Doctors at HCMT Manipal Hospitals successfully performed one of the most complex life-saving liver transplant surgery on a nine-month old. MUSBA HASHMI brings you a report
With fading hopes, but with a stern decision of not giving in to the circumstances, Ali Hamad’s parents thought of reaching out to HCMT Manipal Hospitals after hearing ‘no’ from many big hospitals in Delhi.
It was their strong will to save their baby that even fortune favoured them, so much so that such a complicated surgery was successfully done in nine-month old Hamad.
Liver transplants are often tricky. Sometimes it is too late for a transplant, while the other times the body doesn’t accept the donor’s liver at all. However, the most risky of all is the transplant in babies less that one year of age and 10 kg of weight. So was the case with Hamad who suffered from liver failure due to a rare disorder.
Dr Sailendra Lalwani, Head of the Department of Liver Transplant and Hepato-Pancreatic-Biliary Surgery, HCMCT Manipal Hospitals performed the surgery that makes Hamad one of the youngest babies undergoing a very complex liver transplant procedure. Dr Sailendra Lalwani’s team was supported by Dr Lalit Sehgal HOD — General Anesthesia, Liver Transplant Anesthesia, Liver Critical Care, Dr Vikas Taneja, HOD — Pediatrics and Dr Sufla Saxena, Consultant — Paediatric Gastroenterologist and Hepatologist.
Hamad was a known case of Progressive Familial Intrahepatic Cholestasis Type II (PFIC TYPE 2). He had jaundice since birth. The patient had multiple hospitalisations in Iraq for jaundice and recurrent cholangitis. “He was evaluated for jaundice and a liver biopsy done in Iraq was suggestive of progressive familial intrahepatic cholestasis Type 2. Three other siblings of the patient died because of jaundice and they remained undiagnosed. Given the history, clinical condition, and pathological diagnosis patient was referred for a liver transplant,” Dr Lalwani tells you.
This is not all. Hamad was having infection with cholangitis for which he was admitted and treated. “Apart from recurrent cholangitis, the patient was having marked ascites and growth failure with a bodyweight of 6.1 kg. He underwent evaluation for a living donor liver transplant and his mother was evaluated as a prospective donor. During an evaluation, CT scan showed cirrhotic changes, hepatosplenomegaly with attenuated portal vein with no portal flow with significant ascites and significant portosystemic collaterals,” Dr Lalawani says.
He adds that no supply of blood to the liver or clinically speaking attenuated portal vein is a big challenge to any liver transplant team as vascular complications are high in paediatric transplant patients. The reconstruction of the portal vein with graft is always a challenge as it increases the risk of thrombotic complications.
“To overcome this challenge, we planned to use an iliac vein graft procured during cadaveric liver transplant,” Dr Lalwani explains.
Hamad underwent a transplant on January 3, 2021. “There was no flow in the portal vein. We placed the interposition vein graft to give inflow to the liver. It took around nine hours to complete the transplant and baby was shifted to ICU on a ventilator,” Dr Lalwani elaborates.
The baby was off the ventilator the next morning and gradually in the next few days, he started accepting oral feed, tolerating well, and gaining weight. “Finally, after 20 days of surgery baby was discharged from the hospital. The family plans to go back to Iraq now,” Dr Lalwani adds. The baby, however, was given 80 per cent of successful surgery with a 20 per cent of risk.
“There are no complications in Hamad right now, but since his immunity is almost zero, he needs extra care, especially during the pandemic. However, the donor is healthy and has nothing to worry about. She was on medication for about five days post the surgery, but is now completely fine,” Dr Lalwani explains.
Dr Saxena says that it has been possible because the parents brought the baby right in time which contributed to the successful surgery. “There are three phases of liver failure. Phase I is the most treatable, while in Phase II and III it is comparitively difficult to treat the patient. Hamad was brought to the hospital in the beginning of Phase II, hence we took the chance and with God’s grace completed the surgery,” Dr Saxena tells you.
Hamad’s mother, who also became the donor, says that she was extremely afraid about losing her child again. “He is my fourth son, earlier three died perhaps suffering from the same liver disease. I was very afraid about Hamad’s survival, but the doctors here saved the life of my son. We express since gratitude towards all doctors of Manipal Hospitals. From day one they assured me that everything will be right and I will go back to Iraq with a healthy child,” she says.