Tuesday, 7 May 2019

Complex ICU Liver-support therapy at Apollo Children’s Hospitals


Complex ICU Liver-support therapy at Apollo Children’s Hospitals Saved a Three-Year-Oldfrom Fulminant Liver Failure without a transplant





While Liver transplant remains as the epitome of the many momentous ways that can guarantee survival ina patient with liver failure, Specialist at Apollo Childrens Hospitals, Chennai saved a three-year-old boy, Radhesh from Fulminant Liver Failure without a liver transplant.

 Children with sudden catastrophic liver failure (also called fulminant liver failure) do not have enough time to wait for a favorable donor. In most of the cases, they suffer from malignant brain swelling, torrential bleeding, or galloping infections. If a liver transplant is not performed within the stipulated time gap of a day or two patients might lose their life waiting for a suitable liver for transplantation.

Recently, Three-year-old Radhesh developed a sudden fever, which almost took his life. Hailing from a middle class background his parents were distressed by their sons deteriorating health. When he was brought to Apollo Childrens Hospital Emergency Room for treatment,Dr Priyavarthini, Senior Consultant in the PICU , diagnosed him with Fulminant Liver Failure.

Dr Suchitra Ranjit, Senior Consultant, Chief of Pediatric ICU, Dr Vasanth Kumar, Dr Priyavarthini and Dr Rajeswari N and team of doctors at Apollo Childrens Hospital were worried for his life and sought the advice of the liver-transport team and he was listed for emergency liver transplant. Meanwhile,the team decided to try out all possible ways to bring back the childs condition to normalcy. The child was under the complex ICU Liver-Support Therapy that serves mainly as a bridge to support life until a liver transplant is completed. The ICU Liver Support Therapy supports the entire body-systemand perform the functions of the liver until the liver is totally recovered.

The liver transplant team including Dr Elankumaran, Liver Transplant Surgeon, Apollo Children's Hospitalsscreened the patients parents and family membersto enable a living donor transplant, unfortunately, none had a suitable liver.

Speaking about the case Dr Suchitra Ranjit, Senior Consultant, Chief of Pediatric ICU,Apollo Childrens Hospital, said, Within 24hrs, he worsened further and his life was in a delicate balance. Liver failure has detrimental effects on many important organs, including the brain, kidney, circulation, and blood clotting: he quickly became deeply comatose with a dangerously swollen brain on CT scan, his urine output stopped, and his blood clotting mechanisms failed with very high risk of hemorrhage. We were worried that he would lose his life waiting for a suitable liver, and he was listed for a super-urgent cadaveric liver transplant so that the first available O+ liver in the whole of Tamil Nadu would be rushed for Radhesh.The patients story went viral on a Crowd-funding site and sufficient money was gathered for the procedure, while the patient was still awaiting the organ.



She also added, Our aim was to sustain Radhesh until a liver was made available. We placed him on complete life-support utilizing the same high-end technology that is available in the best liver-units across the world. He was ventilated, placed on chemically-induced coma, and provided Continuous Renal Replacement Therapy (CRRT a technologically advanced form of dialysis) and also a dose of daily plasma-exchange (a form of blood purification therapy), in addition to continuous brain monitoring and circulatory support. These therapies are temporary, highly risky, and invasive and meant as a bridge to transplant. No donor was suitable- and miraculously Radhesh pulled off the most unlikely and marvelous feat and started functioning normally.
Radheshs liver which was totally necrotic (destroyed) started showing recovery. As his liver recovered his brain swelling decreased, and kidney function improved. All the tests started to improve, andon 20April2019 (nine days after admission), he was removed from ventilator and other life-support systems were discontinued.
10 days after discharge, Radhesh is playing cricket with his brother and sister and looking forward to joining school. This was an ordinary family of the street with no-one to speak for them, and we at Apollo Childrens Hospital could offer the child and his family the full might of Apollos formidable technology and support. Apollos motto is to touch lives, and this little life was truly touched with fantastic help from powers above.

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