Transplant Fellow, Queen Elizabeth Hospital, University of Birmingham, UK
Transplant Fellow, Sir Ganga Ram Hospital, New Delhi
Surgeries for liver, gall bladder, pancreatic tumours both benign and malignant (primary and metastatic), Bile duct injuries, biliary stones, cancer gall bladder, cholangiocarcinoma, Management of acute and chronic pancreatitis, Pancreatic cancer, solid cystic tumour of pancreas, Liver transplantation – deceased donor liver transplant, live donor liver transplant, Adult and Pediatric liver transplant, Transplant for Acute liver failure and Chronic liver disease
Treatment for liver cancer , Primary liver tumour, Secondary tumours especially from colorectal cancers, neuroendocrine tumours, Treatment of benign tumours of liver, Haemangioma, Liver cyst, Cystadenomas, Adenomas, Caroli’s disease, Gall bladder cancer, gallstone disease, gall bladder polyp, Bile duct cancer – Cholangiocarcinoma intrahepatic and extra-hepatic, Choledochal cyst, Obstructive jaundice, Benign biliary stricture - Bile duct stones, injury, Malignant obstructive jaundice - Cholangiocarcinoma, Bile duct stones – intra and extra-hepatic choledocholithiasis, Acute and chronic pancreatitis, Pseudocyst of pancreas, Pancreatic abscess, Necrotising pancre Chronic calcific pancreatitis, Pancreatic tumour, Cancer head, body, tail of pancreas, Solid cystic tumour of pancreas, Cystic neoplasm of pancreas, Peri-ampullary tumours, Duodenal cancer, Ampullary cancer, pancreatic tumour, bile duct tumour, Cirrhosis of liver – liver transplantation, Acute liver failure – management including emergency liver transplantation, Portal hypertension and complications, Gastrointestinal bleeding, Ascites, Growth retardation, Splenomegaly and low blood counts, Infection
English, Hindi, Oriya, Kannada, Telugu
After finishing her Basic MBBS training from MKCG Medical College and Hospital, Berhampur, Orissa, Dr Varma did her Masters in General Surgery from Command Hospital Air-Force Bangalore, which is tertiary referral centre. She then did her super-specialty training in Gastro-Intestinal (GI) Surgery from Sir Ganga Ram Hospital, New Delhi. She was part of the pioneer team which started the first successful and sustainable liver transplant program in 2001. She did fellowship in Liver transplantation and Transplant surgery from Queen Elizabeth Hospital, Birmingham and Sir Ganga Ram Hospital New Delhi. She is a member of the Royal College of Surgeons, Edinburgh, UK. Dr. Varma worked as an Assistant Professor in the department of Surgical Gastroenterology, Nizam’s Institute of Medical Sciences, Hyderabad for five years where she performed vast number of complex Gastro-Intestinal and Hepato-biliary-pancreatic surgeries.
She was a consultant Surgical Gastroenterologist and Transplant Surgeon at Sir Ganga Ram Hospital, New Delhi. In May 2013 she moved from there to join the department of liver transplant and hepato-biliary-pancreatic surgery at Kokilaben Dhirubhai Ambani Hospital to start a viable transplant program. She has an extensive experience of more than 700 liver transplants; living and deceased donor liver transplantation, adult and pediatric liver transplantation, split and dual lobe liver transplantation, swap and ABO incompatible liver transplantation, elective and emergency liver transplantation. Dr Varma has been part of the team which performed the India’s first living related intestinal transplant. She has performed the first reported staged liver resection (ALPPS) for extensive liver tumour.
In three years our team has performed 156 liver transplants, majority of which are living donor liver transplants. Deceased donor liver transplants form a small subset of the number. Adult and pediatric liver transplants, elective and emergency liver transplants, split, reduced, and whole liver transplants, ABO incompatible and dual lobe transplants are the variants performed so far at KDAH.
Other HPB cases performed by Dr Varma includes a vast number of complex liver resections, staged hepatectomy for liver tumours with and without vascular resection, pancreatic resection for both benign tumours and cancers of the pancreas, radical cholecystectomy for gall bladder cancer, surgery for biliary obstruction, acute and chronic pancreatitis, and surgery for portal hypertension.
