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Apollo Hospitals Liver Transplant Team Press Meet

The Liver Transplant team at Apollo Hospitals, Jubilee Hills, led by Dr Manish C. Varma, Chief Transplant Surgeon, Apollo Hospitals, Hyderabad, performed a critical liver transplant surgery on a six and half month old baby boy, Master Nitesh, suffering from Biliary atresia. The transplant was carried out by taking a slice of father's liver on 13th October, 2016. The infant is doing well and has since been discharged.

Biliary atresia is a congenital liver condition where the bile cannot drain from the liver through the bile ducts to the intestines. Bile helps to digest fats in the body and also carries waste products from the liver to the intestines for excretion. It occurs in 1 in 10,000 to 1 in 15,000 children. This impairment of the bile flow usually happens due to the bile ducts in the liver being absent or blocked or abnormally narrow. This results in the bile being trapped in the liver eventually leading to liver failure. Initially these children present with jaundice at about 2 weeks after birth. If they are not treated they become malnourished and are easy prey for infections and complications of cirrhosis and a majority of them do not survive beyond 2 years.

Ideally, biliary atresia kids should undergo Porto-enterostomy or Kasai's procedure within 3-4 months of their birth, this procedure enables bypassing the blocked ducts to drain the bile from liver. Kasai's procedure can delay the onset of cirrhosis for up to 5 years in 50% of children and enables the children to grow to an age and size wherein liver transplantation can be safely carried out subsequently as the definitive curative treatment.

This patient Nitesh had developed jaundice a few weeks after his birth. His parents consulted local doctors in Bhimavaram, from where they hail. After prolonged treatment when jaundice did not subside, they brought him to another Hospital in Hyderabad. There they were advised liver transplant as the only cure for his medical condition. It was at this stage, their family and friends strongly advised them to seek the help of the transplant team at Apollo Hospitals. On presentation at Apollo Hospitals, Nitesh was found to be suffering from very high jaundice and had already developed liver cirrhosis, he was very small weighing just about 5.5 kgs.

According to Dr Manish Varma, Nitesh by then had missed the window of opportunity for a Kasai's procedure and we were left with no option but to transplant his liver. These are the patients who pose the biggest challenge for liver transplantation and not many centres in our country are equipped to carry out liver transplant on children smaller than 10 kgs in weight, he points out.

The baby needed a small part of healthy liver for transplantation. The livers of his mother and grandmother were not.suitably matched. The transplant was finally carried out on 13th October, 2016, using a small part of his father's liver. The donor (father) was discharged on 6th day after surgery and the baby was discharged after 2 weeks of transplant. Nitesh will need immunosuppressants all his life, but his overall growth will be normal. There will not be any long term limitations to his growth•, learning and life expectancy, says Dr Manish Varma.

The liver transplantation was done by a team of Specialists led by Dr. Manish Varma and included Dr Anand Khakhar, Dr Anand Ramamurthy, Dr L Sasidhar Reddy, Dr Kirubakaran, Dr Manjunath Balasubramaniam, Dr Dinesh Babu and Dr. Ramesh Srinivasan, Pediatric Gastroenterologist. The post operative care of the baby was done by a team of specialists and critical care doctors including Dr Manjunath B., Anaesthetist & Intensivist; Dr Vishnu Vardhan Reddy, Pediatric Intensivist; Dr Meena Trehan, Pediatric critical care specialist; Dr Sunita Narreddy & Dr. Ravi Barigala, Infectiuos Diseases specialists and Dr Ravi Shanker, Endocrinologist.

Liver Transplantation in general and Paediatric Liver Transplantation in specific requires multi¬disciplinary approach, advanced infrastructure and well qualified staff who are specialised in dealing with critical paediatric patients. Apart from a meticulous surgery, the biggest challenge is the intensive care in the post-operative period. The nutritionists and physiotherapists have a very crucial role to play for a successful outcome. The margin of error in paediatric liver transplant patients is extremely narrow and the medical management has to be coordinated like clockwork.

The Liver Transplant programme at Apollo Hospitals, Hyderabad, has a success rate of over 95%, which is not only the best in India, but also one of the best in the world. The transplant program routine carries out multi-organ transplantation like Combined Liver-Kidney and Simultaneous Kidney-Pancreas Transplantation. World over, Paediatric Liver Transplantation is carried out in a chosen few centres and not all liver transplant centres offer these services. Children with a various disorders like biliary atresia, metabolic disorders, and liver tumours, among other causes may need liver transplantation. With superlative success rates, which speaks of a proficient team and excellent infrastructure, the Liver Transplant Program at Apollo Hospitals, Jubilee Hills, is all equipped to undertake complex endeavours.

About Apollo Hospitals
It was in 1983, that Dr. Prathap Reddy made a pioneering endeavor by launching India's first corporate hospital - Apollo Hospital in Chennai. Now, as Asia largest and most trusted healthcare group, its presence includes more than 10000 beds across 65 Hospitals, 2000 Pharmacies, 92 Primary Care and Diagnostic Clinics, 100 Telemedicine units across 10 countries. Health Insurance services, Global Projects Consultancy, 15 colleges of Nursing and Hospital Management and a Research Foundation with a focus on global Clinical Trials, epidemiological studies, stem cell & genetic research and the first Proton Therapy Center across Asia, Africa and Australia.
In a rare honor, the Government of India issued a commemorative stamp in recognition of Apollo's contribution, the first for a healthcare organization. Apollo Hospitals Chairman, Dr. Prathap C Reddy, was conferred with the prestigious Padma Vibhushan in 2010. For more than 30 years, the Apollo Hospitals Group has continuously excelled and maintained leadership in medical innovation, world-class clinical services and cutting-edge technology. Our hospitals are consistently ranked amongst the best hospitals globally for advanced medical services and research.
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