‘Liver Uncle’ created history by successful transplant in smallest baby

By: Dhananjay Kumar
This rare feat is set to put Medanta’s liver transplant program on world map

New Delhi: Dr A.S Soin, chief liver transplant surgeon at Medanta, has earned the nickname ‘Liver Uncle’ for successfully doing most number of liver transplants in kids. He is uncle to them. This time, he has created history by doing successful liver transplant in world’s smallest baby weighing barely 2.1 kg. It was the most difficult transplant yet in a kid with most number of challenges.
David from Lagos, Nigeria, getting transplant, also became the first survivor in the condition called neonatal hemochromatosis. In this condition liver is bogged down by iron deposition. Before this, Japan is said to have the distinction of having successful liver transplant in a baby weighing 2.59 kg. David was just two months old when he was brought to Medanta from Lagos by his lawyer parents. Frail David was as good as dead.
By all reckoning, it was well neigh an impossible case for liver transplant. But prodded by David’s parents, Dr. Soin and his team took the chance. And lo and behold! David rose from the dead. It took 9 hours of strenuous surgery and 11 hours of anaesthesia to David. When he was discharged nine weeks after the transplant surgery, he weighed 3 kg and had normal liver and bone marrow functions.
Dr. Soin says, ‘We ourselves are overwhelmed by the outcome. He was 2.1 kg with his bloated liver. Without it, he would have been left

barely 1.4 kg. The portion of liver to be derived from his fat father was also a great challenge. We needed to harvest only a 5-6% portion of his father’s liver to fit in his frail body. Cutting such a small portion of liver is difficult because we have to keep the 1mm-vein, 0.1mm-artery and the bile duct intact for the liver to function on its own’
Dr Neelam Mohan, director of paediatric hepatology and liver transplant, said, ‘The baby was at a high-risk of infection because of the failure of the bone marrow, which produces white blood cells to fight infections, coupled with the immune-suppressant given to transplant patients to prevent rejection. This made the case most difficult to handle.’
Dr. Soin called it a spectacular feat because it needed a combined effort of a 50-member multidisciplinary team of doctors. Its scientific report has been submitted to an international journal. He said he had scanned world medical literature and found it a rare outcome.
David had to stay in the hospital for nearly two months. Being weak and malnourished, David could not even breathe on his own for 45 days, so he had to be kept on ventilator support and intravenous nutrition.


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