It was December 2021. Amarnath Keshavamurthy lay anticipatedly in the operating room of a Bengaluru hospital, awaiting a 12-hour liver transplant surgery. He was donating his liver to his seven-year-old son Vishnusharan.
In 2020, Vishnusharan was diagnosed with urea cycle disorder, a genetic disorder causing the accumulation of ammonia in the blood.
Ammonia is a waste product formed during the digestion of protein. In a urea cycle, ammonia is broken down into urea by the liver enzymes and expelled as urine.
A deficiency in these enzymes is called urea cycle disorder which causes a build-up of ammonia which is toxic to the body.
Vomiting, fatigue and abdominal pain became Vishnusharan’s constant companions, with frequent hospitalisations to lower his ammonia levels.
He also showcased aggression, lethargy and mood swings. “Initially we mistook these for a behavioural issue,” says Swathi, Vishnusharan’s mother.
Vishnusharan became fearful of hospitals due to recurrent hospitalisations. “He had to stay in bed, connected to tubes. The immobility made him irritable,” says Swathi.
A liver transplant was the last resort to free Vishnusharan from the metabolic disorder.
What is a liver transplant?
“Liver transplant is a surgery where a diseased liver is replaced by a healthy liver,” says Dr Sonal Asthana, lead consultant, hepatobiliary and transplant surgery, Aster Hospitals, Bengaluru, who also treated Vishnusharan.
“Initially, we were apprehensive and wanted to continue with medications. When he didn’t improve, we realised that transplant was inevitable,” says Amarnath.
The search for a donor wasn’t arduous as the father was willing to donate and all parameters matched, which was a matter of relief to the family.
Liver donors are of two types. “A healthy liver is procured from either a brain-dead donor or a living liver donor,” Dr Asthana says. In a living donor liver transplant, a part of the liver is taken from the donor who is usually a near relative, which can be the spouse, child, parent, sibling, grandparent or grandchild of a person needing an organ.
According to Dr Karthik Mathivanan, a senior liver transplant surgeon from MGM Healthcare, Chennai, the liver has a regenerative capacity and regrows into its original size in four to eight weeks after transplant.
When is a liver transplant needed?
According to Dr Asthana, a liver transplant is advised in persons with chronic cirrhotic liver disease (scarring of liver tissue). Chronic viral hepatitis, chronic alcoholism and non-alcoholic fatty liver disease are some conditions that can progress into liver cirrhosis.
Dr Pradeep Krishna, consultant, hepatobiliary surgery and liver transplantation, BGS Gleneagles Global Hospital, Bengaluru, notes that acute liver failure and liver cancer may also entail a liver transplant.
“Metabolic liver diseases are a common cause of liver transplant among children,” he adds.
Organ donation: what has to match
The donor and recipient undergo various tests before surgery, which the father-son duo had to go through.
“An ECG of the heart is done to assess the ability to withstand the stress of the surgery. A cardiac condition may pose a hindrance in undergoing a liver operation. Any malfunction of vital organs is dealt with before the operation,” points out Dr Pradeep.
“The quality of the donor’s liver including fat percentage and any stiffness is probed for. A CT scan helps ascertain if the portion to be donated is enough for the recipient and the remaining part is sufficient for the donor,’’ Dr Mathivanan says.
According to Dr Pradeep, the donor should either be of the same blood group as the recipient or belong to the group ‘O’ as they’re universal donors and should fall between 18 and 50 years.
Amarnath cleared all the tests and was found fit to donate a portion of his liver to Vishnusharan.
Care after liver transplantation
The road to recovery was slow yet steady for Vishnusharan. He recovered significantly in six months and is on life-long immunosuppressants.
“The immune system may perceive the new liver as a threat and attack it. Immunosuppressants prevent the immune system from rejecting the liver,” says Dr Asthana.
“One is more susceptible to infections in the first three months of surgery. The immunosuppressants also pose a slightly increased risk of infections. Hence, one must maintain hygiene and evade infections,” says Dr Pradeep.
According to Dr Mathivanan, donors usually get discharged within a week of surgery. They have follow-ups until the sutures are removed and recover by one month. They’re advised to avoid strenuous activities for six months.
December 2022 marks one year since Vishnusharan’s surgery and the boy is back to studies.
He has been attending classes online as the fear of infections still hovers over their mind. They are hopeful that he can resume school soon.
The restrictions don’t deter the sprightly Vishnusharan, who nurtures a love for cars. As he gleefully shoots down miniature T-Rexes with his toy gun, he shares his dreams of becoming a race car driver. The glint in his eyes lights up the whole room.
Takeaways
- In a liver transplant a diseased liver is replaced by a healthy liver.
- Liver donors are of two types: Living donors and brain-dead donors.
- Liver transplant surgery is advised during the cirrhotic or late stage of liver disease.
- Immunosuppressants are lifelong medications that a donor has to take to reduce the chance of organ rejection.
