Children with sudden catastrophic liver failure (also called fulminant liver failure) do not have enough time to wait for a favorable donor. In most of the cases, they suffer from malignant brain swelling, torrential bleeding, or galloping infections. If a liver transplant is not performed within the stipulated time gap of a day or two, patients might lose their life while waiting for a suitable liver for transplantation.
Recently, three-year-old Radhesh developed sudden fever, which almost took his life. When he was brought to the Emergency Room of Apollo Children’s Hospitals for treatment, Dr Priyavarthini, Senior Consultant in the PICU, diagnosed him with Fulminant Liver Failure.
Dr. Suchitra Ranjit, Senior Consultant, Chief of Pediatric ICU, Dr. Vasanth Kumar, Dr. Priyavarthini , Dr. Rajeswari N and the team of doctors at Apollo Children’s Hospitals sought the advice of the liver-transplant team, and he was also immediately listed for emergency liver transplant. Meanwhile, the team decided to try out all possible ways to bring back the child’s condition to normalcy. The child was under the complex ICU Liver-Support Therapy that serves mainly as a bridge to support life until a liver transplant is completed. The ICU Liver Support Therapy supports the entire body-system and perform the functions of the liver until the liver is totally recovered.
The liver transplant team including Dr. Elankumaran, Surgical Gastroenterologist, screened the patient’s parents and family members to enable a living donor transplant, unfortunately, none had a suitable liver.
Dr Suchitra Ranjit, Senior Consultant, Chief of Pediatric ICU, Apollo Children’s Hospitals, said, “Within 24hrs, his condition worsened further and his life was in a delicate balance. Liver failure has detrimental effects on many important organs, including the brain, kidney, circulation, and blood clotting. He quickly became deeply comatose with a dangerously swollen brain on CT scan, his urine output stopped, and his blood clotting mechanisms failed with very high risk of hemorrhage. We were worried that he would die waiting for a suitable liver, and he was listed for a super-urgent cadaveric liver transplant so that the first available O+ liver in the whole of Tamil Nadu would be rushed for Radhesh.”
She also added, “Our aim was to sustain Radhesh until a liver was made available. We placed him on complete life-support utilizing the same high-end technology that was available in the best liver-units of the world. He was ventilated, placed on chemically-induced coma, and provided Continuous Renal Replacement Therapy (CRRT is a technologically advanced form of dialysis) and also a dose of daily plasma-exchange (a form of blood purification therapy), in addition to continuous brain monitoring and circulatory support. These therapies are temporary, highly risky, and invasive and meant as a bridge to transplant. No donor was suitable- and miraculously Radhesh pulled off the most unlikely and marvelous feat and started functioning normally.”
Radhesh’s liver which was totally necrotic (destroyed) started showing recovery. As his liver recovered his brain swelling decreased, and kidney function improved. All the tests started to improve, and on 20th April 2019 (nine days after admission), he was removed from ventilator and other life-support systems were discontinued.
