Chennai:Global Hospitals, part of Parkway Pantai, Singapore which operates a chain of multi super specialty hospitals in Hyderabad, Chennai, Bangalore and Mumbai, has set a new benchmark in Paediatric Liver transplants in the world. The specialist teams from Institute of Liver Disease & Transplantation and the Institute of Advanced Paediatric Sciences at Global Health City, Chennai, successfully performed three complex Paediatric Liver Transplant surgeries in a span of just 18 hours. The transplants were performed in an effort to save the lives of a young child and 2 one-year-old infants, one of whom had flown down from overseas. All three surgeries were successfully completed by 3 am on the 22.10.2016, a feat that no single center has ever achieved in the world.
Ms. Rega, an 8 year old who hails from a small village near Nagercoil was diagnosed with Non-Cirrhotic Portal Fibrosis (NCPF) which is a chronic liver disease that also affected her lungs. Ms. Sanghivi, aged 1½ years old was diagnosed with Biliary Atresia which is a rare disease of the liver and bile ducts that occurs in infants. Ms. Sanghivi is from Hyderabad and had already undergone a failed Kasai surgery and was in dire need of a donor for transplant. Due to their conditions both Rega and Sanghivi were also diagnosed with Jaundice. 6 month old baby Leilah*, who weighed about 4 kgs, was born with a genetic condition called Progressive Familial Intrahepatic Cholestasis which is a rare congenital liver disease.
Baby Leilah* was scheduled to undergo a living donor transplant on the morning of 21.10.16. Given the small size of the child the liver team was already set to perform a special form of Mono-segmental Liver transplant. While Leilah’s* father who was the donor for her transplant was being wheeled into the operation theatre, the liver team received news of a potential cadaveric donor in the hospital. The donor was a 12 year old child who was previously well, and had suddenly become unconscious on her way to school. Investigations revealed that she had developed a massive bleed in the brain due to a burst blood vessel. Despite emergency surgery, the damage to the brain was irreversible and the treating team declared her brain dead. The child’s family had no hesitation in making the decision to donate their daughter’s organs.
This generosity of the child’s parents provided a unique opportunity for the liver transplant team headed by Prof Mohamed Rela. Good quality livers of sufficient size can be split into two parts and used to perform liver transplantation in two different patients. Ms. Rega and Ms. Sanghivi both of who were in a desperate need for a liver transplant were chosen for the split graft surgeries. This proved to be a tough challenge for the liver team at Global Health City who went on to create history by successfully completing a complicated Mono-segmental liver transplant, while proceeding with the cadaveric harvest operation, splitting the donor liver and performing two split liver grafts all within 18 hours.
“It was a tough decision to commit ourselves to three complex surgeries back to back,” said Prof. Mohamed Rela, Director & Head Institute of Liver Disease & Transplantation Global Hospitals, India. “But we were committed to making the best use of the generous gesture of the donor’s family. We believe that every healthy liver should be split and offered to two individuals and in this case the children had been waiting for a long time and there might not have been a second chance for them. This is a medical milestone as three liver transplants in children within 18 hours has never been done in any part of the world.”
Commenting on the accomplishment, Dr Ravindranath, Chairman and Founder, Global Hospitals, India, said, “It is truly an honour to be associated with a team as capable as our specialists’ from the Institute of Liver Disease & Transplantation and the Institute of Advanced Paediatric Sciences at Global Health City, Chennai. The technique called Split Liver transplantation is rarely performed in India due to the lack of experience. The Global Liver Transplant team has already performed over 20 such transplants the largest such experience in South East Asia. It gives me great pleasure to see the smile on these children’s faces today and to know that we were able to provide them with a fresh lease of life.”
Four teams consisting of surgeons and anesthetists were formed with specific responsibilities. While the first two teams were performing the operations on the 6 month baby Leilah* and her donor father, the third team retrieved the liver from the cadaveric donor and performed an in-situ liver split procedure to minimize delays before transplantation. The fourth team began the surgery on 1 ½ year old Sanghivi simultaneously. Once the living donor liver transplant was completed, transplant surgery for 8 year old Rega commenced. By 3 am on 22.10.16, the liver transplants were completed and all three children were shifted to the intensive care unit for observation.
Mr. Harish Manian, Chief Operating Officer, Parkway Pantai, India, said, “It’s indeed a proud moment for all caregivers at Global Health City. This momentous feat was possible to achieve only because of the futuristic thinking of Professor Rela. He continues to invest his time in nurturing a world class team of surgeons, anesthetists, intensivists and nurses who deal with large volumes of complex paediatric liver cases with the highest quality of care.”