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Pediatric Liver Transplant Recipient Becomes Accounting Adult

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Successful Liver Transplantation at 6 years of age rekindles the hope, aspirations and dreams of a 21-year old accountancy student

Twenty one year old Saumyadeep studies accountancy away from home. He spends his weekends with his parents. He knows they cherish him and look forward to his visits.

They snatched him back from the jaws of death and nurtured him to his current blissful existence. The journey has been long and arduous, putting to test their physical, mental, moral and spiritual strength, yet immensely rewarding as well.

Saumyadeep was just 2 weeks old when they noticed that he was jaundiced. When it persisted longer than normal, his aunt who was a medical student rang the alarm bells. It’s not the usual jaundice of newborns, it was something sinister. A series of tests revealed he had biliary atresia of a type in which only a part of the biliary system outside the liver including the gall bladder and the ducts were present.  A variation of the classic Kasai procedure was performed using the gallbladder as a conduit to drain the intrahepatic ducts–“gallbladder Kasai”. He was around 2 and a half months old at that time.  Although Kasai procedure is not a permanent cure for biliary atresia, in many cases it allows patients to grow and remain in good health for several years. This delays (or in about 25% of children, eliminates) the need for a liver transplant

Thus began Saumyadeep and his family’s struggle with disease, this being first of the many hospitalizations he would endure. Post operatively, Saumyadeep developed severe infection and was on the ventilator for a few days. Thereafter, he remained well for about 3 years after which the jaundice reappeared. He was re-operated and the classic Kasai surgery was performed. His jaundice persisted with a fluctuating course. His liver was getting progressively fibrosed and scarred, leaving him at risk for even more serious complications. He was managed with medications but they were only supportive. He would need a liver transplant. The cost outside India was prohibitive, way beyond the reach of the family. It seemed they would have to watch their son die….

A report in the papers about Sanjay, the first successful pediatric liver transplant recipient in India in 1998, gave them hope. Saumyadeep could be next, was this to be the unfolding of the miracle they had been praying for? It sounded too good to be true, but true it was.

Saumyadeep was 6 years of age when he underwent a liver transplant in 1999. He was very weak and malnourished due to his prolonged illness and was in hospitalised for weeks before his transplant. The team wanted him to gain strength. He was nutritionally rehabilitated and psychologically prepared to cope with the daunting surgery.

A liver transplantation is a long abdominal surgery, the risk of intestinal perforation in view of 2 previous abdominal surgeries was high. He had to be operated thrice  after the first week for recurrent intestinal perforation.  Due to the gut leak, he had to be kept on artificial feeding through specialised preparations given intravenously. He also developed pneumonia requiring ventilation for 2 weeks.  His recovery consolidated the family’s faith that he was divinely protected.

He walked home after 4 months, his medical and surgical problems sorted. But he was a changed child. Angry and aggressive after all the days in hospital, he required lots of emotional support from his family and teachers. Two years down the line he developed tuberculosis that involved his brain giving him seizures. He recovered fully after regular medication. When he was 11, their family moved to Canada but it was his place of birth that charted his destiny. He is now a successful accountant.

The Clinical Perspective After Sanjay, Saumyadeep proved to be our next challenge. Pretransplant, he grew a bug in his blood and was also detected to be a silent carrier of salmonella, the bacteria that causes typhoid. He was treated with appropriate antibiotics to eradicate the infection. The postoperative course was tumultuous. He developed sepsis, pneumonia, gut perforations, all one after the another. He had to be kept fasting for a prolonged period of time to allow his gut to heal. He transiently showed features of raised intracranial pressure raising fears of a brain haemorrhage but thankfully, his CT head was normal. On follow up, he had neurotuberculosis from which he recovered fully after adequate treatment. 
Verified By Dr Smita Malhotra
Consultant Pediatric Gastroenterologist & Hepatologist, Indraprastha Apollo Hospital
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