Dr Ajitabh Srivastava, senior consultant, Liver Transplant team, Fortis Healthcare Ltd; patient Azhariah, six-month-old boy in his mother’s arms; patient’s father Mr. Semi Keuva Sua
Paediatric Liver transplants solution to several cases of congenital liver defects
New Delhi, June 15, 2017 : Fortis Hospital recently conducted extremely complex and delicate surgeries, giving infants a second chance to life. Azariah Malala and Lilaz Bakhtiyar were both suffering from foetal development issues of the liver which were a threat to their health and vitality. Therefore these infants had to undergo elaborate procedures in which their parents were the donors.
Azhariah, a six-month-old boy from Samoa Island near Fiji, was presented at Fortis Memorial Research Institute and diagnosed with a rare congenital defect called “Biliary atresia with cystic malformation of biliary tract”. This is a condition in which the bile duct has not developed completely and is blocked, thereby not draining the bile from the liver. This resulted in stretching and blockage of blood supply of liver mainly portal vein which supplies 75% of blood to liver. Keeping in mind the age and weight (6kg of the baby, out of which liver was 2Kg) an 8 hour long liver transplant surgery was conducted in a systematic and detailed manner. The father, Semi Keuva Sua, donated 25% of his liver to his son. His portal vein was atretic (poorly developed) a procedure of venoplasty was done to increase the size of portal vein. Surgical incision was conducted carefully to minimize blood loss and post-operative care was provided to the immunosuppressed infant. Challenges faced:
- Extremely small baby
- Distorted structure due to stretching.
- Atretic portal vein
Lilaz Bakhtiyar was presented at Fortis Escorts, Okhla Road, New Delhi at the age of 21 months and was suffering from “Biliary Atresia”, a condition in which the bile duct is not formed in the fetal stage. At three months of age, Lilaz had undergone a biopsy which helped diagnose the congenital abnormality. She underwent an ABO incompatible (donor and recipient of different blood groups) transplant where her mother, a A blood group donated to Lilaz who has O blood group. ABO – I Transplant because of lack of ABO – compatible donor. Intensive treatment for removal of antibodies was done before surgery to minimize the risk of rejection. Surgery was uneventful and child was discharged in satisfactory condition. It was hearting to see child stand and walk without support after transplant. Due to the intensive nature of the cases, Dr. Vivek Vij, Director, Liver Transplant, Fortis Healthcare, and his team meticulously planned and cautiously executed these two intensive surgeries.
Dr. Vivek Vij, Director, Liver Transplant, Fortis Healthcare said, “Children with the foetal form of biliary atresia are more likely to require liver transplants, usually sooner rather than later. The need for a transplant is decided by the extent of damage and how badly the liver is diseased. Pediatric patients account for about 12.5% of liver transplant recipients. Biliary atresia is reason for transplant in pediatric age group in 50% of patients.”
Added Dr Ajitabh Srivastava, senior consultant, Liver Transplant team, Fortis Healthcare Ltd, “Conducting transplants in the paediatric age group is safe and effective. Evidence highlights how the transplants have a high success rate and limited mortality. The risk faced by the child is negligible. As compared to a liver donor for an adult where the right lobe (comprising of 60% of the donor liver) is transplanted, this case required only 25% section of the liver from the left lobe ensuring faster recovery for the father himself.”
Dr Simmardeep Singh Gill, Zonal Director, Fortis Memorial Research Institute said, “Armed with the correct knowledge and expertise, technology and infrastructure makes way for miracles. This case was extremely tricky and required an experienced hand. We were only able to save this child’s life because of the skill and proficiency displayed by Dr Vivek Vij. While we have piloted several complex surgeries in the past, it is cases such as these that make us believe that every cloud has a silver lining.”
Dr Somesh K Mittal, Zonal Director, Fortis Escorts Heart Institue, said, “Infants may need transplantation as they are in fragile medical conditions. They may experience high complication rates, difficult postoperative courses, and poor graft and patient survival. However Dr Vivek Vij’s exemplary performance in the operating room was an example of how even lost causes have hope. It was in depth understanding of the situation and timely action that allowed for the correction of the problem.”
Dr. Vivek Vij is a highly qualified doctor and is known for having completed 1000 liver transplants. He has established safety procedures in accord with liver transplants and has been an active developer in the living donor surgery sector. He also founded the liver transplantation and hepatobiliary Sciences at Fortis Healthcare. He has the lowest complication rate when it comes to liver transplants, and has established very successful programs with regard to liver transplants in Fortis Noida and Fortis Mohali. Along with his team, he has conducted, supervised and facilitated over 2,500 surgeries, majority of which have taken place at Fortis hospital, Noida, with a 100% donor rate and 96% patient rate.