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Seen in the photograph – seated from left to right: Patient parents (Zanzibar patient – 6 Month baby), Mrs. Mallika Mohandas, Chairman – MIOT International, Patient parents (Seychelles patient – 2 years baby). Seen in the photograph from Top left to right: Mr. Sagayam – Transplant Coordinator, Dr. Palaniappan. S – Senior Gastroenterologist, Hepatologist & Interventional Endoscopist, Dr. Shrinivas .V.C – Paediatrician, Dr. Sarva Vinothini – Paediatric Anaesthetist, Dr. Vimal Raj. V – Surgeon, Hepato-Pancreato-Biliary & Solid Organ Transplant, Dr. Partheeban – Anaesthetist, Intensive Care & Liver Transplantation, Dr. Surendran. R – Director, Hepato-Pancreato-Biliary & Solid Organ Transplant, Dr. Ragavan. M – HOD, Paediatric surgery, Dr. Paari Vijayaragavan – Surgeon, Hepato-Pancreato-Biliary & Solid Organ Transplant, Dr. Senthil Kumar – Micro Vascular Surgeon, Dr. Ashish Bangaari –Liver Anaesthetist and Dr. Arun. T – Consultant Gastroenterologist & Hepatologist

6 Months Old Baby Weighing 6 Kgs Gets New Liver After Complicated Procedure

Baby Amed Hafidh born 6 months ago in Zanzibar (Tanzania) was detected to have jaundice and bleeding tendency 15 days after birth. Various medical treatments in their native place did not yield results. By 4th month of age, the baby started deteriorating fast, with fluid accumulation in the belly, increasing jaundice, poor feeding, white clay like stools and poor growth. Further tests showed irreversible damage of the liver due to a peculiar disease of bile ducts, where the bile ducts are malformed since birth. He was referred for further treatment to MIOT International.

Our evaluation it showed that the liver damage was too advanced for any corrective surgery and that the liver transplantation where by the damaged liver is changed for a new one was the only hope of cure for the child.

The procedure of liver transplantation would be a challenge in any child due to very tiny nature of the blood vessels to be attached to the new liver and the immature systems of the babies to withstand the major operations. In this case, the challenge was even more as the child was weighing only about 6 kg and due to liver damage since birth all the systems in the body were fragile. Moreover, even the size of the small portion of the liver that the child’s mother came forward to donate was too big to fit inside the tiny abdomen cavity of the child. As it was the only lifesaving option for the baby, the challenges were explained in detail to the family who understood and were keen on going ahead with the liver transplantation.

After adequate pre-operative preparations, the child underwent liver transplantation about 6 weeks ago. About 20% portion of the left side of the mother’s liver (350 gm) was removed and further reduced in size through a complicated procedure without disturbing the blood vessels and bile ducts to achieve a size of about 240 gm. This reduced size liver graft was fixed to the babies’ abdomen after removing the old damaged liver. The child and the mother had very good and rapid recovery. The baby started feeding well right from the third day after surgery. The jaundice completely disappeared and the stools became normal. The baby has started gaining weight and is back to normal health and awaiting return back to Zanzibar.

1^st Liver Transplant Patient (2 Year Old Baby) From Seychelles

Baby Grace Kiarah Cheryl, was born with a condition called Biliary Atresia where the bile ducts are absent in such children and they are jaundiced since birth.

Baby Grace had undergone a corrective surgery for the same at 6 weeks of birth in Sri Lanka. The surgery for biliary atresia usually works only for a few years before the liver becomes irreversibly damaged. So by the time the child was 2 years of age, her liver had become irreversibly damaged and she became deeply jaundice with recurrent attacks of fever. The child’s growth became stalled and the feeding became very poor. She was diagnosed to have end stage liver disease at the hospital where the previous surgery was done and was referred for liver transplantation to MIOT International, which was the only hope to cure the child.

The child’s mother was willing to be the liver donor and was found to be fit. The child underwent liver transplantation surgery where a small portion of the mother liver was removed and transplanted to the child. The surgery in this child was specially challenging due to the dense and severe adhesions that develop after the previous surgery, which makes it sometimes impossible to safely remove the damaged liver and the poorly developed blood vessels of the liver. With meticulous surgical technique the adhesions to the liver were released and through a special ‘patch’ technique the blood vessels’ size was enlarged and the liver transplantation was completed successfully.

The baby had a rough post-operative course in the first week after the transplantation which was successfully managed. The baby is now about 4 weeks after the transplantation and already has normal liver function and the jaundice has completely resolved. She has good appetite and has started to gain weight. She looks cheerful and is planned to be discharged and shortly would travel back to their country. Incidentally Baby Grace is the 1^st liver transplant patient from Seychelles

About MIOT  Hepato-Pancreatico-Biliary Centre for Surgery & Solid Organ Transplantation

The MIOT Hepato-Pancreatico-Biliary Centre for Surgery & Solid Organ Transplantation (a part of MIOT Advanced Centre for Gastrointestinal and Liver Diseases) through its MIOT Gold Standard Liver Transplant Programme has performed several successful Adult and Paediatric Liver transplants (including cadaver and live donor) since the inception of the programme with success rate in par with international standards.

MIOT’s multidisciplinary liver transplant team includes hepatologists, India’s top transplant surgeons and anesthetists who specialise in liver surgery, besides haematologists, oncologists, interventional radiologists and infectious disease specialists. The team is supported with a world-class surgical & intensive care team, sophisticated imaging and radiology facilities, advanced laboratory services, surgical and ICU facilities, a dynamic blood bank, specially-trained nursing staff, counsellors and nutritionists.