Apollo Hospitals Successfully Performs Four Liver Transplant Surgeries Following COVID-19 Recovery

Apollo Hospitals, Navi Mumbai, successfully performed four liver transplantation surgeries following COVID-19 recovery. Four patients were diagnosed with end stage liver disease, 3 patients underwent living donor liver transplant and 1 deceased donor liver transplant. Post the liver transplant all the patients have recovered and are doing well.

Tanvi Palande, 19-year-old liver transplant survivor, said, “With my deteriorating health condition, lockdown and pandemic, it was a challenging situation for my family. We had to be strong as we took up the decision to go ahead with a liver transplantation surgery. However, following our decision, my family was diagnosed with COVID-19. So, when I read that my test results were also positive, it instilled a sense of fear in me. It was the first time that I was really scared. The doctors gave me a lot of support and counselled us which gave us the confidence to go ahead with the liver transplant. I am ever thankful to my mother, who had donated a part of her liver, to save me and the doctors for all the support and giving me a new lease on life.”

One of the patients, a 37-year-old, suffered from a case of chronic liver disease that persisted for 8 months. Recurrent encephalopathy, ascites and vomiting of blood due to a deteriorated liver was noted as an immediate liver transplant was suggested. Subsequently, he also suffered from COVID-19, making the case more challenging. Taking on the case with proper protocols as introduced during the COVID-19 pandemic, the liver transplant team at Apollo Hospitals Navi Mumbai, successfully performed the surgery.

Another 64-year-old patient suffering from ethanol related decompensated chronic liver disease also approached Apollo Hospitals with persistent fever and myalgia. He tested positive for SARS-CoV-2 by RT-PCR (real-time polymerase chain reaction).

Following a recovery from COVID-19, all the necessary steps were taken to prepare him for a liver transplantation surgery. Owing to the seriousness of the case, many complications such as unsuitable donor for living-related donor liver transplant did arise. However, essential evaluation of the organ donor's liver, including RT-PCR tests were conducted twice before the surgery took place.

The liver transplantation was a success and the patient is in great health now. Similarly, the other cases have also been treated successfully.

Dr AabhaNagral, Consultant, Hepatology (Adult &Paediatrics), Apollo Hospitals Navi Mumbai, says that Liver transplantation on COVID-19 patients poses major challenges not only to the patient and her family, but the entire systems and medical teams in the hospital.

Treating patients with liver conditions following a recovery from COVID-19 comes with tremendous challenges, as the patients are more prone to infections.

Despite the emergency situation, we had all the efforts to continue with liver transplant activity, minimising the waiting list and mortality.

In some of the cases, aggressive care was maintained in COVID-19 diagnosed patients with end stage liver disease to overcome viral infections.

However, despite facing these concerns, by taking all the precautions and protocols, we proceeded with lifesaving treatment, successfully conducted liver transplantations on four patients who recovered from COVID-19.

Talking about the same, Dr. Vikram Raut, Consultant, HPB & Liver Transplant Surgery, Apollo Hospitals Navi Mumbai, said, It has been challenging to work on the four patients with liver conditions. The four cases we received came with many complications, including being COVID-19 positive.

However, by following the mandatory precautions of COVID-19 and post negative reports of COVID-19 tests, we performed the liver transplantation for all the patients. One of the patients had to receive a donor from a deceased person following a recovery from COVID-19, making it first post-COVID-19 DDLT (Deceased Donor Liver Transplant) in Western India.

Taking prudent intra and post-operative precautions to prevent possible transmission from health-care personnel, ensuring adequate availability of blood products, drugs, supplies and infrastructure, strict postoperative infection control measures and quarantine protocols and judicious management of immunosuppression post-operatively formed the cornerstones for ensuring a successful liver transplantation surgery during the peak of the pandemic.

 He further adds, “Risk of mortality due to decompensated liver disease is 30 -50% vs risk of mortality due to COVID-19. COVID-19 infection aggravates acute decompensation in cirrhosis patients which increases risk of mortality."

Santosh Marathe, Unit Head & COO, Apollo Hospitals Navi Mumbai commented that over the years our institution has treated and performed numerous transplant cases. This year has been challenging with the rising cases of COVID-19 in Maharashtra and patients facing the related comorbidities out of chronic liver diseases has been observed nationwide.

Following all the international safety control protocols, we continued with the transplant programme, as most the patients are with end stage organ failure. In the last 14 months, we have successfully performed 29 liver transplants, 42 kidney transplants and 2 heart transplant with excellent clinical outcomes ensuring quality of life.

Also, we have created accessibility of liver transplant services through speciality clinics for screening and evaluation in different districts of Maharashtra and partnered with different institutions to perform liver transplants surgeries helping people in getting access to advanced clinical expertise.