Nagpur: In a rare procedure performed in Central India, an 11-month old child underwent liver transplant at a Nagpur hospital. The child received liver donated by his maternal aunt during a transplant surgery performed at New Era Hospital and Research Institute.
Mohammed Abbas, the 11-month old child from Nagpur, was suffering from Biliary atresia. He became the youngest to undergo liver transplantation in Central India. The doctors at the hospital not only performed the procedure but arranged 100% funds considering the not-so-good financial condition of the patient’s parents. This is the 51st liver transplant performed at the hospital.
Biliary atresia is a condition in which there is an absence of the gallbladder and the biliary tract leading to defective digestion. People with these symptoms suffer from liver failure and have deep jaundice, water in the tummy and growth failure. “The child was just 6 kg in weight which is very low in comparison to similar aged children. He was very sick, always crying and his growth was retarded,” a doctor said.
The operation was performed by a team led by liver transplant surgeon Dr Rahul Saxena and supported by Anaesthetists Dr Sahil Bansal and Dr Ayushma Jejani. Postoperatively, the child was managed by a team of Paediatric hepatologist Dr Nishu Khemka-Bansal, Pediatric intensivist Dr Swapnil Bhisikar and Dr Anand Bhutda.
“The transplantation surgery was performed on June 21 last. The patient was discharged two weeks after the surgery. His health is absolutely stable. This is the first such type of surgery performed in Central India. Since the child’s mother was herself suffering from fatty liver and father was the sole earning member of the family, her maternal aunt came forward for the donation,” the doctor added.
According to the doctors, technically, the surgery was very challenging as the portion of liver that was taken out from the living donor had to be reduced in size so that it could be safely adjusted in the small abdominal cavity of the child. There was a very high size mismatch between the blood vessels of the child and the adult liver graft. The diameter of artery, veins and bile ducts was very small. The small doses of medicines and even the amount of saline had to be calibrated with precision, as per body weight of the child and even a few milliliters can make a major difference. Administering anaesthesia in such a low weight patient also was challenging because of small sized airways and needed intensive monitoring.
Before meeting Dr Rahul Saxena at New Era Hospital, the patient’s family had consulted doctors at hospitals in Delhi and Mumbai. However, they refused to perform surgery considering the low age and low weight of the patient. Later, a one of the friends of the family, who was earlier treated at New Era Hospital, referred the patient to Dr Saxena. Abbas‘s father is a daily wage worker and the family belongs to a low socio-economic strata. For the surgery 100% of the funds were arranged by the hospital through appeals and various NGOs’ help was taken.
The hospital team is also arranging for free postoperative investigations and medicines. The hospital is subsidising the costs involved. To lower the chances of rejection of the new liver by the patient’s immune system, postoperatively these patients are given medicines to lower their immunity. “Drop in immunity might lead to new infections, hence utmost hygiene and care is important for the first 3 to 6 months. To ensure everything is on the right track, we are regularly reviewing the patient’s liver function tests,” informed Dr Rahul Saxena. Such patients have a normal life expectancy ahead. They grow and develop normally like any other child, Dr Saxena added.
