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It was in 2021 when a six-year-old girl from Vellore near Chennai had become very frail, skinny and her belly was filled with fluid and bloated. Lithikasri eventually became bedridden and could barely walk. It was only after thorough investigations that the family learnt that she was suffering from hepatic fibrosis and autosomal recessive polycystic kidney disease. The genetic condition, which affects the liver and kidneys, manifested in her at the age of 6, entailing a multi-organ kidney-liver transplant.
“By the time, she received a diagnosis, both her liver and kidneys were damaged to the point that a muti-organ liver-kidney transplant was inevitable,” says Dr Sanjay Govil, senior consultant, HPG & Multi-organ Transplantation, Apollo Hospitals, Sheshadripuram, Bangalore.
After struggling for two years, the girl (8) is now a recipient of liver and kidney and is back to life, thanks to cadaveric organ transplant at Apollo hospitals, Sheshadripuram, Bangalore. She underwent combined liver, kidney transplant through a 14-year-old cadaveric donor in Bangalore in October 2023. The girl who got a new lease of life is all set to restart her studies from this academic year.
Innovative aquadex technology
What makes the multi-organ transplant surgery unique is that it employed an innovative technology called Aquadex therapy done through Aquadex System, made by Nuwellis, earlier known as Wayinia Lifesciences.
Aquadex therapy is an ultrafiltration process in which the excess fluid is removed from the body precisely and gently. It is also seen as an effective alternative to dialysis for those who may not be deemed fit for dialysis. It is a simpler procedure and is especially useful in those falling in the pediatric population for whom dialysis may pose risks. The hospital claimed that the technology was used for the first time in India.
Shedding light on the technology Dr Arun Kumar N, Senior consultant nephrologist and transplant physician, Apollo Hospitals, Sheshadripuram, who treated her says that generally, when doing a transplant in pediatric cases with kidney failure, dialysis was performed. “Dialysis has three components—removal of excess water and salts, altering electrolytes, and removal of waste products.”
Dr Arun adds that in certain cases we need to selectively remove the excess water and salts, while retaining the other molecules. “This is when aquadex technology comes into play,” he said.
“Lithikasri’ s creatinine levels were not very high, hence we restricted to aquapheresis—the removal of excess salt and water from the body,” says Dr Arun.
He explains that dialysis can cause the kidney to shut down and become dialysis dependent, whereas the aquadex method allows the kidneys to keep functioning.
“Besides, the technology does not cause complications like lowered blood pressure associated with dialysis,” he said. Dr Arun added that he came across the novel technology during his participation in a medical summit in the US and he introduced the same in India.
He adds that if the fluid accumulation in the body is high, it can pose hindrances in administering anaesthesia. The fluid has to be drained before anaesthesia. “About 30 litres of water had to be removed from the girl’s body,” says Dr Arun. Speaking to Happiest Health he added that the Aquadex therapy was used for a transplant case for the first time in southeast Asia. “This is largely used for those with cardiac issues in the US,” he said.
Challenges during surgery
“We faced a significant challenge during the kidney-liver transplant procedure. Removing her native kidneys and inserting this new kidney posed a unique challenge due to the risk of infection from the cystic native kidneys. Additionally, accommodating a 14-year-old kidney presented spatial constraints, leading us to opt for the left side,” said Dr Manohar T, Chief of Urology Services, Uro-oncology, and Kidney Transplantation, Laser, Laparoscopic, and Robotic Surgeon.
Dr Govil says that the peri-operative period also posed challenges. “She developed breathing difficulties, as the large size of the organs exerted pressure on the lungs. She had to be on ventilator support. She would also develop fits, and infections. These effects are seen in some children post-transplant,” says Dr Govil.
Finding the right match
Though the parents were willing to be her donors, they were not found to be suitable donors for the kidney-liver transplant. The family had also registered for the transplant at Tamil Nadu transplant authority seeking organ donation. When the child grew very sick, she was brought to Bangalore. “We registered for cadaveric donation in Bengaluru, and received the organs within four weeks of registering,” says Lithikasri’ s father.
The girl can’t stop thinking about going back to school. Lithikasri consistently scored first rank in her academics and the school authorities have decided to promote her directly to class 5,” said her father.
Takeaways
- An 8-year-old girl from Tamil Nadu with a rare genetic condition affecting the liver and kidneys successfully received a combined kidney-liver transplant in Bengaluru in October 2023.
- The girl whose parents weren’t suitable donors, received the organs from a 14-year-old cadaver donor.
- The multi-organ transplant used the innovative aquadex technology which is used as an alternative to dialysis in those who are not deemed fit for it. The technology selectively removes excess fluids and salts from the body
