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State’s First Auxiliary Liver Transplant for acute liver failure in a Child done at Jupiter Hospital

An 11-year-old girl suffering with jaundice for past two days was admitted to a city’s private hospital for appropriate care and further management. After initial testing, she was diagnosed with liver failure and shifted to Jupiter Hospital, Pune.

“Her condition deteriorated rapidly over the 24 hours since her admission. Her liver functions tests were grossly abnormal, and she developed encephalopathy (altered consciousness) due to acute liver failure,” said Dr. Vishnu Biradar, the Pediatric Hepatologistat Jupiter Hospital.

“Under such circumstances, these patients usually need an urgent liver transplant to restore liver function,” he added.

Acute liver failure is an uncommon condition associated with a high mortality and most patients do not survive without liver transplantation.

The patient’s family was counseled about her condition and her father volunteered as a liver donor for the ailing girl. Due to acute nature of the illness, an auxiliary liver transplant was planned for the child. Auxiliary liver transplantation has emerged as a therapeutic option in the last few decades.

Shedding light on the details of the procedure, Dr. Gaurav Chaubal, Chief Transplant surgeon said, “During the auxiliary liver transplant technique, part of her native liver – the right lobe wasretained and the left lobe was replaced with the donor’s left lobe.” The benefit of this particular transplant is that, “once her native liver recovers, we can stop the medicines required to prevent rejection of the transplanted liver,” added Dr. Chaubal.

The complex surgery was clinically very demanding and enforced extensive coordination between several specialties. Post-surgery, the girl presented unique set of challenges which were successfully overcome by the team.  “The patient experienced rapid clinical improvement after the transplantation and recovered completely,” said Dr. ShrinivasTambe, Pediatric Intensivist. The duo visit the hospital for regular follow-ups and both continue to be healthy and happy.

Liver transplantation is often the only curative treatment in acute liver failure (ALF) patients, however, it is only performed in 18%[1] of cases. As a valuable alternative to orthotopic liver transplantation in the ALF setting, auxiliary liver transplantation (ALT) allows liver function support during the period of native organ failure, giving the necessary time frame to the injured liver to regenerate.

“Though rarely performed, auxiliary liver transplant is a real hope for patients of acute liver failure or metabolic liver disease in children,” said Dr. Vishnu Biradar. This is the first time, a child underwent auxillary liver transplant for acute liver failure in Maharashtra.

The surgery was highly challenging considering the patient’s condition and the nature of the ailment. “We are really happy that the child has done extremely well and is on the road to recovery,” concluded Dr. Gaurav Chaubal.

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