Gut Microbiome Dysbiosis in LT Recipients
Objectives -
1. Explain the disruption of the gut-liver axis caused by liver transplantation (LT) 2. Review the link between post-LT dysbiosis and the high risk of C. difficile infection (CDI) 3. Evaluate emerging microbiome-modulating therapies to prevent and treat post-LT complications.
The Gut-Liver Axis and its disruption: Implications it holds after Liver Transplantation
09:00 - 09:10 Didactic talk
Navigating Post-Transplant Diarrhoea: From Etiology to Management A) Cytomegalo Virus B) C.Difficile C) Non-infectious Diarrhoea
1. Review current indications and contraindications for PVR-TIPS 2. Discuss technical advances in portal vein recanalization 3. Highlight clinical outcomes, complications, and long-term follow-up 4. Present real-world case studies and multidisciplinary perspectives"
From Blocked Pathways to New Lifelines: The Journey of PVR-TIPS
The Robotic Surgery Workshop is a hands-on training program designed to introduce and enhance surgical expertise in minimally invasive liver resections and donor surgeries using robotic platforms.
Debate: All cryptogenic cirrhosis should undergo genome sequencing
Quick Rebuttal & Discussion with Moderator
09:59 - 10:02 Debate
Role of genetic testing in cholestatic disorders of adults
10:02 - 10:10 Didactic talk
Case based Panel Discussion: 30 yr male with child A cirrhosis have AST and ALT of 600IU/550 IU /ml
Sub-topics: 1. What are the most likely causes of such high transaminase levels in a patient with known Child-Pugh A cirrhosis? 2. Are there any infectious or autoimmune etiologies that need to be considered and investigated further? 3. Herbal supplements, or other drugs leading to this scenario? 4. Work up for cryptogenic cirrhosis 5. Role of Liver Biopsy in this patient 6. Algorithm for work up
Theme - When friend beomes foe: The art of reconciliation
Objectives -
Learn T-cell role – Understand how T-cell changes drive PBC, AIH, and overlap syndromes.
Diagnose overlap – Use current scores and AI tools to identify PBC-AIH overlap.
Manage refractory disease – Plan treatment for tough cases, control pruritus, and know when to consider liver transplant.
T cell immunology
10:45 - 10:51 Introductory Talk
Case based Panel Discussion: 39 yr old female diagnosed as PBC and intractable pruritus, LFTs shows ALT 880IU/ ml
Sub-topics: 1. Differentials for High ALT levels in PBC patient. 2. Diagnosis of overlap syndrome? Newer scoring system. 3. Role of AI in diagnsosis of PBC-AIH. 4. Prognosis in comparison to AIH alone. 5. Management strategy in this patient (including pruritus), Role of Liver Transplantation
Case based Panel Discussion: Alcoholic ACLF presenting with MELD 37 (after initial admission in local unit), proc al 2.5, blood c/s- no growth and TLC 20000/mm3, planned for an ABOi Liver Transplantation
Sub-topics:
1. How should the elevated TLC be interpreted in the context of ACLF? Is it indicative of an infection not detected by blood culture, or could it be related to the severe inflammation associated with ACLF?
2. In ALF we start prophylactic antibiotics and anti-fungal: Does same holds true for ACLF, High MELD
3. What role do other inflammatory markers (e.g., CRP, procalcitonin) play in guiding management decisions in this patient? Practice in Panelists unit
Theme - Not Just on Ice: Redefining Transplantation Through Machine Perfusion
Objectives -
1. Insight into the translational research paradigm 2. Understand various machine perfusion techniques 3. Understanding the future prospects and ethical dilemmas
Unmasking the Viable Liver: Integrating Functional Assessment and Omics Data During Machine Perfusion
Case based Panel Discussion: 52 yr female with MASH cirrhosis and recurrent hematemesis. Endoscopy shows large esophageal and gastric varices
Sub-topics: 1. What factors you will look for recurrent bleed in this patient (High HVPG/underlying PVT etc) 2. Is endoscopic management sufficient in hands of excellent endoscopist 3. Role of Dynamic contrast CT in planning further action: Discuss 4. Is it an indication for TIPS/BRTO/ EUS guided therapy/ Transplant: Discuss 5. Data on Pre-emptive TIPS: Discuss
Theme - Scoring Systems, Prognostic Models, and Perioperative Challenges
Objectives -
1. Understand the role of scoring systems and prognostic models in timely decision-making for LT in pediatric ALF 2. Review a case journey from ALF diagnosis to LT and postoperative care 3. Decide critical issues in timing and candidate selection for transplant in ALF 4. Learn about perioperative hemodynamic monitoring and critical care in PALF 5. Discuss novel therapies and evolving strategies in PALF management
Prognostic Modeling in PALF: Diagnostic criteria and efficient use of scoring systems (e.g., King’s College, Clichy, Liver Injury Units, PALF-specific models, NWI) to guide transplant decisions
12:30 - 12:40 Talk
Case Discussion: From ALF to LT: case-based walk-through of decision-making, transplant timing, and postoperative care
1. Introduce the role of liver transplantation (LT) in managing hepatoblastoma 2. Review case-based learning: diagnosis, neoadjuvant therapy, LT, and postoperative chemotherapy 3. Debate primary LT vs. extreme hepatic resection in challenging cases 4. Explore current outcomes, controversies, and future directions in hepatobalstoma management
Genetics and molecular insights, risk stratification (PRETEXT), multimodality management, and when Liver Transplantation is considered
Debate: Primary Liver Transplantation vs Extreme Hepatic Resection Should borderline cases go straight to liver transplantation, or is maximal resection justified?
