Medanta Hospital, Lucknow conducts first paediatric Liver Transplant

Lucknow: Two months ago, Tejas Singh, a 9-year-old boy from Allahabad, was suffering from Acute Liver Failure due to Hepatitis A virus. He was admitted in Sahara Hospital for 3 days, where he was not responding to medical management. He was transferred to Medanta Hospital, Lucknow for Liver Transplantation. Within 12 hours of admission, fast workup of donor and recipient were conducted and urgent Living Donor Liver Transplantation was performed. The Child was discharged in stable condition after 2 weeks. Two months later, the kid is absolutely stable and living a life like a normal boy.

The Liver Transplantation was performed by Dr. A. S. Soin, Chairman, Medanta Institute of Liver Transplantation and his team of Surgeons, Dr. Amit Rastogi, Dr. Prashant Bhangui, and Dr. Rohan Jagat Chaudhary, and Senior Paediatric Gastroenterologist, Dr Neelam Mohan and Dr. Durgaprasad and Anaesthetists, Dr. Vijay Vohra and Dr C.K. Pandey.

Dr A.S. Soin said, ‘Paediatric Liver Transplantation is very challenging. It is technically difficult because of small size of children and also smaller diameter of artery, portal vein and bile ducts. With our vast experience of over 450 paediatric Liver Transplants and one of India’ largest series, we are happy to provide this facility at Medanta Hospital, Lucknow. We advised Liver Transplantation for Tejas as soon as we examined his condition. Tejas’ father with the help of his relatives quickly arranged all the logistics. Tejas’ mother was the donor and she donated her left lobe of liver which was around 40%. Tejas’ diseased liver was removed and a part of his mother’ liver was transplanted in him.’

Dr. Rohan Chaudhary, Consultant Hepatobiliary and Liver Transplant Surgeon, said, ‘Tejas’ case was a difficult one as the timing of Liver Transplant was very important and any delay in surgery would have led to failure. On 26th April, 2022, the child presented with worsening jaundice, Hepatic encephalopathy and high INR. He also had increasing Cerebral edema due to acute liver failure. His condition was worsening and he would have gone into coma state if no transplant was done. On 27th April, 2022 Living Donor Liver Transplant was successfully performed. Post-operatively he was managed by well-coordinated team of Surgeons, Paediatrician and Intensivists. Few days later, on 17th May 2022, we celebrated his 9th birthday and the boy was elated.’

Dr. Durgaprasad, Senior Paediatric Gastroenterologist said, ‘Paediatric liver transplant cases are challenging because of small doses of medicines as per body weight and high susceptibility to infections. Tejas’ liver failed due to Hepatitis A Virus (HAV) infection. Acute HAV infection is common in children but rarely, around 2% progress to acute liver failure. Few Acute liver failures recover on medical management, whereas others require Liver transplantation or otherwise they die. Tejas had ALF and met the King’ college criteria of ALF. Urgent Liver Transplantation saved his life.’

Dr. Rohan Chaudhary added, ‘Post-operation, Tejas was given immunosuppressant medicines to weaken his immune system so that his body does not reject his mother’ liver inside it. However, because of the immunity system getting weak, there is always an imminent threat of infections. So, it is important to take certain precautions like he is not allowed to eat raw vegetables or outside food for 1 year, not play in the dust, and always wear a mask when outside, among others. To ensure everything is on track, we are regularly reviewing the Liver Function tests of Tejas weekly.’

Tejas’ father said, ‘Initially we got scared by the news of Liver transplantation, but when we met Dr A.S.Soin, we felt relieved as he explained us about the surgery. Hoping against hope, we swallowed our fears and chose to risk all we had to save Tejas’ life. It was a decision we celebrate today when our son hugs us. His mother still finds it difficult to hold back her tears when she recollects his days in hospital.’

Tejas said with determination, ‘I will study hard and I want to become an all-rounder in Indian Cricket team.’

Dr. Neelam Mohan, Director of Paediatric Hepatology, said, ‘We have a vast experience in Liver Transplantation for Acute Liver Failures in children. If done at right time, the outcomes are miraculous. Unfortunately, not all children with acute liver failures reach to Transplant centres on time or are unaware of this kind of treatment. We have a good number of paediatric liver transplant recipients who are in our long term follow-up and have crossed 5-year or 10-year survival, living a normal life.”

On addressing the question of Life After Transplant, Dr A.S. Soin said, ”when like Tejas, a child is doing well over a month after the operation, the transplant is considered completely successful, with a normal life expectancy ahead. These children grow and develop normally like any other child. Barring a few restrictions like taking medicines on time and having regular blood tests, life is absolutely normal.”

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