PUNE: City-based surgeons performed the state’s first split cadaver liver transplant during the pandemic, in December last year.
The relatives of a 35-year-old brain-dead Nashik man had donated his liver, which was split. The smaller part (20-25%) of the liver, the size of a chikoo, was given to a child and the larger portion was given to an adult patient at Jupiter and Sahyadri hospitals, respectively.
The girl, who was just 18 months at the time of the transplant, had accidentally ingested rat poison (zinc phosphide). She slipped into acute liver failure within a week and had also developed brain-swelling and renal failure.
The transplant, over the period, restored her brain and kidney functions. Around six months after the surgery, the girl is doing well.
“It is Maharashtra’s first split cadaver liver transplant during the pandemic. It’s a pleasure to watch the child smile and play once again post-surgery,” Gaurav Chaubal, Jupiter hospital’s transplant surgeon, said.
The girl is the daughter of a farmer from a village in the Buldhana district. She had just turned 18 months and started walking.
“While playing she got hold of a rat-killer paste in a corner and swallowed some of it without our notice,” her father said.
She was rushed to a paediatrician and was later admitted to a hospital in Aurangabad on December 21. However, her condition kept worsening and progressed to acute liver failure due to zinc phosphide poisoning.
The rat poison caused liver failure, which led to the accumulation of ammonia in the blood, resulting in brain swelling. It also caused direct toxicity to the brain. The girl was shifted to Jupiter hospital in Pune for an emergency liver transplant on December 23.
“She was very sick. We had to intubate and put her on ventilator support. She was started on plasmapheresis to remove poison from her body,” the hospital’s paediatric intensivist Shrinivas Tambe said.
The girl also developed renal failure, for which she was started on continuous dialysis. “It was a challenge to put her on dialysis as she was very small, weighing just 9kg. Not many centres have the facility for dialysis of such a small child,” Tambe said.
The child was listed in the super-urgent category for cadaver liver transplant from a brain-dead person. Within 24 hours, she was offered the liver of a 35-year-old man, who had suffered grievous head injuries in a road accident and was declared brain-dead at Ashoka Medicover hospital in Nashik. The girl underwent transplant surgery on December 25.
“She improved slowly over the next few weeks and started showing improvement in her liver function. Slowly, her kidneys also started functioning well and dialysis was stopped,” Vishnu Biradar, the hospital’s paediatric hepatologist, said. The girl was discharged on January 19, this year.
