New Delhi: It is piece de resistance of HCMCT Manipal Hospitals in liver transplant. India is yet to document success of such rare liver transplant. Surgeons of the hospital scripted a new life for a 9 month old Iraqi boy who had been written off as not fit for survival by other big centres of transplant in Delhi.
Emaciated and a picture of helplessness in the clutch of death spiral, barely 9 month old Ali Hamad survived by the skin of his teeth thanks to meticulous hands of surgeon. He is now a veritable cute bundle of joy for his parents and is seen listening to rhymes and becoming cynosure of all eyes by his playfulness. Dr Shailendra Lalwani, Head of the Department of Liver Transplant and Hepato-Pancreatic-Biliary Surgery in Manipal, said liver transplant literature does not document any such rare liver transplant success in India. It took 10 hours of surgery and a team of 100 members to save Hamad from near death. His mother gave him a morsel of her liver for transplant.
It was one of the most complex live-saving Liver transplants on Ali Hamad who suffered from liver failure due to a rare disorder. Normally, surgeons find it risky for a transplant less than one year of age and 10 kg weight. Hamad was born after three kids who perhaps died of a similar disease that could not be diagnosed and treated timely.
Dr. Lalwani’s team was supported by Dr. Lalit Sehgal HOD – General Anesthesia, Liver Transplant Anesthesia, Liver Critical Care, Dr. Vikas Taneja, HOD – Pediatrics and Dr. Sufla Saxena, Consultant – Paediatric Gastroenterologist and Hepatologist.
Baby Hamad was a known case of Progressive Familial Intrahepatic Cholestasis Type II (PFIC TYPE 2). He had jaundice since birth. The patient had multiple hospitalizations in Iraq for jaundice and recurrent cholangitis. He was evaluated for jaundice and a liver biopsy done in Iraq was suggestive of progressive familial intrahepatic cholestasis type 2. Three other siblings of the patient died because of jaundice and they remained undiagnosed. Given the history, clinical condition, and pathological diagnosis patient was referred for a liver transplant.
“Hamad was having infection with cholangitis for which he was admitted and treated. Apart from recurrent cholangitis, the patient was having marked ascites and growth failure with a bodyweight of 6.1 kg. He underwent evaluation for a living donor liver transplant and his mother was evaluated as a prospective donor. During an evaluation, CT scan showed cirrhotic changes, hepatosplenomegaly with attenuated portal vein with no portal flow with significant ascites and significant portosystemic collaterals,” said Dr. Lalawani
“No supply of blood to the liver or clinically speaking attenuated portal vein is a big challenge to any liver transplant team as vascular complications are high in paediatric transplant patients. The reconstruction of the portal vein with graft is always a challenge as it increases the risk of thrombotic complications. To overcome this challenge, we planned to use arranged an iliac vein graft procured during cadaveric liver transplant,” he elaborated.
On 3rd January 2021, the baby underwent a transplant. “There was no flow in the portal vein. We placed the interposition vein graft to give inflow to the liver. It took around 9 hours to complete the transplant and baby was shifted to ICU on a ventilator,” said Dr. Lalwani.
The baby was off the ventilator the next morning and gradually in the next few days, he started accepting oral feed, tolerating well, and gaining weight. Finally, after 20 days of surgery baby was discharged from the hospital. The family plans to go back to Iraq now.
Hamad’s Mother, who donated liver to her son, said, “He is my fourth son, earlier three died perhaps suffering from the same liver disease. I was very afraid about Hamad’s survival, but the doctors here saved the life of my son. We express since gratitude towards all doctors of Manipal Hospitals. From day one they assured me that everything will be right and I will go back to Iraq with a healthy child.”
Congratulating the team for this remarkable milestone at a Press Conference on February 5, 2021 in New Delhi, Mr. Raman Bhaskar, Hospital Director, HCMCT Manipal Hospitals said, “As a leading tertiary and quaternary care hospital we continue to strive for our core value of clinical excellence which along with Patient Centrality and Ethical Practices. HCMCT Manipal Hospitals Dwarka is a fully digital, paperless hospital. It is one of the top 10 biggest hospitals with 24X7 Emergency & Trauma Services, Modular Operations theatres, 380 beds, and 118 critical care beds. Moreover, we are well equipped with advanced technology such as robotic surgery, linear accelerators, and PT Scan, etc. We have several Centres of Excellence for Specialties including Liver Transplant.”