KDAH Success Rates
International success rate
85% - 89%
Elective Liver Transplants
86% - 90%
Emergency Liver Transplants
78% - 80%
"Is Ultrasonography alone adequate enough to diagnose & assess resectability in gall bladder cancer?" XII Annual Conference of the Indian Association of Surgical Gastroenterology (IASG), 2002
"Clinical presentation versus resectability in cancer gall bladder". Proceedings of XIII Annual Conference of the Indian Association of Surgical Gastroenterology (IASG), 2003.
"Pseudoaneurysm Right hepatic artery following laparoscopic cholecystectomy". Sir Ganga Ram Hospital, ASI Conference, Delhi Chapter Meet 2003.
Case Capsules-Surgery in Necrotizing Pancreatitis. Symposium on Acute Necrotizing Pancreatitis, Hotel Katriya, Hyderabad, September 2006.
Invited lecture on "Pathophysiology of portal hypertension" & "Budd Chiari Syndrome" at 6th National Surgical Gastroenterology Update 2007 at Bangalore on 14th and 15th July 2007.
Invited lecture on "Bile Duct Injury" as part of "Surgery CME 2007" at J N Medical College KLE's Prabahakar Kore Hospital & Medical Research Centre, Belgaum on 6th & 7th October 2007.
Pancreatic head mass: Is a preoperative diagnosis always necessary? Poster presentation at 8th World Congress IHPBA 2008, Mumbai, 27th Feb – 2nd Mar'08.
Aggressive management of patients with gall bladder cancer – Is it worthwhile? Poster presentation at 8th World Congress IHPBA 2008, Mumbai, 27th Feb – 2nd Mar'08.
Hepatopancreatic tuberculosis masquerading malignancy. Poster presentation at 8th World Congress IHPBA 2008, Mumbai, 27th Feb – 2nd Mar'08.
Infected pancreatic necrosis – open surgery is still the gold standard, Debate spoke for the motion at XVIIIth Annual Conference of the Indian Association of Surgical Gastroenterology (IASG), Chennai 2008.
Liver transplantation in Cirrhosis with portal vein and superior mesenteric thrombosis. Presentation in Clinical combined rounds at Sir Ganga Ram Hospital, New Delhi, 24th March 2009.
Audit on "Pancreatic Resections for Insulinoma" presented at Queen Elizabeth Hospital, Birmingham, UK on 20th January 2010.
Poster presentation: Varma V, Mehta N, Kumaran V, Mohanka R, Rastogi AN, Shah A, Nundy S, Soin AS. Spontaneous Collateralization Following Hepatic Artery Thrombosis After Living Donor Liver Transplantation. XXth Annual Conference IASG, Hyderabad, 2010
Oral presentation: Varma V, Kakodkar R, Kumaran V, Mehta NN, Nundy S, Soin AS. Double Graft Inflow Vessels in Living Donor Liver Transplantation: Does Double Mean Trouble? Oral presentation at "The 2011 Joint International Congress of ILTS, ELITA, and LICAGE, June 2011, Valencia, Spain.
Oral presentation: Varma V, Banz VM, Karam V, Gunson B, Redding R, Heaton N, Klempnaur JL, Rogiers X, Castaing D, Gauthier F, Colledan M, Adam R, Mirza DF. Liver Re-Transplantation (LReT) In Children-Analysis Of European Liver Transplant Registry Over Three Decades. XVth Congress of the European Society for Organ Transplantation, Glasgow, September 2011.
Invited Panelist inthe symposium on "Ethical issues in the practice of Surgical Gastroenterology"XXIst Annual Conference of IASG, Jaipur, October 2011.
Invited Chairperson in the session on "Clinical approach to Hilar block" in the Hepatobiliary & Pancreatic Malignancies – An Update, "Gastrocon 2012" organized by the department of Gastroenterology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, 25th and 26th August 2012.
Invited member of the Consensus Development Meeting on Portal Hypertensive Biliopathy under the aegis of INASL Working Party on 'Portal Hypertensive Biliopathy(PHB)' held on October 12 and 13, 2012 at Chandigarh, India.
Invited speaker for the Consensus Development Meeting on Portal Hypertensive Biliopathy under the aegis of INASL Working Party on 'Portal Hypertensive Biliopathy(PHB)' spoke on "Surgical management of portal biliopathy – Sir Ganga Ram Experience" held on October 12 and 13, 2012 at Chandigarh, India.
Invited speaker on "Life after liver transplant" at a meet organized by the Academy of Infection Management on 27th October 2012, New Delhi.
