Two-month-old Nigerian boy undergoes liver transplant in Delhi

A two-month-old Nigerian infant weighing a little over 2 kg has been successfully operated for a liver transplant at a city hospital, which claimed it to be the smallest baby by weight to have undergone the surgical procedure.
The boy, weighing 2.1 kg, was brought to the Medanta Mediclinic Hospital by his parents in the "absence of medical advancement" in the African region.
"David was in severe liver and bone marrow failure when he reached us, malnourished and barely alive. He and his parents travelled from Nigeria in the hope that we could save him. While the odds weighed heavily against him, we decided to proceed with the rare, first of its kind transplant," the hospital authorities said.

The surgery was led by Dr A S Soin, Chief Liver Transplant Surgeon and Chairman of Medanta Liver Institute.
"Since birth, he was suffering from a rare metabolic disorder called Neonatal Hemochromatosis (NH) which caused excessive iron deposition in his liver, causing it to fail. While his birth weight was 3 kg, the disease ravaged him, leading to malnourishment and weight loss," said Dr Neelam Mohan, who was part of the team.
He came with severe jaundice, bleeding tendency, anaemia and low blood counts. Detailed evaluation not only confirmed liver failure due to NH, but also revealed bone marrow failure due to a condition called hemophagocyticlymphohistiocytosis (HLH), she said.

The doctors also said that there was a dilemma on whether HLH would let them do a successful transplant at all.

"We cautiously treated HLH and infection for three days and proceeded with a high risk transplant which would give him at least a 70 per cent shot at life. The usual success rate of transplants at our centre is 95 per cent. Without a transplant, the baby was unlikely to survive beyond a few days," she added.
Soin further said, David's father James, the only suitable donor, was about "43 times" as heavy.
"There were no previous reports of a successful transplant with donor heavier than 25 times the recipient's size. This meant we could use only 5-6 per cent of James' liver for the transplant, whereas usually, about 10-20 per cent of the donor's liver is used for transplanting children," he said.

Dr Vijay Vohra, head of the liver anaesthesia, said, "It was a big challenge to maintain David under anaesthesia over the 9 hour surgery, because of his very small veins and wind pipe, small dosages of medicines needed, and the precision required down to a millilitre in managing fluid and blood product administration.