The treatment involved expertise of multiple specialities including Liver transplant, Oncology & Cardiac teams
Hyderabad, 12th January, 2020: Apollo Hospital, Jubilee Hills, has accomplished a rare and complex feat of performing combined procedures of Living Donor Liver Transplantation and Coronary Artery Bypass Graft (CABG) operation, on a patient in a single sitting. The surgery spanning over fourteen hours, involved expertise of multi speciality teams including Cardiac, Oncology and Liver transplant.
67 year old male patient from Hyderabad, Mr
Siva Prasad Rao, was suffering from Liver Cirrhosis and Liver cancer.
During evaluation for liver transplant he was found to have significant
coronary artery disease with critical blocks in the blood vessels to the heart.
The heart disease was found to be significant enough to preclude performing a
liver transplant. Coronary stenting was not an option as, after stenting, liver
transplant could not be carried out for 8-12 weeks, and waiting was not an
option as the patient’s liver cancer could spread during the waiting time. The
multidisciplinary team at Apollo Hospitals, decided to perform both the
operation, Liver transplant and Coronary Artery Bypass at the same time.
The patient’s 33 year old daughter, Mrs Rohini, came forward to donate a part of her liver.
The operations were carried out on December 6th, 2019. CABG was done first followed by Living donor liver transplant. The Living-donor liver transplant is a surgical procedure in which a portion of the liver from a healthy living person, in this case the patient’s daughter was removed and transplanted in the patient. The entire operation took 14 hours to complete. The donor was discharged on 6th Day after operation and the patient was discharged on 12th day after the operation. Both the patient and donor are doing fine.
planning, carefully timing the donor and recipient surgery and availing all
concerned specialty services when needed, as recipient had to undergo cardiac
bypass surgery first and then followed by liver transplant, ensured incident
free treatment, says Dr Manish C. Varma. This
is the second of its type surgery done at Apollo Hospitals, four years ago we
did a similar combination surgery on a small baby four years ago, which was the first of its kind in the world,
than. The decision of patient’s daughter to donate part of her liver is heroic,
which really saved her father.
The treatment rendered for this patient is rarely performed as it is extremely high risk case.
Performing such cases successfully require a multidisciplinary approach involving critical medical and surgical specialities, very competent nursing, support staff and an excellent hospital infrastructure. The team of Specialists involved in this dual surgeries were Dr Manish C. Varma, Senior Consultant and HOD, Liver Transplant and HPB Surgery; Dr Naveen Polavarapu, Consultant, Gastroenterologist and Transplant Hepatologist; Dr Manoj Agarwala, Senior Consultant Cardiologist and Dr Sanjay Agarwal, Cardio-thoracic Surgeon.
Not just in India,
even abroad in the best of the medical centres, a patient in an advanced age
coupled with multiple complications like liver cirrhosis, liver cancer and
critical blocks in the heart, would have been avoided for further care, most
experienced medical teams wouldn’t have dared to go further. But the doctors at
Apollo took on the challenge, as they were confident of their expertise and the
back-up infrastructure and support at their disposal. This will be recorded in
the annals of medical history and will serve as an inspiration for the Indian
medical fraternity for generations, says Dr
Hari Prasad. Most often the treating
doctors give up on seeing complications beyond their realm, but if they start
exploring options by taking the support from across specialities and work in
unison, they can save many lives and that is the underlying message from this
particular case. Here each of the surgeries, CABG and Liver Transplant were
major and complex surgeries, doing one after another to give space for patient
to cope and recover from each of them wouldn’t have saved the life of the
patient and not treating the patient was not an option at all as the tumour was
progressing rapidly and he wouldn’t have survived for long. This is definitely
a message to the medical fraternity world over to not to give up, there are
opportunities and solutions to treat most complicated ailments and we need to put
our minds together across specialities and through teamwork can save such
critical patients. Also the message has to go to the layman that donating a
part of you liver actually saves lives, without impacting you in any manner,
without restricting you and without having any after-effects on you in any
Dr Manoj Agarwala said, both the vessels of the patient were very
critical, almost 80-90% of his heart was at risk, in fact right coronary was
almost 99% blocked and at high risk, it seemed impossible to do a liver
transplant for him with his state of the heart. But since the tumour was
spreading fast, we had no option but to perform both CABG and Liver transplant
one after another in one sitting. If his heart condition was not assessed properly, the patient would have
been lost during the transplant.
Mr Siva Prasad Rao said, when I heard of all the complications that
I was suffering from, I just gave up hope on me surviving further, just wanted
to leave it to destination in the short time I would live. But it was my
daughter who went about with everything getting herself prepared for the
donation and preparing me for the treatment. That’s when I gained hope and as
an official at NABARD, I had seen several of my staff members getting cured of
most critical complications at Apollo Hospitals, that gave me the necessary
confidence, also there was no alternative for me, either do or die. But my
worry was only about my daughter and grandson. Today, when I look back it all
seems to be a dream and nothing less than a miracle with two major surgeries I
underwent in one sitting. The Health Insurance guys were astonished, so is the
case with my relatives and friends, none would believe that I underwent two
surgeries that too major ones.
daughterMrs Rohinisaid, dad had an accidental fall in October and
one problem led to another as far as his health was concerned and we came to
know he had a tumour in the liver, spreading rapidly and transplant was the
only option. Though I am well educated, I was ignorant of the fact that liver
could regenerate in 6 to 8 weeks after donation and one can lead a completely
normal life thereafter. October, 2019, is when I was enlightened about this. I
was scared initially to donate liver, as I also have a two and half year old
son and was really worried about him and his future, if in case something goes
wrong with me who will take care of him. But on the other hand was guilty of me
not helping my father. Therefore I was looking for options like getting the
liver from a cadaver, but that had a long wait list and one was not sure when
we would get it. Since we didn’t have much time as his heart and liver were at
risk and the fact that we might lose dad made me to explore the option of
living donor. Liver donation is painful and surgery is scary, but saving some
one’s life is a much bigger satisfaction than all that trauma, everyone in a
situation like that should go ahead and donate. No parent will ask you to
donate your liver in such a situation, they don’t want their children to suffer
for their sake, it is we who should be magnanimous to our parents and come
forward and donate.
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