First cross-liver transplant in India a success

Nigerian Tot, Mumbai Woman Benefit From Rare Surgery Kounteya Sinha | TNN  New Delhi: Three months ago, nobody could have guessed their fates would be tied, but a little Nigerian boy and a woman from Mumbai were brought together in Delhi by—of all things—terminal liver failure.      Unable to find suitable donors with matching blood types for both 18-month-old Dike Ezeanya and 44-year-old Priya Ahuja, doctors at Sir Ganga Ram Hospital decided to attempt a liver swap, similar to a swap kidney transplant which is now a fairly common procedure. Thus Dike and Priya have become India's first patients to successfully undergo such liver surgery.      Five months after his birth, Dike was diagnosed with Billiary Atresia—a rare condition in newborns in which the common bile duct between the liver and the small intestine is blocked or absent. This condition can lead to liver failure, which is exactly what happened to little Dike.      Priya's state was also critical. On top of advanced liver failure due to Hepatitis C infection, she was diagnosed with tuberculosis.      With transplants their only hope, doctors were at a loss when compatible cadaver donors could not be found. It was fortuitous that Drs A K Soin (chief of liver transplant unit), Neelam Mohan (paediatric hepatologist) and Sanjiv Saigal (transplant hepatologist) discovered that Dike's mother Chinwe had the same blood group (A) as Priya, and that Priya's husband Haresh had the Type B blood, as did Dike. Liver swap carried out in 16 hrs in 4 theatres  New Delhi: Doctors at Delhi's Ganga Ram Hospital, unable to find suitable liver donors for Nigerian toddler Dike Ezeanya and Mumbai resident Priya Ahuja, decided to attempt a swap liver transplant surgery after learning that Dike's mother Chinwe had the same blood type as Priya, and that Priya's husband Haresh shared the blood group of Dike. A 35-member surgical team then took 50% of Chinwe's liver and transplanted it into Priya, while Haresh gave 20% of his liver to save Dike. Almost two months after the surgery, both Dike and Priya are doing well.      "While the donors' blood groups did not match the recipient they were related to, they were suitable for the other recipient. Dike's father had the same blood group as the kid but he had a fatty liver and wasn't a suitable donor. When we suggested donor exchange—also called paired donation—both families jumped at the opportunity,'' Said Dr Neelam Mohan, paediatric hepatologist at Ganga Ram Hospital.      Dr A K Soin, who heads Ganga Ram Hospital's liver transplant unit, added, "The biggest challenge in paired donation transplants is that both must take place simultaneously, otherwise the donor for the second transplant (first recipient's relative) may refuse to undergo surgery once his own loved one has been transplanted.''      "While donor swaps are common in kidney transplantation, which takes two hours, they have not been previously attempted in liver transplantation as conducting two simultaneous living donor liver transplants (four operations) is a daunting task that takes 10-12 hours per person. The swap transplant was carried out over 16 hours in four operating theatres on June 25,'' Dr Soin said. Dr B K Rao, chairman of Ganga Ram Hospital said, "This swap transplantation is a blessing at the time of acute organ donor shortage. Around 30% of rejected donors can become suitable swap donors, increasing transplant rates by 30%.''      India at present requires 30,000 liver transplants a year. Unfortunately, due to the country's low level of cadaver donation, doctors end up doing just 400-odd transplants a year. Transplant hepatologist Dr Sanjiv Saigal said, "We have now instituted the registration of patients with medically suitable family donors who don't match their own recipients due to inappropriate blood groups or liver size. This opens up opportunities for matching donors and recipients from different families, helping us save more lives." AND THEY LIVED HAPPILY EVER AFTER: Eighteen-month-old Dike Ezeanya of Nigeria is the toast of doctors, his mother (L) and the Ahuja couple (R) at Ganga Ram Hospital in Delhi