Apollo transplant team performs complex paediatric liver transplant on a four & half year old suffering from a rare disorder

The Transplant surgeons at Apollo Hospitals, Hyderabad      performed a rare and complex paediatric liver transplantation on a four and half year old child Salama, on 23^rd July 2015. The critical operation was carried out by a team of Specialists led by Dr. Manish C. Varma, Chief Transplant Surgeon, Apollo Hospitals, Hyderabad. This was announced at a press conference by Dr. Manish Varma & Ms Upasna Kamineni, MD, Lifetime Wellness RX International Ltd. Ms Kamineni offered the first chocolate to Baby Salama on the occasion.

Salama had a traumatic life of not leading a normal childhood till now. She was deprived of small luxuries, which most children of her age would cherish, like eating chocolates or drinking milk. According to her father Md. Mujeebuddin, a marine engineer by profession, hailing from Hyderabad, the baby was frequently falling ill with symptoms of jaundice for the last one and half year. Several visits to different doctors were futile. It took almost six months of to identify the problem during a visit to a genetics specialist. She was diagnosed to be suffering with a rare metabolic disorder, OTC (Ornithine transcarbamylase) deficiency, wherein the liver lacks enzymes required for processing proteins. As a result, she would become unconscious every time she consumes proteins in her diet. The incidence of OTC is around 1 in 14000 and is more common in children. She was advised liver transplantation to lead a normal life. Her parents consulted at various centers in and outside Hyderabad and opted for Apollo Hospitals, Hyderabad.

Since 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 transplanted in a child. However, on 22^nd 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 this liver was an appropriate match and the Liver Transplant was carried out successfully on 23^rd July 2015. 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, “finding appropriate size organs for small babies is an onerous task and hence closing the abdomen after fitting the new liver in is always a challenge. We have used a new technique, composite graft, wherein the closure became very easy.” 

Dr. Manish 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 besides being the best in India, is 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 have the requisite expertise. 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.