For - Primary Liver Transplantation
14:40 - 14:48 Debate
Debate: Primary Liver Transplantation vs Extreme Hepatic Resection Should borderline cases go straight to liver transplantation, or is maximal resection justified?
Debate: Primary Liver Transplantation vs Extreme Hepatic Resection Should borderline cases go straight to liver transplantation, or is maximal resection justified?
Rebuttal
14:56 - 15:00 Debate
Current Outcomes & Evolving Approaches: Survival, recurrence, long-term follow-up, novel agents, and future directions
Theme - PICC Line Placement and Management – Techniques, Complications, and Hands-on Training
Objectives -
• Understand indications and contraindications of PICC line placement • Learn patient selection and pre-procedural evaluation • Familiarize with ultrasound and fluoroscopic techniques of insertion • Recognize and manage PICC-related complications • Understand maintenance protocols and care pathways • Gain hands-on experience with PICC line insertion kits and simulators
Theme - AKI in cirrhosis: A spectrum, not a single snapshot
Objectives -
1. To learn about updates on AKI in cirrhosis 2. To understand management of AKI in cirrhosis with real world case discussion 3. To understand complete spectrum of Kidney dysfunction in cirrhosis
Case-Based Panel Discussion: A 45 year old decompensated cirrhotic male presented with decreased urine output. There is h/o recent ascitic tap. His serum creatinine is 2.8mg%. pretransplant management strategies
Sub Topics:
1. Discuss post ascitic tap PICD, risk factors, serum markers, prevention beyond albumin
2. Approach to AKI in this patient
3. When to start terlipressin
4. Terlipressin doesn’t work in 50% of patients with HRS- how to optimize these patients.
5. Liver Transplantation is cure for HRS- Is there any cut off of creatinine beyond which Liver Transplantation alone should not be done
Theme - From Survival to Recovery: Overcoming Malabsorption and Fueling Growth
Objectives -
1. Review the role of TPN and enteral feeding in the immediate post-transplant phase 2. Explore the causes and management of diarrhea, malabsorption, and feeding intolerance 3. Discuss strategies to induce anabolism and optimize growth post-transplant 4. Understand monitoring and adjusting nutritional interventions in the long-term
Early Nutrition: The First Step: Pre-transplant nutrition: optimizing weight, micronutrients, and feeding strategies (NG feeds, parenteral nutrition, specialized formulas)
15:15 - 15:25 Talk
Feeding the Fragile Gut: Post transplant feeding challenges: fluid restriction, immunosuppression-induced metabolic issues, enteral vs. parenteral nutrition (immunosuppressants, infections, bile salt malabsorption, pancreatic insufficiency), diagnostic approach, and dietary interventions
15:25 - 15:35 Talk
Post transplant diarrhea : Case = Infection vs intolerance vs medication side effects(persistent diarrhoea post Liver Transplantation)
Beyond Calories: Long-term growth monitoring, catch-up growth, and puberty considerations, Long-term nutrition: preventing obesity, metabolic syndrome, sarcopenia, and bone loss
Case-Based Panel Discussion: 45 yr Female with Decompensated CLD (CTP B7) with BMI 33 planned for right hemicolectomy for Carcinoma Colon. Pre op optimization strategy.
Sub Topics:
1. What are Challenges in this patient?
2. Cardiopulmonary assessment and optimization
3. Optimization of cirrhosis (Albumin infusion? TEG analysis, protein intake, variceal evaluation/ evaluation of portal hypertension/ collaterals)
4. Does pre op weight reduction in this patient will improves outcome/ strategies
The workshop has been structured to equip transplant coordinators with an in-depth understanding of organ donation and transplantation, with particular emphasis on the legal and ethical frameworks governing the field.
