Paediatric Liver Transplantation

Baby Salama 4.5 years had grown up this far without chocolates or milk. She had OTC deficiency, a rare metabolic disorder, wherein the liver lacks enzymes required for processing proteins. As a result, she would become unconscious everytime she would eat proteins in her diet. Doctors advised her to undergo liver transplantation as that was the only way she could have normal life. Her parents consulted at various centres in and outside Hyderabad and decided to get her treatment done at Apollo Hospitals, Jubilee Hills, Hyderabad. As there were no suitable donors in the family, she was put on the waitlist for a cadaver organ. The most likely possibility was a split liver transplant, where an adult liver from a brain dead person is divided into two parts and the smaller one is given to a child. However, on 22nd July the organs of a brain dead child were made available through Jeevandan Scheme of Telangana, and the liver was offered to Baby Salama.

The doctors at Apollo Hospitals, Jubilee Hills decided that the liver was an appropriate match and the Liver Transplant was carried out on 23rd July 2015. The operation was carried out by a team of Specialists led by Dr. Manish C. Varma, Chief Transplant Surgeon at Apollo Hospitals, Hyderabad. The baby recovered uneventfully after the operation and was moved out of the ICU after 3 days and was discharged on 12th post-operative day.

Paediatric Liver Transplantation requires advanced infrastructure and well qualified staff who are specialised for dealing with critical paediatric patients. Apart from a meticulous surgery, the biggest challenge is the intensive care in the post-operative period. The margin of error in paediatric liver transplant patients is extremely narrow and the management has to be coordinated like clockwork. The post operative care of the baby was done by a team of specialists and critical care doctors including Dr. Manjunath (Intensivist), Dr. Sahoo (Intensivist), Dr. Meena Trehan (Pediatric critical care specialist), Dr. Shweta Priyadarshini (Pediatric Nephrlologist), Dr. Sunita Narreddy (Infectiuos Diseases specialist), and Dr. Ravi Shanker (Endocrinologist). Speaking about the operation, Dr. Anurag Shrimal (Liver Transplant Surgeon) said , “ it is difficult to find appropriate size organs for small babies and hence, closing the abdomen after the fitting the new liver in is always a challenge. We have used a new technique of using composite graft wherein closure becomes very easy”.

Dr. Varma noted that Liver Transplantation is a complex multidisciplinary exercise which requires proficient medical and nursing staff and excellent support from other departments like Nutrition and Physiotherapy. The Liver Transplant programme at Apollo Hospitals, Hyderabad has a success rate of over 97%, which is not only the best in India, but also one of the best in the world. The transplant program routine carries out mute-organ transplantation like Combined Liver-Kidney and Simultaneous Kidney-Pancreas Transplantation. World over, Paediatric Liver Transplantation is carried out in a chosen few centres and not all liver transplant centres offer these services. Children with a various disorders like biliary atresia, metabolic disorders, and liver tumours, among other causes may need liver transplantation. With superlative success rates, which speaks of a proficient team and excellent infrastructure, the Liver Transplant Program at Apollo Hospitals, Jubilee Hills, is all equipped to undertake complex endeavours.