Liver transplant of an 11-month child
Baby Harshita was diagnosed with biliary atresia. Her liver failed despite initial surgery. She required liver transplantation urgently. However, due to the absence of a matched donor in her family, liver transplantation looked a distant dream for her. Due to repeated ICU admissions, finding a donor was a race against time.
A specialized Paediatric Liver Transplant Team led by Dr Ravi Mohanka and Dr Anurag Shrimal at Global Hospital, Parel, Mumbai; has performed a medically challenging A-B-O blood group incompatible (mismatched) liver transplantation in an 11 months baby (weight 5.5 kg) with end-stage liver disease. It makes this operation as first successful ABO-incompatible blood transfusion in an infant in western India.
Dr Ravi Mohanka, Liver Transplant Surgeon at Global Hospital, Parel, Mumbai, highlighted, “Baby Harshita had undergone timely Kasai portoenterostomy for biliary atresia. But her illness progressed. She continued to have jaundice, poor weight gain, fluid in the tummy, repeated infections requiring ICU admission and blood in the vomitus. The only treatment available was urgent liver transplantation. For any routine liver transplantation, blood group of donor and recipient should match. However, baby Harshita did not have a suitable blood group matched donor in her family. With limited time available and absence of donor, liver transplantation was looking like an impossible task for Harshita”.
Dr Vibhor Borkar, Paediatric Hepatologist at Global Hospital, Parel, Mumbai, said, “In ABO-incompatible liver transplantation, we go ahead with liver transplantation even though blood groups of donor and recipient do not match. It is a medically challenging task. Such transplantations have more risk compared to routine transplant. Patients have a higher risk of rejection and infections. They need stronger immunity suppressing medications and sometimes specialized dialysis.
Dr Anurag Shrimal, Paediatric Liver transplant surgeon at Global Hospital, Mumbai, said, “We had done such operations earlier in adults. However; for an infant, this was also our first time. Apart from this, Harshita also had other major challenges like her age was less than 1 year, and weight only 5.5 kg. Her family understood the need of the situation and risk involved for such kind of operation. Harshita’s father has B blood group. He came forward to donate a small part of his liver to her.
The post-operative recovery of tiny infants is as challenging as the surgery. Keeping infections at bay was a challenging task in Harshita. She required ICU for only 4 days. She was discharged in 16 days. Now after 2 months of her surgery, she is free of jaundice, active, growing well, gaining milestones and with no active infections.
Mr Kajrolkar, father of baby Harshita said, “We could see every day Harshita’s condition was deteriorating. When we learnt that none of us (father and mother) could become a donor for her, we had lost all our hopes. When we meet Dr Anurag, he explained to us a possibility of ABO-incompatible transplant. This gave us a ray of hope. We had decided to scale all the challenges for saving Harshita’s life. Today we find her in good health, and we are happy about that.