In an unusual case — a seven-year-old Cambodian boy’s previous diagnosis and treatment helped save his baby sister.
Kim Sroy, now aged seven, was diagnosed with liver cirrhosis and underwent a liver transplantation at the age of 18 months.
In doing so, he unknowingly also helped his younger sister, who was detected with jaundice in the first few weeks after birth.
Giving details of this case which came to Delhi’s Apollo Hospitals Prof. Anupam Sibal, group medical director and senior paediatric gastroenterologist and haepatologist said, “After a successful liver transplant, Kim was discharged in the third week, but within two years he developed swelling all over his body and was brought back.”
Rare condition
He developed chronic renal disease due to transplant-related thrombotic microangiopathy, a rare condition where the small blood vessel get occluded due to the damage to their inner lining.
This is a very rare, but devastating complication of transplantation with mortality ranging from 60-90%.
Upon diagnosis, doctors realised that Kim urgently needed renal transplant and was put on haemodialysis. He underwent a kidney transplant. “Now it’s been more than five years and Kim is hale and hearty with both his liver and kidneys doing well,” said the doctor.
In 2017, Kim’s mother seeing her daughter Angel’s eyes become yellow after birth brought her to Apollo Delhi for an assessment.
“Given our understanding of Kim’s case, we immediately investigated Angel. She, too, was diagnosed with paucity of bile ducts. Her liver disease continued to progress rapidly, resulting in end-stage liver disease within a few months. The family took the baby to France for a second opinion where experts concurred with our plan. She underwent a liver transplant at the age of 11 months,” said Prof. Anupam Sibal.
Many transplants
He added that awareness about liver transplantation has increased considerably and the Apollo programme has now carried out transplants on more than 280 children from 20 countries.
Dr. Neerav Goyal, senior consultant, liver transplant and haepatobiliary, pancreatic surgery at Indraprastha Apollo Hospitals said, that Angel was really small and deeply jaundiced.
A challenge
“Such small babies are a challenge as the donor liver has to be specifically reduced as per the size of the small abdominal cavity, kind of custom built to fit in.
Big size grafts can create a lot of post-operative problems but fortunately for her, the reduced liver worked really fine. Also joining the tiny blood vessels can be quite challenging in babies,” he said.
“In the last three months alone, 10 children including babies as small as weighing 3.5 kg have been successfully transplanted,” added Dr. Goyal.
