MGM Healthcare, a super-specialty hospital in Chennai, on Thursday announced that it has successfully conducted an emergency liver transplant on May 21, 2021 to treat a 26-year-old COVID-infected patient who was battling fulminant liver failure. It is reported to be the world’s first emergency living donor live transplant for an acute liver failure patient with SARS COVID-19 positivity.
The 26-year-old patient Raghul Gandhi, a national level Kabaddi player hailing from Puducherry, developed acute liver failure and his condition worsened due to sudden onset of jaundice. He slipped into deep coma within two days after being diagnosed with the disease and had little hope left when he was shifted to MGM Healthcare in Chennai. The situation was further complicated when he tested COVID positive and the only positive sign was his tests didn’t show any lung involvement in the chest CT scan.
“We took up the challenge to do the emergency liver transplant bearing in mind the complicated nature of the patient’s health condition, Dr. Thiagarajan Srinivasan, Director, Institute of Liver Diseases, Transplant and HPB surgery, MGM Healthcare said, while elaborating on the case. A liver transplant is only performed on COVID-free end stage liver disease patient or 4-5 weeks post COVID recovery with two successive negative RT-PCR tests. In Raghul’s case, it was a critical situation and the transplant had to be done within 24 hours or else he would have lost his life. Our rapid liver failure response team sprang into action and his condition was first stabilised with emergency ventilation under PPE protocol. He was then moved to a secluded ICU in accordance with all COVID protocols as he underwent continuous plasma purification, toxin filtration and liver dialysis.
“Our biggest hindrance came in the form of very limited functioning of cadaveric organ donation system with only one liver donation in the month of May in the entire state of Tamil Nadu. We came up with an innovative solution of emergency related living donor liver transplant in which a part of donor’s liver is transplanted after removal of the diseased liver. In Raghul’s case, two of his family members who were staying with him also tested COVID positive but luckily his own brother who stays 200 km away from Chennai came to his rescue. He immediately rushed to the hospital and he returned COVID negative with good SARS COVID antibody titre which means he had been exposed to COVID infection but had recovered completely from it,” said Dr Thiagarajan.
Dr. Karthik Mathivanan, Associate Director, Liver Transplant Surgeon said, “The transplant workup procedure which normally takes 3-4 weeks was accelerated at a rapid pace with a 50 member team working round the clock and managed to complete the workup in a record 6 hour time.” Dr. Thiagarajan and his team conducted the Emergency Liver Transplant within 12 hours and adhered to all the COVID protocols. A bio-bubble was put in place to avoid non-mixture of donor and recipient teams, building of separate COVID-proof transport corridors, ICUs, wards and Operation Theatres throughout the entire hospital stay of 15 days for the patient and the team.
Dr. Dinesh Babu and Dr. Nivash, Senior Consultants-Anaesthesia, MGM Healthcare said, “We used a scavenging system for the airflow from the ventilators along with the usage of Hepa Filters to keep the air clean in the ICU and in the O.T. to reduce the chances of team members and family members catching COVID infection. The patient has recovered well with the new liver and has successfully defeated COVID infection and will be monitored for the next few days and we expect him to resume his normal life soon.”