"Indications and Contraindications for liver transplant" Grand Round at Sir Ganga Ram Hospital, New Delhi, December 2012. Grand Round at Kokilaben Dhirubhai Ambani Hospital, Mumbai, April 2014.
"Recipient selection beyond conventional wisdom: HCC, alcoholics, performance status, recent sepsis" invited panelist, 25th Annual Conference of. Indian Society of Organ Transplantation, Aurangabad, 30 Oct - 01 Nov 2014.
Invited speaker"Liver Transplant – overview" FPNATCON-2014, FFPAI, Surat, 3rd-5th October 2014 & Annual Conference of Gujarat State Surgeons' Gujarat State chapter of ASI, Sylvassa, 23rd November 2014.
Poster: Varma V, Nath B, Kapoor S, Shah A, Lalwani S, Mehta N, Nundy S, Kumaran V. Correlation between portal pressure and outcome post liver transplant. ILTS 20th Annual International Congress June 2014, London, UK
Poster: Vibha Varma, Shailesh Sable, Sorabh Kapoor, Barun Nath, Vinay Kumaran. Varied Presentation of Tuberculosis from a Living Donor Liver Transplant Centre in India - Do We Have the Right Answers for the Treatment Option? ILTS 21st Annual International Congress 8-11th July 2015 Chicago, IL, USA
Poster:Vibha Varma, Shailesh Sable, Sorabh Kapoor, Barun Nath, Vinay Kumaran. Biliary Complications Post Living Donor Liver Transplant – Our Experience ILTS 21st Annual International Congress 8-11th July 2015 Chicago, IL, USA
Invited panelist in a discussion on "Difficult Biliary Anatomy" in The CLBS Symposium: Managing Complications in Liver transplant, New Delhi, India. September 25th – 27th, 2015.
Soin AS, Gupta S, Jain P, Kumar A, Singhal D, Varma V, Somashekar U, Kumar M, Nundy S. – Management of middle hepatic vein outflow in right lobe liver transplantation. Proceedings of the 7th Congress of the Asian Society of Transplantation (CAST), 2002; O-6-L-3-003: 170.
Gupta S, Soin AS, Jain P, Singh A, Singhal D, Somasekhar U, Varma V, Kumar M, Nundy S. – Role of CT angiography in defining the plane of transection in right lobe liver transplantation. Proceedings of the 7th Congress of the Asian Society of Transplantation (CAST), 2002; O-6-L-3-004: 170.
Varma V, Thumma V M, Bheerappa N, Sastry R A. – Pancreatic head mass: Is a preoperative diagnosis always necessary? PP 6.02, HPB (Oxford). 2008; 10 (S1): 101.
Varma V, Gupta S, Soin, A S, Nundy, S. – Aggressive management of patients with gall bladder cancer – Is it worthwhile? PP 14.07, HPB (Oxford). 2008; 10 (S1): 119.
Varma V, Gandhi V, Bheerappa, N, Sastry R A. – Hepatopancreatic tuberculosis masquerading malignancy. PP 44.02, HPB (Oxford). 2008; 10 (S1): 181.
Thumma V M, Varma V, Bheerappa N, Sastry R A. Has incidence of hemobilia increased with increasing conservative management of blunt liver injury? HPB (Oxford) 2008;10(S1): 31.
Bharatan A, Varma V, Sastry RA. Chapter "Management of Gastric Ulcer" Annals of GI Surgery 2008.
Varma V, Gupta S, Soin AS, Nundy S. Does the Presence of Jaundice and/or a Lump in a Patient with Gall Bladder Cancer Mean that the Lesion Is Not Resectable? Dig Surg 2009;26:306-311.
Daga S, Varma V, Bheerappa N, Sastry RA. Chapter "Central pancreatectomy for mid body lesions of pancreas" Annals of GI Surgery 2009.
Varma V, Webb K, Mirza DF. Liver transplantation in Alcoholic liver disease. World J Gastroenterol 2010 ; 16(35): 4377-4393.
Rastogi AN, Varma V, Kumaran V, Mohanka R, Mehta NN, Saraf N, Mohan N, Saigal S, Nundy S, Soin AS. Pre-Transplant Portal Vein Thrombosis: Operative Management and Outcome in 426 Consecutive Liver Donor Liver Transplants. Liver Transplantation 2010:16(6 Supplement 1);S84.
