Dr Asthana with the baby and his parents
Surgery has, and continues to fascinate me. I chose a surgical residency due to its immediacy- one can exercise a certain set of skills and be privy to seeing instant results--stopping hemorrhage for a trauma victim, for example. Transplant surgery is the combination of several skill sets- surgical dexterity, a deep knowledge, and an understanding of medicine and critical care. More importantly, it is the ultimate team sport- needing specialists from diverse specialties at the top of their game to deliver good results.
I am a transplant surgeon with an interest in pediatric liver transplant surgery. I have been doing liver transplants on small children for over 20 years. Among my patients are those children who are born with conditions that affect their liver function in their first few months. If detected in time, most of these conditions can be treated with medicines or minor surgical procedures but there are times when they are brought to us late, leaving transplant as the only treatment option.
Recently, a three-month-old baby boy was brought to us by his parents from Midnapore, West Bengal. The infant’s skin and eyes were pale, and he weighed only 5.5 kilograms. He was suffering from biliary atresia, a condition in infants in which the bile ducts outside and inside the liver fail to develop, and are scarred and blocked. As a result, the normal flow of bile—a digestive fluid secreted by the liver—to the intestine is impeded. This disruption leads to the buildup of bile, within the liver, harming its tissues and eventually causing liver failure.
If this condition can be diagnosed within the first two months of life, an operation called the Kasai procedure may be possible. In this, we connect a segment of the child's small intestine directly to the liver, which then functions as a new extrahepatic bile duct system. However, most children in India are diagnosed late, by which time liver damage has already developed,
This was also the case for this infant – the liver was already damaged and a liver transplant was our only option to save his life. A liver transplant requires extensive testing of the baby and finding a donor. Fortunately, his mother was a perfect match and she, too, was more than happy to donate her liver to her child.
Every operation is different, no matter how many times one enters the OR. When operating on very small children, the size can be daunting. We need highly skilled anesthesia teams to manage the child during surgery. Technically the blood vessels of children are very small and prone to blockage. This child was very small and was already malnourished, so there was no room for error. The eight -hour surgery went well. Postoperative care for these infants is critical -in our field, there is nothing we can achieve alone. It takes the entire team – including surgeons, anaesthetists, intensivists, technicians, nurses, and ward attendants – working together wholeheartedly to save a life.
Every operation is different, no matter how many times one enters the OR. When operating on very small children, the size can be daunting. We need highly skilled anesthesia teams to manage the child during surgery. Technically the blood vessels of children are very small and prone to blockage. This child was very small and was already malnourished, so there was no room for error.
Infants are delicate and extremely fragile. If you make a mistake, they don’t give you much time to mend it. The baby was in the hospital for about 20 days. He, the youngest ever liver transplant recipient in Karnataka, recovered fully and his mother was too happy to hold him in her arms.
One of the advantages of a liver transplant is the remarkable compatibility of this intelligent and versatile organ with the recipient's body. Additionally, it rapidly regenerates to its original size within a few weeks in the donor's body. The medications utilized in this context are both potent and safe. In the case of liver transplants, we often swiftly lower the dosage of immune-suppressant drugs, allowing individuals to lead a regular life with minimal precautions, as opposed to kidney transplant recipients.
One of the advantages of a liver transplant is the remarkable compatibility of this intelligent and versatile organ with the recipient's body. Additionally, it rapidly regenerates to its original size within a few weeks in the donor's body.
The feeling one gets when seeing these patients off is one of relief. It is immensely rewarding to be part of the family’s journey – watching the baby grow up healthy, and live a full normal life.
We have operated on close to 200 children over the past decade. They have become fine young men and women, and some of them are studying in college. It is a blessing for us to be able to impact lives in this way.
(Dr Sonal Asthana is lead consultant--HPB and Liver Transplant Surgery, Aster CMI hospital, Bengaluru. Views expressed are his personal)