Global Health City to the rescue
Baby Poojani was 2 months old when she was diagnosed to have Liver disease and at the age of 16 months she was still weighing only 4.8 kg, was jaundiced, malnourished and was showing features of failure to thrive as her liver disease, Biliary Atresia , would not allow normal growth of the child.
It was at this juncture that she came to Global Health City, Chennai, India where she was further evaluated. She was reviewed by Prof. Mohamed Rela, Director of Liver Transplant Services, Global Hospitals Group and it was decided that she needed a Liver transplantation to cure her underlying liver disease and as a result help with her growth and development.
She was about 5 kg at transplantation at that was after providing nutrition through a tube into the stomach for a few days. She was irritable, incessantly crying, jaundiced and malnourished. Her mother donated part of her liver to the child and Poojani underwent Liver transplantation in 2010. The liver transplant was successful and there was a very rapid and visible change with the functioning liver in the child as she gained weight to 6kg in one month. Liver function was normal, she was very sociable and had a catch up in her developmental milestones over the next few months.
Poojani had periodic follow up with the liver transplant team to monitor her liver function and medications, most impor- tantly her Immune-suppressant medication which she would have to continue life long as in patients who undergo any organ transplantation. She is now 4 years old and unstoppable, doing what all kids her age would do - going to pre-school, being naughty and bears appropriate weight for her age. Timely and appropriate intervention of her liver disease has helped put Poojani’s life back on track inspite of being born with a disease which caused Liver failure.
This gave the hospital an opportunity to visit a few issues associated with diseases of the Liver and its management. Liver disease is caused by a multitude of factors from basic lifestyle issues which cause alcoholic liver disease or fatty Liver disease progressing on to cirrhosis of the liver or due to Viral infections of the liver like Hepatitis A, B and C which can cause acute liver failure in an otherwise so far healthy individual or chronic Liver disease which can cause damage over several years leading to cirrhosis of the Liver and ultimately reaching a point of needing Liver transplantation.
In some patients the manifestation maybe with tumors in the liver which develop on a background of chronic liver disease. Whatever be the cause of liver disease, the presentation can be a spectrum from non-specific symptoms like fatigue, minimal swelling of the legs to life threatening symptoms of blood vomiting, disorientation and coma.
The important aspect in the management of patients with liver disease is the timely diagnosis and appropriate intervention to provide a long term survival and good quality of life. In the early stages of compensated cirrhosis, the management can be medical measures, but when the patient shows features of de-compensation (eg - coma, recurrent bleeding, repeated fluid accumulation in the abdomen needing drainage or formation of tumors in the liver) it is important to make the decision to proceed with Liver transplantation. In children, as exemplified in Baby Poojani’s situa- tion, in addition to the above mentioned indications, failure to thrive, malnutrition, and delay in developmental milestones secondary to failure to thrive become important parameters in decision making for Liver transplantation.
Reflecting on the case of Baby Poojani, Dr Gomathy Narasimhan, Consultant Liver Transplant Surgeon, Global Health City, Chennai, India says in conclusion that “Preventive medicine always gives the best outcome, hence, a healthy lifestyle with balanced diet and good exercise can guard against fatty liver and alcoholic live disease. But in other situations a timely decision goes a long way in good outcomes after treatment.”