Varma V, Mehta N, Kumaran V, Mohanka R, Rastogi AN, Shah A, Nundy S, Soin AS. Spontaneous collateralization following hepatic artery thrombosis after Living Donor Liver Transplantation. Trop Gastroenterol 2010; 31:S.
Varma V, Tariciotti L, Coldham C, Taniere P, Buckels JA Bramhall SR. Preoperative localisation and Surgical Management of Insulinoma – Single centre experience. Dig Surg. 2011;28(1):63-73. Epub 2011.
Varma V, Mehta N, Nundy S. Liver Transplantation in India. In: Soin AS, Nundy S (eds). The History in Liver Transplantation. ECAB Delhi 2010;1:8–14.
Varma V, Mehta N, Kumaran V, Nundy S. Indications and Contraindications for Liver Transplantation. International Journal of Hepatology 2011, Article ID 121862. doi:10.4061/2011/121862
Varma V, Kakodkar R, Kumaran V, Mehta NN, Nundy S, Soin AS. Double graft inflow vessels in living donor liver transplantation: does double mean trouble? The 2011 Joint International Congress of ILTS, ELITA and LICAGE. Liver Transplantation 2011; 17 (Suppl S1): S1-S324.
Banz V, Varma V, Karam V, Gunson B, Jamieson N, Heaton N, Pinna A, Pollard S, Frimam S, Porte R, Belghiti, Adam R, Mirza D. Indications for and Survival after liver retransplantation in Europe: Evaluation of the last 28 years. Transplant International 2011;24:S4.
Nundy S, Varma V. Ethical issues in liver transplantation in India. Indian Journal of Transplantation 2011; 5:116-118.
Mehta NN, Varma V, Govindasamy M, Kumaran V, Mohanka R, Rastogi A, Nundy S, Soin AS. Incidence of hepatic artery thrombosis in 522 consecutive living donor liver transplants. The 2011 Joint International Congress of ILTS, ELITA and LICAGE. Liver Transplantation 2011; 17 (Suppl S1): S1-S324.
Varma V, Mallya A, Kumaran V, Mehta NN, Kapoor S, Nundy S. Cytomegalovirus infection in post-liver transplant recipients- is it mandatory to give routine antiviral prophylaxis? Liver Transplantation 2012; 18 (5, Suppl 1): S166.
Mallya A, Nath B, Kapoor S, Varma V, Mehta N, Nundy S, Kumaran V. Renal dysfunction following liver transplant-stratification based on RIFLE criteria and outcome. Liver Transplantation 2012; 18 (5, Suppl 1): S214.
Mistry JH, Mehta N, Varma V, Kapoor S, Nundy S, Kumaran V. Diabetes after liver transplantation. Liver Transplantation 2012; 18 (5, Suppl 1): S260.
Varma V, Mallya A, Kumaran V, Mehta NN, Kapoor S, Nundy S. Cytomegalovirus infection in post-transplant recipients – Is it mandatory to give antiviral prophylaxis? Liver Transplantation 2012:18(S1);S166.
Kumaran V,Chaudhary N, Mehta N, Varma V, Kapoor S, Nath B, Nundy S. Preventing biliary complications in donors using the modified hilar plate glissonian approach. Liver Transplantation 2013; 19 (6 Suppl 1): S47
Mehta NN, Srivastava M, Varma V, Kapoor S, Nundy S, Kumaran V. Living donor liver transplantation with cavoportal hemitransposition in porto-mesenteric thrombosis. Liver Transplantation 2013; 19 (6 Suppl 1): S54
Chaudhary N, Varma V, Mehrotra S, Kapoor S, Mehta N, Nundy S, Kumaran V. Outcomes of segment 4 drainage preserving living donor right hepatectomy. Liver Transplantation 2013; 19 (6 Suppl 1): S60
Srivastava M, Mehta N, Varma V, Kapoor S, Nundy S, Kumaran V. Zygomycosis in living donor liver transplant recipients: a single center experience. Liver Transplantation 2013; 19 (6 Suppl 1): S68
Nagaraja R, Govindasamy M, Varma V, Yadav A, Mehta N, Kumaran V, Gupta A, Nundy S. Hepatic Artery Pseudoaneurysms: A Single-Center Experience. Ann Vasc Surg 2013; 27: 743–749. .doi.org/10.1016/j.avsg.2012.08.018.
