Omani Child’s Liver Saves Indian Child In A Rare Domino Transplant

In a meticulously executed 10-hour long procedure, liver transplant surgeons, Dr. Shaleen Agarwal and Dr. Rajesh Dey at Max Hospital, Saket performed the rare Domino Liver Transplant. In this chain transplant, one of the recipients also becomes the donor. The first recipient gets a healthy donor liver.  In our case, this was a living related donation, but it could also be done from a cadaveric liver if available.

The three-year-old kid from Oman named- Alyazan Ahmed Sayed Khamis Al-Mashrafi was diagnosed with Maple Syrup Urine Disease. In this rare genetic disorder, the body lacks an enzyme involved with metabolism of branched chain amino acids. Unmetabolized branch chain amino acids accumulation in the body is associated with episodes of altered behavior and coma. The Omani kid liver was a perfect match for five-year-old Pushkar Ojha from Delhi who had advanced liver disease, but his body did not lack the deficient enzyme. 

Dr. Subhash Gupta, Chairman, Centre for Liver & Biliary Sciences, Max Hospital, Saket, and one of the three lead surgeons who carried out the transplants said, "Domino transplants tests the ability of Transplant teams to carry out multiple procedures simultaneously as once a liver is out from a recipient, a new liver must be implanted quickly and the recipient liver must be worked upon in the bench outside the body to make it suitable for implanting in another recipient whose liver needs to be taken out just before the completion of back bench work. In this transplant, complete coordination between the three teams is a must to ensure success of both the transplants.  

Dr. Shaleen Agarwal who carried out the back bench wok used innovative techniques to join the multiple hepatic veins into a shape that would allow for easy implantation. 

The donor and two recipients luckily did not face any hiccoughs in the postoperative recovery period.

Elaborating on the disease and its implications, Dr. Vikram Kumar, Principal Consultant, Pediatric Liver Transplantation, Gastroenterology & Hepatology said, “MSUD is caused by the lack of an enzyme in the body. Once the patient gets a liver transplant, he can make enough of the enzyme in the new organ to overcome the shortfall elsewhere in the body. In turn, an MSUD patient's otherwise normal liver, can be transplanted into someone else without passing on the disease, as other cells in the patient can make the enzyme lacking in the donor liver. MSUD can cause vomiting, poor feeding, weight loss, and convulsions and the patient can ultimately land in a coma. Since high levels of acids in the urine give it the smell of burnt sugar, the name Maple Syrup. The disease can be treated with a very specialized diet which has to be strictly followed lifelong, and hence is extremely difficult to sustain a healthy growth basis that diet only. The actual treatment then is only a liver transplant. 

Expressing his gratitude at the successful liver transplant, Alyazan’s uncle Mr. Sulaiman said, “I am indebted to the doctors at Max Hospital who conducted the transplant successfully and gave my nephew a new lease of life. Now, our child can lead a healthy life without further challenges.” 

With the success of the procedure, Pushkar’s parents are also looking forward to giving their child a normal life. 

Max Centre for Liver Transplant and Biliary Sciences is one the busiest and a popular destination for liver transplantation in India. Many patients from overseas chose to come here for their treatment as the outcomes have been hugely successful. The Centre has experienced doctors with the entire team being established in liver transplantation in India way back in 2001. A team of 200 members with 20 years of experience have done 3000 plus transplants ensuring that patients receive intense care during and after the surgery. Currently, the success rate of Liver transplants is over 95% at 1 month and the ten-year survival is over 80%.