The programme will provide a comprehensive overview of the coordination processes involved in organ donation and transplantation, with a specific focus on Donation after Brain Death (DBD), Donation after Circulatory Death (DCD) and the unique complexities associated with Living Donor Liver Transplantation.
State-Of-The-Art Session- Expanding horizons in organ donation: innovation, ethics and fair access
Aims to introduce fundamental hand-eye-mind coordination techniques for performing micro-anastomosis and to provide hands-on training in the use of microsurgical instruments and sutures with the aid of a surgical microscope.
Registration at Venue
9:00 - 9:15
Operation of Surgical Microscope
09:15 - 09:30 Talk
Microinstruments & Micro-sutures
09:30 - 09:45 Talk
Preconditioning for Microvascular Surgery
09:45 - 10:30
Tips & Tricks for performing micro anastomosis
10:30 - 11:00
Practice suturing using intact latex glove Participants will develop precision hand movements and needle control on a latex glove, simulating delicate tissue handling. This exercise helps reinforce fine motor coordination and basic suturing technique in a controlled setting.
11:00 - 12:00 Hands on
Practice suturing using Silicone micro vessels Simulated micro vessels made of silicone allow participants to practice vascular anastomosis and fine suturing under magnification. It mimics real-life vessel suturing challenges in liver transplant surgery.
12:00 - 13:00 Hands on
Practice suturing on chicken wing vein tissue model
This realistic tissue model provides tactile feedback and simulates human vein texture, enhancing practical surgical skills.
13:00 - 14:00 Hands on
Batch 2
Practice suturing using intact latex glove Participants will develop precision hand movements and needle control on a latex glove, simulating delicate tissue handling. This exercise helps reinforce fine motor coordination and basic suturing technique in a controlled setting.
14:00 - 15:00
Batch 2
Practice suturing using Silicone micro vessels Simulated micro vessels made of silicone allow participants to practice vascular anastomosis and fine suturing under magnification. It mimics real-life vessel suturing challenges in liver transplant surgery.
15:00 - 16:00 Hands on Workshop
Batch 2
Practice suturing on chicken wing vein tissue model This realistic tissue model provides tactile feedback and simulates human vein texture, enhancing practical surgical skills.
The Robotic Surgery Workshop is a hands-on training program designed to introduce and enhance surgical expertise in minimally invasive liver resections and donor surgeries using robotic platforms
Case-based Panel Discussion: 55 yr old lady with HBV related HCC with post Liver transplant recurrence of HCC: Management
Sub Topics: 1. Tumor recurrence- Risk factors a) Tumor related b) Patient related c) Treatment related 2. Post Liver Transplantation surveillance – (Retreat score, interval of imaging/biomarkers testing) 3. Immunosuppression decision in HCC patients 4. Treatment (Curative/ palliative)- Discuss Surgical resection and loco regional therapies 5. Immunotherapy post Liver transplant- Any role?
Pre Liver Transplantation rehabilitation: Prehabilitation approach in Liver Transplant recipients and its impact on Post Liver Transplantation outcomes
Case: “Refractory Ascites in Cirrhosis: Managing Beyond Diuretics” Sub-topics: 1) Pathophysiology and modern management strategies (TIPS, albumin infusions, vasoconstrictors). 2) When to bridge to transplant and when to delist. 3) Impact of refractory ascites on perioperative mortality.
Case based Panel Discussion: 45 y old lady with child B cirrhosis, detected to have partial PV thrombosis on screening USG
Sub-topics: 1. Further assessment- CT triple phase role, Procoagulant workup. Variceal screening (before anti coagulants) 2. Indication for anti-coagulants? 3. In case of < 30% luminal compromise how will you monitor this patient? 4. Challenges in Liver Transplantation in this patient
Case based Panel Discussion: 58 yr old morbidly obese cirrhotic (MELD 20) planned for Liver Transplantation. Risk assessment and optimizing for Liver Transplantation
Sub-topics:
1. Morbid obesity and potential donor-recipient mismatch, in living donor LT (LDLT)?
2. What are the potential perioperative and post-transplant complications associated with obesity in this specific case?
3. Does the presence of sarcopenia (muscle wasting), along with obesity (sarcopenic obesity), further impact prognosis and potential post-LT complications?
4. What are the most appropriate and effective weight loss strategies for this patient, considering the liver function and potential risks of worsening malnutrition or sarcopenia? Does GLP1 agonist have any role?
5. If considering bariatric surgery, what are the optimal timing (before, during, or after LT) and the most appropriate surgical approach (e.g., sleeve gastrectomy), weighing the benefits and risks in this specific clinical context?
