Children sometimes need liver transplantation, often for reasons very different from adults. The commonest reason for liver transplantation in children is a condition called biliary atresia in which the bile ducts do not develop. Other causes include genetic defects like Wilson's disease, Crigler Najjar Syndrome, PFIC etc. Children can also get acute liver failure due to viral hepatitis, adverse reactions to medicines and so on.
Pediatric Liver Transplantation at Sir Ganga ram Hospital
We have done 52 liver transplants in children of which 50 were successful. 48 are doing well as of last follow up.
P was 3 months old when she was brought to us. She had biliary atresia. Her bile ducts had not developed normally. Bile accumulated in her liver and had no way out. Her liver had been damaged and become cirrhotic.
If biliary atresia is diagnosed soon after birth then an operation known as the Kasai operation can be done to try and drain the small bile ducts in the liver into a bowel loop. Unfortunately P was diagnosed too late and had already developed cirrhosis.
She needed a liver transplant but the best timing had to be decided. Ideally it would be better to wait until she was bigger and better able to tolerate the operation.
We decided to manage her medically until she was bigger or until she began to show signs of liver failure. When she became 6 months old she began to lose her appetite. She was admitted in hospital in Kolkatta with fever and it became evident that it was time for the transplant.
Her blood group was AB+ve so we did not anticipate a problem with either of the parents donating a portion of their liver for her. Unfortunately, when they were evaluated, both of them had fatty livers which disqualified them as donors. Her Uncle (father's brother) came forward and offered to donate for her.
By now she was quite sick. She had lost weight because she was not feeding well and she had had repeated episodes of infection. She weighed only 4.8 Kg.
We realized that she was going to get sicker and that we would have to transplant her quickly.
Since she was so small, the operation was technically difficult. She had very small blood vessels which had to be joined to the blood vessels of the portion of the donor liver. A very small part of the donor liver had to be taken so that it would fit into her abdomen and get enough blood flow from her small blood vessels. It was technically very demanding to remove such a small part of the donor liver in such a way as to keep it's blood supply and venous drainage intact.
She recovered well after the operation and is now doing well. She is feeding well and rapidly catching up with her growth.
As far as we know, this is the smallest baby to have a successful liver transplant in India.