Kenyan infant undergoes unusual liver transplant in Delhi

A one-year-old infant from Kenya with a complex anatomy underwent an unusual liver transplant at a city hospital where his liver was joined directly to his heart.
According to doctors, Paul is doing fine now and will soon fly back to his country.
He was suffering from biliary atresia since birth, a condition in which the bile ducts (required to drain the bile from the liver to the intestine) were not developed.
One the commonest reason for liver failure in infants, this condition can be treated by Kasai portoenterostomy operation if detected within two months of birth. Unfortunately for Paul, the condition went undetected and he developed liver failure.

The only treatment option before doctors was liver transplant.
"Paul's case was high risk case because he was severely malnourished, he was born with a complex anatomy and his liver failure was rapidly worsening. He needed an urgent transplant," says Anupam Sibal, Group Medical Director and Senior Pediatric Gastroenterologist at Apollo Hospitals.

Dr Subash Gupta, Chief Transplant Surgeon at Indraprastha Apollo Hospitals, who operated on Paul on December 17 said, "Paul did not have the inferior vena cava (IVC)- the vein which drains blood from the limbs, kidneys and the heart. The living donor liver transplant in itself is quite a difficult operation, the absent of IVC posed an even greater challenge.

"Special techniques were used to join the liver directly to the heart. Working from the abdomen the lower most part of the right atrium was freed so that the liver could be rejoined to the portion of the heart where the IVC would have joined. The lateral segment of the father's liver was taken out and implanted in the child after removing his native liver."
The entire operation took 12 hours and involved a medical team consisting of over 50 members. Paul was discharged two weeks after the surgery.
According to Dr Neerav Goyal, senior consultant (Liver Transplant) at Apollo, it was a challenging surgery since the child was very young and weighed only 6 kg.

"Joining of blood vessels is very tricky in such cases since the blood vessels tend to get blocked in young children. Absence of IVC is a rare anomaly and found in about 2 per cent of the patients," he said.