Liver Transplantation Done On a 6.5 Kg Baby: Surgeon Shares Insights

Highlights:

Baby Ram, is the smallest baby at 6.5 kgs in Maharashtra to undergo a liver transplant after being diagnosed with biliary atresia.
Dr. Darius F Mirza with his team of surgeons performed the risky liver transplant on the critically ill one-year-old baby.
The liver transplant was entirely funded by charitable donations, CSR grant from the hospital management and crowd-funding initiatives.

Baby Ram was diagnosed with a rare congenital condition called biliary atresia, the disease was later found to have progressed to advanced liver cirrhosis within months of his birth. In this rare condition, the baby’s common bile duct (a duct between the liver and the small intestine) is blocked or absent.

Dr. Darius F Mirza and his team of surgeons at the Apollo Hospitals, Navi Mumbai performed a liver transplant on the critically ill one-year-old baby in February, 2018. He is by far the smallest baby at 6.5 kg to have undergone a liver transplant in Maharashtra. The baby’s donor was his loving aunt - Divya who donated a part of her liver.

Liver Transplantation - Facts, Contraindications, Procedure, Follow up, Complications & Prognosis
Liver transplantation is a surgical option for the treatment of liver failure where the diseased liver is replaced with a healthy one.

‘Liver transplant is an increasingly successful treatment option for biliary atresia. Children with biliary atresia have survived well into adulthood. Survival after liver transplant has increased to encouraging levels in the recent years.’

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Early surgical intervention- Kasai portoenterostomy (KPE) surgery is critical to prevent irreversible damage. However, in baby Ram’s case the irreversible damage was already done, the liver failed to respond, and hence a liver transplant was the only surgical option left.

The baby’s parents had to search high and low for a team of surgeons who could successfully do the liver transplantation. The cost of treatment was also a major concern for the family.

Dr. Darius F Mirza, Head, Liver Transplant, Apollo Hospitals, Navi Mumbai spoke to Medindia exclusively about the biliary atresia and Ram’s liver transplant operation.

Common Types of Liver diseases leading to Liver Transplantation
Liver disease that ends in liver failure (end stage liver disease), disrupting several important metabolic functions needs liver transplant for patient survival.

Q: In what state had the baby Ram come to you?

Ans: Baby Ram was quite jaundiced, malnourished and weak when he came to see us. He was also suffering from multiple infections.

Liver Failure - Types, Causes, Symptoms, Complications, Diagnosis, Treatment & Prevention
Liver failure occurs when the liver loses its ability to perform its normal functions of regeneration or repair. It can be a gradual or a sudden process.

Q: Is Kasai portoenterostomy (KPE) surgery which is considered to be the first-line treatment for biliary atresia - not applicable for baby Ram?

Ans: Ram did undergo a Kasai portoenterostomy (KPE). This operation is successful in between 30 and 60 percent of patients. Sadly he was one of the non-responders.

Quiz on Liver
How many of us know that the liver is a vital organ the size of an American Football? To understand more about the liver and its functions spend a few minutes taking part in this quiz.

Q: Can you expect a normal growth of the baby?

Ans: Yes, and most of these children experience to catch up growth after their liver transplant.

Q: How long would the baby have survived without the surgery?

Ans: Probably between 3 and 12 months.

Q: Will baby Ram be needing any more surgeries in the future?

Ans: Hopefully not.

Q: Tell us what was the difficult part of the surgery?

Ans: Dealing with the small size and removing the old diseased liver due to the extensive adhesions and dilated blood vessels as a consequence of his previous surgery and advanced liver disease.

Q: Will the baby need a life-time of follow ups?

Ans: Yes

Q: Do you think there is a need to create a national screening program using stool color cards, as part of standard care in the neonates to raise awareness among young pediatricians and parents?

Ans: The main message is jaundice that persists after birth is abnormal and needs careful investigation. This is completely different from the self-limiting transient jaundice that many small babies experience soon after birth.

Q: Tell us without crowdfunding would this miracle be possible?

Ans: We needed a combination of individual generous donations and the crowd-funding platform, along with a CSR grant from the hospital management, to allow us to achieve successful transplantation.

Improvements in organ transplant techniques have led to greater availability of livers for transplantation in children. In the past, livers of small children would only be preferred for transplants in children, however now revolutionary surgical techniques have allowed the option of "reduced size" or "split liver" transplants. In these "split liver" transplants, a piece of an adult liver can be used for transplantation in a child. Parents or close relatives of the children are eligible for "split liver" transplants in children.

Souls go to heavens; organs don't. So let's all donate our organs and save lives.

Source-Medindia