Mumbai: A two-year-old girl’s entire liver was removed for four-and-a-half hours to take out a massive tumour, before the salvaged portion of the organ was successfully replanted to save her life. Such procedures were so far performed in adults, but her doctors turned to it as a last resort.The ideal option was a transplant, but with no donors available across the country, the team at Wadia Hospital believed this was Aphsa Shaikh’s only fighting chance for life.Dr Pradnya Bendre, head of the paediatric surgery unit at Wadia Hospital, said the girl’s parents could not serve as donors as they were undernourished. “It was a huge tumour, and the dissections needed were massive,” said Dr Bendre, who also leads the hospital’s solid organ transplant unit. This kind of tumour, known as hepatoblastomas, is among common liver cancers in children. Aphsa underwent multiple rounds of chemotherapy months prior, but it could not reduce the size of the tumour sufficiently. “It was located just below the heart and involved two major veins. Such a situation is typically defined as inoperable, where a transplant is the only solution.”After searching fruitlessly for a donor in the city, the state, and across the country, it was decided to move forward with an “out-of-the-box” plan. Parents were counselled, risks were explained, and consent was obtained last month. The liver was completely removed and placed on a surgical bench. To keep the organ functional and mitigate any risks, it was connected to a system providing hypothermic machine perfusion, a process which uses a fluid to maintain the liver at a specific temperature.Dr Abhishek Mathur, chief of liver transplant at the hospital, who performed this procedure on adults in the US, was brought on board to oversee the procedure. “We had unparalleled exposure and acce-ss to remove the tumour-affected liver and perform reconstruction of the blood vessels. Once completed, the reconstructed remaining healthy liver segment was auto-transplanted back into the body.”Haseena, Aphsa’s mother, said one crisis ended, but another one just began. “We have a couple of lakh debt to pay, which includes the initial Rs 85,000 that was put as hospital costs and the allied expenses incurred over months. Now, she will also have to undergo another round of chemotherapy.” Aphsa’s father works as a daily wage labourer, who lost pay during the course of the treatment.But life also came full circle for the family as they moved to Mumbai from Uttar Pradesh a few years ago for Aphsa’s grandfather’s cancer treatment at Tata Memorial Hospital. Doctors said the history of cancer was a coincidenceMeta Analysis:Autotransplantation bypasses donor shortages by salvaging the patient’s own organs. Data shows that in the US, 1,700 out of 17,500 waitlisted liver patients die annually. India’s gap is even wider, with approximately 19,000 patients waiting for just 4,000 available transplants. In this context, ex-vivo resection (bench surgery), which was used in this case, can be a clinical alternative to bridge the organ supply-demand gap.Status: Not ApprovedHEAD: 20_Mum_EK_liver cancerByline: Eshan KalyanikarLiver taken out for 4.5 hrs to operate on a 2-year-oldEshan.Kalyanikar@timesofindia.comMumbai: A 2-year-old girl’s entire liver was removed for 4 and a half hours to take out a massive tumour, before the salvaged portion of the organ was successfully replanted to save her life. Such procedures were so far performed in adults, but her doctors turned to it as a last resort.The ideal option was a transplant, but with no donors available across the country, the team at Wadia Hospital believed this was the child’s only fighting chance for life.Dr Pradnya Bendre, head of the paediatric surgery unit at Wadia Hospital, said that the girl’s parents could not serve as donors as they were undernourished. “It was a huge tumour, and the dissections needed were massive,” recalled Dr Bendre, who also leads the hospital’s solid organ transplant unit.The child, Aphsa Shaikh, underwent multiple rounds of chemotherapy months prior, but it could not reduce the size of the tumour sufficiently. “It was located just below the heart and involved 2 major veins. Such a situation is typically defined as inoperable, where a transplant is the only solution.”After searching fruitlessly for a donor in the city, the state, and across the country, it was decided to move forward with an “out-of-the-box” plan.Parents were counselled, risks were explained, and consent was obtained. Then the liver was completely removed and placed on a surgical bench. To keep the organ functional and mitigate any risks, it was connected to a system providing hypothermic machine perfusion, a process which uses a fluid to maintain the liver at a specific temperature.Dr Abhishek Mathur, Chief of liver transplant at the hospital, who performed this procedure on adults in the United States, was brought on board to oversee the procedure. “We had unparalleled exposure and access to remove the tumour-affected liver and perform reconstruction of the blood vessels. Once completed, the reconstructed remaining healthy liver segment was auto-transplanted back into the body.”Haseena, Aphsa’s mother, said one crisis ended but another one just began. “We have a couple of lakh debt to pay, which includes the initial Rs 85,000 that was put as hospital costs and the subsequent allied expenses incurred over months.” Her father works as a daily wage labourer who lost pay during the course of the treatment.But life also came full circle for the family as they moved to Mumbai from Uttar Pradesh a few years ago for Aphsa’s grandfather’s cancer treatment at Tata Memorial Hospital. Doctors said the history of cancer was a coincidence. MSID:: 126820413 413 |
