Emergency liver transplant in young mother with 2 weeks coma and severe jaundice

A young mother 6 months post-delivery presented with ‘ACUTE HEPATIC FAILURE’ Jaundice of 1 month duration. After initial illness secondary to viral hepatitis, she took native medicine for 10 days duration. After taking native medicine her condition worsened her jaundice worsened to 30 mg % and with deep jaundice she went into coma with frequent seizures for which she was on ventilator. She also had severely low platelet and poor blood clotting secondary to liver failure. It was in this condition that she was shifted to Pace hospitals for a possible emergency transplant.

“It was a very difficult and challenging scenario in acute liver failure with infection, seizures, grade 4 coma and such high bilirubin. The situation changes minute to minute and chances of mortality after transplant go as high as 50 %” said Dr Govind verma, chief hepatologist.

The patient was listed for Super urgent transplant under Jeevandan but as liver was not available and patient was rapidly deteriorating it was decided to for living donor transplantation.

"The challenge in Acute liver failure is that the patient assessment and preparation has to be done rapidly. The golden hours before transplantation are very crucial as the patient may suddenly collapse due to bleeding in the brain or severe infection.” said Dr Manjunath transplant anesthetist. “Preoperatively as her bilirubin was very high, our hepatology team performed an urgent liver dialysis – Plasma exchange to bring her bilirubin down from 30 to 15 and reduce brain swelling. With excellent minute to minute care despite respiratory problems, infection, deep coma we could keep patient stable till surgery" said Dr Ravula Phani Krishna, liver transplant surgeon. 

After controlling her jaundice, brain swelling and infection she underwent an emergency transplant by the 10 member transplant team consisting of Dr Madhusudhan, Dr Ravula Phani Krishna, Dr Manjunath, Dr Govind verma and other medical staff. The right half of her brother's liver was donated to the patient. Despite the numerous challenges, the surgery and the post op recovery were very smooth. The patient had a dramatic recovery, her coma completely reversed within 12 hours after surgery. Her jaundice rapidly normalized within 7 days and at 10 days post transplant she was fit for discharge.

“Considering her very poor condition at transplant despite a very smooth transplant, we were keeping our fingers crossed as these patients mostly struggle to recover. But her miraculously rapid recovery especially from complete coma for 2 weeks to fully conscious within 6 hrs of transplant was very heartening" said Dr Madhusudhan, transplant surgeon

“We had almost given up hopes after 2 weeks of coma on ventilator with such high jaundice. She has a 6-month-old baby depending on her. We are very thankful to Pace hospitals for their prompt action and giving her a second life. It is a miracle and god's blessing” said her parents.

"After completing a dozen liver transplants in the past 6 months at Pace Hospitals this challenging acute liver failure case highlights the combined efforts of our liver ICU, hepatology and transplant team which are geared up to take on more challenging cases establishing Pace Hospitals as a center of excellence for liver transplant” said Dr Govind verma.

"This case also highlights a warning against unnecessary usage of native medicine in jaundice patients. Most viral hepatitis are resolve without any problem the affected individual have to be patient, but mostly in panic they go for alternative therapy which is very dangerous in jaundiced patients. It worsens the liver damage causing DILI (Drug induced liver injury) which is the commonest causes of admission and death in liver ICU" added Dr Dhiraj Agrawal, transplant hepatologist.