Mehta NN, Mangla V, Varma V, Lalwani S, Kumaran V, Nundy S. Minimizing incidence of hepatic artery thrombosis in living donor liver transplantation. Liver Transplantation 2014; 20 (6 Suppl. 1): S217-S218.
Pawar T, Shah AJ, Maheshwari S, Varma V, Kapoor S, Nath B, Shah J, Devarbhavi H, Kumaran V. Kinetics of liver regeneration after living donor liver transplantation. Liver Transplantation 2014; 20 (6 Suppl. 1): S253.
Varma V, Nath B, Kapoor S, Shah A, Lalwani S, Mehta N, Nundy S, Kumaran V. Correlation between portal pressure and outcome post liver transplant. Liver Transplantation 2014; 20 (6 Suppl. 1): S255.
Kumaran V, Kapoor S, Nath B, Shah AJ, Pawar T, Varma V. A safe and reproducible technique for performing the hepatic arterial anastomosis in living donor liver transplantation: the "W" technique. Liver Transplantation 2014; 20 (6 Suppl. 1): S365
Varma V, Sable S, Kapoor S, Nath B, Kumaran V. Varied Presentation of Tuberculosis from a Living Donor Liver Transplant Centre in India - Do We Have the Right Answers for the Treatment Option? Transplantation 2015; 99(7S):238
Varma V, Sable S, Kapoor S, Nath B, Kumaran V. Biliary Complications Post Living Donor Liver Transplant – Our Experience Transplantation 2015; 99(7S):315.
Varma V, Pawar T, Sable S, Kapoor S, Nath B, Kumaran V "ALPPS for a Large Hepatocellular Carcinoma in Hepatitis C Patient " accepted for publication Tropical Gastroenterology 2016;37(2).
Varma, V, Pawar T, Sable S, Kapoor S, Nath B, Kumaran V. "Massive Hepatocellular Carcinoma in a Hepatitis C Patient Treated with ALPPS." Journal of Clinical and Experimental Hepatology 5 (2015): S63-S64.
Yadav, K, Sable S, Kapoor S, Nath B, Kumaran V, Varma V. "Patient-Directed Management for Cytomegalovirus Infection in Post-Liver Transplant Recipients—Do We Have the Right Answer?." Journal of Clinical and Experimental Hepatology 5 (2015): S66-S67.
Association Of Surgeons Of India (ASI)
Indian Association of Surgical Gastroenterology (IASG)
Association Of Minimal Access Surgeons of India (AMASI)
Indian association of Hepato-Pancreato-Biliary Surgeons (IHPBA)
Indian Society of Organ Transplantation (ISOT)
Fulminant Liver Failure Committee, Zonal Transplant Coordination Centre (ZTCC)
ALPPS – Hope in a situation of Despair
A 45 year old male patient presented to Dr Vibha Varma with a diagnosis of liver cancer and he was told that he had inoperable disease and that nothing could be done. He presented with history of weakness and loss of appetite of one month duration. He came for second opinion to Kokilaben Dhirubhai Ambani Hospital, HPB and Liver transplant department. His CT scan was reviewed and it showed a large tumour occupying the whole of right lobe of liver with some more lesions going to the medial segments of left lobe. He was found to have hepatitis C virus infection however his liver function tests were within normal limits. For a cure he would have required removal of right lobe of liver along with a portion of the left lobe which would leave him with a very small remnant liver and this would risk him of having liver failure in the postoperative period. As he was young and otherwise fit, Dr Varma gave him the option of surgical treatment in the form of either liver transplantation or in the form of an innovative technique of staged liver resection.
The family did not agree for liver transplantation hence he was left with the second best option of surgical cure in the form of staged hepatectomy otherwise known as ALPPS (Associating Liver Partition with Portal vein ligation and Staged hepatectomy) procedure. ALPPS is indicated in patients who present with massive tumour in the liver and where surgical treatment would leave behind a small remnant liver. This patient was evaluated and had the first stage of procedure wherein the liver was transected and blood supply was cut off to the portion which had to be removed and after a gap of 14 days a CT scan was performed which confirmed that the remnant liver had increased in size by 70%. He was again taken up for second stage procedure and the tumour could be successfully removed. He had a smooth recovery and was discharged home 7 days after second surgery. This ALPPS procedure is the first case to be registered from India http://www.alpps.net. It is an option where so called inoperable/unresectable tumour of the liver can be operated and one can offer a new lease of life to these patients.
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