A Malaysian Miracle in the Middle of the COVID – 19 Chaos

New Delhi: 10 months old Noor, from Malaysia, successfully undergoes liver transplant at Indraprastha Apollo Hospitals in the middle of COVID-19 chaos.  Noor soon after birth had developed jaundice that worsened with time and was diagnosed with biliary atresia, a rare liver and bile disease which is seen in 1 out of 12000 infants.

In addition to this, Noor also had heterotaxy, an abnormal arrangement of the internal thoracic-abdominal organs across the left-right axis of the body. Her liver and stomach lie in the middle of the abdomen and her heart lies in the middle of the chest.

At about 2 months of age Noor underwent a Kasai surgery that connects the undersurface of liver directly to the intestines to achieve biliary drainage. She also underwent abdominal surgery to correct intestinal malrotation.  Both surgeries at that time had failed.

According to Dr Anupam Sibal, Group Medical Director, Apollo Hospitals Group and Senior Paediatric Gastroenterologist & Hepatologist, Apollo Hospitals, Delhi, “If Kasai surgery fails to clear jaundice, then the only treatment is a liver transplant. Noor fell into this category of failed Kasai and developed progressive liver failure leading to severe jaundice, a bloated belly with ascites, growth failure, bleeding episodes due to liver dysfunction and increased pressure in the veins supplying her hardened liver.

She was hospitalised in Kuala Lampur multiple times and there once nearly died of a massive gastro-intestinal bleed in February. Initially her transfer to India was cancelled as she was on ventilator but since it was a very high-risk case requiring immediate surgery, she was referred to us.”

According to Dr Neerav Goyal, Senior Consultant and Head, Apollo Liver Transplant, Hepatobiliary and Pancreatic Surgery Unit, Apollo Hospital, Delhi , “The day after the family  landed in Delhi, an advisory was issued by the Government to quarantine all travellers from Malaysia for 2 weeks.

It was an ethical dilemma for the treating team as on one hand was the fear that she would not pull through that long and on the other hand the baby or her parents should be in the COVID incubation period. The team acted fast and put the family in quarantine. For 2 weeks post which the liver transplant was planned.”

“She developed a rhythm disturbance with a very slow heart rate while awaiting a transplant. She required temporary pacemaker.Post the quarantine period, after testing for SARS-COV- 2 which was negative and taking all precautions including PPE, she underwent a living related liver transplant on 31st March 2020.

The donor was her mother. At the time of the transplant, Noor had a bilirubin level of about 45 mg/dl as against a normal of less than one.Her weight was only 6.5 kg at the age of 9 months.” Said, Dr Smita Malhotra, Consultant, Paediatric Gastroenterologist & Hepatologist, Apollo Hospitals, Apollo Hospitals Delhi.

“Starting with the first successful liver transplantation in India in 1998, the Apollo Liver Transplant Program has now performed more than 3500 liver transplants including 361 in children.

“Because of heterotaxy, low weight precarious over all condition due to pronounced liver failure and the heart condition, this liver transplant was very high-risk procedure. Our extensive experience in liver transplantation helped us conduct an uneventful Liver transplant ina very complicated situation,”added, Dr.Sibal.

Our transplantation success rates are comparable to the best published outcomes in the world, which is truly a credit to the excellent team at Apollo Hospital that adheres to the highest standards of clinical care.  We value the trust our patients.

We have performed the most complicated of liver transplants (e.g., in babies weighing as less as 4 kilograms), combined liver–kidney transplants and multi-organ transplants,” Said Dr. Goyal.

By divine Grace driving modern medicine to its best, Noor underwent a successful liver transplant. The Liver transplant was done under the expert supervision of Dr Anupam Sibal, Medical Director, Apollo Hospitals Group and Senior Paediatric Gastroenterologist & Hepatologistand his team comprising Dr Neerav Goyal, Dr Smita Malhotra, Dr Vikas Kohli, Dr Varun Kumar, Dr Sanjeev Kumar Aneja.

She smiled beautifully at the staff and the sparkle in the eyes of the parents hides all the torment they have been through. She has now been discharged and awaits her return to Malaysia.