7-year-old Baramati girl youngest in Maharashtra to undergo cadaver liver transplant | Pune News – Times of India

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PUNE: Shreya (name changed on request) is raring to eat a piece of cake. “My doctor said I can have ‘gulab jamun’ too, and some pastry. All in a week’s time from now,” she said with a joyful glint in her eyes.
The seven-year-old deserves the treats. On November 8, she underwent a full cadaver liver transplant after relatives of a 10-year-old brain-dead girl from Pune agreed to donate their child’s vital organs.
Shreya’s doctors told TOI she’s now something of a record holder. “She’s the state’s first case of a full cadaver liver transplant in a seven-year-old,” said her treating doctor Dr Vishnu Biradar, a paediatric gastroenterologist at Pune’s Jupiter Hospital.

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Since her birth in June, 2015, Shreya had been in and out of hospitals due to a rare birth defect that rendered her liver dysfunctional. Surgeons have been performing living-donor transplants on kids with liver defects much younger than Shreya, in which a parent donates a portion of the liver as it’s the only organ that can regrow to normal size. In this case, however, there was no matching donor in her family.
Then there is the option called the split cadaver liver transplant, in which only a portion of the liver from an adult brain-dead donor is transplanted into the child. Such surgeries are rare. “Finding a liver that matches the size and abdominal cavity of the recipient is extremely crucial. That is why full cadaver liver transplants in the paediatric age group are so rare,” Dr Biradar said.
Children like Shreya, with congenital liver defects, also rarely get donations from brain-dead donors from their age group as most organ donations are from adult brain-dead donors. Before Shreya, a 13-year-old boy from Mumbai was believed to be the youngest patient in Maharashtra to get a full liver from a brain-dead donor.
Shreya was diagnosed with jaundice when she was just six weeks old. A thorough assessment confirmed she had a rare congenital liver condition called biliary atresia, in which the patient has no bile ducts in the liver from birth. It’s unclear what causes the condition.
In babies with biliary atresia, flow of bile from the liver to the intestine is blocked and that can lead to deadly liver damage and cirrhosis.
At three months, Shreya underwent an emergency procedure called Kasai portoenterostomy (KPE), which connected her liver to the small intestine. The surgery was a stop-gap and would keep her okay for the next five years. But at five, she was diagnosed again with jaundice, a clear indication the liver had started to give in.
“She came to us with jaundice, weakness, and importantly, stunted growth and extremely low body muscle mass. She was registered for a cadaver liver transplant a year ago. Without a transplant, her chances of survival were slim,” Dr Biradar said.
A battery of investigations also found her with extremely low platelet and albumin levels, esophageal varices (enlarged veins in the tube that connects the throat and stomach), massive splenomegaly (enlarged spleen), and ascites (water build-up in the abdomen), which presented a classic picture of liver cirrhosis.
“The child had started decompensating and in the absence of a cure, a liver transplant, either from a living donor or brain-dead donor (cadaver), emerged to become the only option,” he added.
Unfortunately, her parents and family members were not fit for a liver donation. So the family was given the option of a cadaveric liver transplant.
Shreya’s year-long wait ended on November 8 when the family of the 10-year-old girl handed in their consent. Doctors said the transplant was challenging due to history of surgery, the small size of blood vessels and bile ducts and the possibility of a size mismatch. Besides, the difference in weight and age presented another challenge while placing the liver in the abdominal cavity.
“But the large size of Shreya’s previous liver helped,” said Jupiter hospital’s liver transplant surgeon Dr Manoj Shrivastava. She was finally discharged from care on November 22. “Shreya is a twin. Her sister is absolutely fine and has no health issues. She is doing well after the transplant” said her father, a tax consultant.
Dr Rajendra Patankar, CEO of Jupiter Hospital, said: “As a nation, we need to motivate all paediatric intensive care units (PICUs) to carry out cadaveric liver donations as hundreds of children are on liver transplant list every year.”

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