A rare liver transplant

NEW DELHI, Dec 5 (UNI) — Doctors at Indraprastha Apollo Hospital here have successfully performed a living-related liver transplantation on an 18-month-old boy, the first of its kind in the subcontinent.

The procedure, which is more complex than an adult liver transplant, involves removing a portion of the donor liver and transplanting it into the child after removing the old diseased liver. The surgery was carried out on Sanjay Kandasamy of Kancheepuram on November 15 by the hospital’s transplant team consisting of surgeons Dr M R Rajasekar and Dr A. Soin and paediatric herpetologist Dr A. Sibal. The donor was the child’s own father.

Briefing presspersons here today, Dr Sibal said Sanjay suffered from a congenital disorder of the bile ducts called biliary atresia. The child was diagnosed with the condition at two months of age and was earlier operated upon at Chennai. However, after the operation he developed jaundice which worsened into cirrhosis of the liver.

First, in a five-hour-long operation, the surgeons removed 25 per cent of the father’s liver successfully without any need for blood transfusion, thus disproving myths that a lot of blood was required for such operations, Dr Rajasekar said. The baby was next operated upon. The first five hours involved removing of the diseased liver and then the new organ was transplanted which took another four hours.

The first successful living-related transplant in the world was carried out at the University of Chicago Hospital, USA. Only six to seven specialised centres have been established around the world to undertake this complex procedure which takes between eight to nine hours.

About 50 to 60 per cent of liver transplants in children are for biliary atresia. In Sanjay’s case the doctors decided against waiting for a cadaver( brain dead) donor as this could involve delays due to mismatch. Instead, the boy’s father offered to be the donor. The father has suffered no harm by giving 25 per cent of his liver as this is an organ which is regenerative , says Dr Soin.

Even if you remove 80 per cent of the liver it will grow back to its normal size. In Mr Kandasamy’s case it will resume to normal size within two to three months .

The cost of the operation is between Rs 8 lakh and 10 lakh. This is just a fraction of what it would cost abroad. It is between Rs 50 and Rs 60 lakh in Britain and Rs 1 crore in the USA And this is just the cost of the operation itself, Dr Rajasekar said.

In Sanjay’s case, the costs have been largely met by private donations. The boy will require periodic monitoring and the hospital is considering relocating the entire family to Delhi for about a year. He will, however, require medication for the rest of his life. The monthly costs of medicines work out to about Rs 5000.

Earlier, on November 6, the hospital had also successfully carried out a liver transplant on a 45-year-old man, Bharat Bhushan. Mr Bhushan, who was present at the press conference, said he was still weak after the operation but had recovered his appetite and felt much better physically.

Dr Sibal said about 60,000 people die each year in the country due to liver-related diseases. One child out of 15,000 gets biliary atresia so at a rough estimate about 2000 children are born each year with this inherited disorder and 90 per cent of these die of the disease.