PUNE: An expert team of Jupiter Hospital, Pune performed a successful complicated paediatric whole liver transplant on a 7-year-old girl child. Baby Sreya (name changed) was noticed to have increasing jaundice starting from 6 weeks of age. A thorough diagnosis and systematic assessment was conclusive of the baby suffering from a rare congenital liver disease called Biliary Atresia where there are no bile ducts in the liver from birth. It is not known what causes the condition.
In babies with biliary atresia, the flow of bile from liver to intestine is blocked which can lead to liver damage and cirrhosis of the liver, which is deadly if not treated. The family was in a rude shock as her health was continuously deteriorating. The infant underwent Kasai portoenterostomy (KPE) to connect the liver to the small intestine, going around the abnormal ducts. The procedure is the primary treatment with subsequent liver transplantation in failed cases. Post-surgery many children develop liver cirrhosis in first or second decade of their life.
After reviewing the patient’s condition, she was found to have a low platelet and albumin levels, esophageal varices, massive splenomegaly, and ascites which presented a classic picture of liver cirrhosis. The child had started decompensating and in the absence of a cure for the ailment, we offered them the option of liver transplant,” he adds.
Unfortunately, her parents and family members were not fit for a liver donation. So, the family was suggested a cadaveric liver transplant option. Though, the chances of a suitable liver were slim, the patient was listed for a cadaveric donor. With luck by her side, the year-long wait for Sreya ended in the first week of November 2022 with a whole liver donated by the family of a brain-dead child who met with an accident.
Once we received the liver donor, our team swiftly handled all the necessary preparations for the surgery. Surgical team included Dr. Manoj Shrivastava, Dr. Guruprasad Shetty, Dr. S S Bhalerao and Dr. Amol Jadhav, Dr. Bhagyashree Arbhi, and Dr. Amit Bhargava, were part of anaesthesia team during surgery.
Sharing details of the surgery, Dr. Manoj Shrivastava, Consultant – Transplant Surgeon, Jupiter Hospital, Pune said, “Surgery was technically challenging due to previous surgery, small size of blood vessels and bile ducts, and a possibility of size mismatch. Besides, the difference in weight and age presented difficulty in placing the liver in the abdominal cavity. However, the large size of the previous liver and fluid in the stomach helped to close the abdomen without any complications.”
The surgery went on for 8 hours, and though it was technically challenging but well experienced team effort handled the challenges efficiently and the child was later shifted to transplant intensive care unit.” he added.
Post-operative she was managed in liver transplant intensive care unit, by Dr. Sushil Kumar Yadav. She had some medical challenges which were tackled by our team. Valuable suggestions were given by Dr. Pavan Hanchanale during post operative course.
Speaking on the occasion, Dr. Rajendra Patankar, CEO, Jupiter Hospital, Pune said, “This was possible due to the brave decision of the parents of a 10-year-old kid who consented to donate his organs when he met with an accident. The patient has recovered well and discharged within 2 weeks post liver transplant.”
Recently, we have completed more than 25 paediatric liver transplants in patients less than 16 years of age and more than 110 adult liver transplants at Jupiter Hospital Pune, he added.
According to the team at Jupiter, she will be able to lead a normal life without any further issues. The patient’s family expressed their gratitude to the donor’s family for their brave decision to Jupiter Hospital.
Courtesy: The Times of India
Successful paediatric liver transplant
