Success Story of Living Donor Liver Transplantation for Decompensated Liver Cirrhosis | Case study

Pace Hospitals

Liver Transplantation team at PACE Hospitals carried out successful Living Donor Liver Transplantation (LDLT) of a 55-Year-old suffering with Chronic Liver failure

A 55-year-old male patient with a history of hepatic encephalopathy (brain dysfunction due to liver insufficiency) and a known case of chronic liver disease was presented to the hepatologist with a distended abdomen and altered behavior. He was admitted to the hospital for further management.

Medical History

Delving deeper, it was evident that the patient was a known case of diabetes, chronic liver disease and underwent multiple EVI banding in the past.

Diagnosis

Upon being admitted to PACE Hospitals and undergoing necessary investigations, the patient was diagnosed with the following:

Decompensated Chronic Liver Failure with Portal Hypertension, Ascites, Hepatic Encephalopathy, Hepto Renal Syndrome.

Based on the multiple diagnoses, including Decompensated Chronic Liver Failure, Portal Hypertension, Ascites, Hepatic Encephalopathy, and Hepatorenal Syndrome, the patient was advised to undergo End-Stage Liver Disease Treatment in Hyderabad, India, under the specialized care of the Liver Transplant Department.

The recommendation was made considering the high MELD Na score of 32 and a Child-Turcotte-Pugh (CTP) score of Grade C, indicating advanced liver dysfunction.

Treatment

The diagnosing transplant hepatologist, Dr. Govind Verma, asserted a liver transplant was the only way to salvage / save the patient for liver cirrhosis treatment.

Following the confirmed diagnosis, the patient was scheduled for a living donor liver transplant in Hyderabad at PACE Hospitals, under the expert supervision of Liver transplant surgeon Dr. CH Madhusudhan.

The patient was put on multiple life-saving supports; efforts were made to obtain a liver from donors after the party was counseled about the urgency of a liver transplant. Finally, the wife of the patient came forward willfully to donate a portion of her liver.

Both the patient, the donor, and their attendees were counseled about the liver transplant procedure. Passing the pre-anaesthesia checkup (PAC) test and obtaining all the clearances, the patient signed the informed consent.

The patient underwent Living Donor Liver Transplantation (LDLT), receiving a right lobe modified liver graft, and the procedure was performed by the liver transplant surgeons in Hyderabad at PACE Hospitals, without any complications.

The aftermath

The post-operative period was uneventful except for the requirement of insulin infusion to counter the level of uncontrolled sugars in the blood. The recuperation was devoid of any defects in the liver draft, as evidenced by Doppler examination.

On the 9th day of post-operation, the medical team observed a sudden onset bloody drain output, which was managed conservatively. Coagulopathy is one of the most commonly anticipated complications in patients suffering from end-stage liver disease (ESLD). In fact, coagulopathy and thromboembolic disorders have been considered one of the dominant clinical complications in ESLD. This is a similar hemorrhagic post-operative hemorrhagic incident that was dealt with in the conventional way.

The necessary medicines, immunosuppressive, antibiotics, antifungals, proton pump inhibitors, multivitamins, antiemetic, analgesics, antipyretics & other supportive care were given along with the counseling. Once the patient achieved hemodynamic stabilization, he was discharged with the necessary medications and advice for follow-up.

Praising the selfless sacrifice of the wife of the patient, the liver transplant surgeon - Dr. CH Madhusudhan remarked on the role of the liver transplant doctor/specialist in the procedure, “Thanks to the tireless efforts of devoted family members and the exceptional skills of the PACE team of coordinators and medical specialists, a life-saving liver transplant was successfully performed. Both the donor and the recipient are on the road to recovery, showcasing the triumph of human compassion and medical excellence," said Dr. CH Madhusudhan, Liver Transplant Surgeon at PACE Hospitals, Hyderabad.

Altered sensorium (altered mental status) refers to the broad spectrum of disorders of mentation, including impaired cognition, diminished attention, reduced awareness, and/or altered level of consciousness, which may be gradual or sudden in onset in cirrhosis patients.

Although believed to be originated from hepatic encephalopathy, the etiology of altered sensorium this is a challenge to the medical fraternity as they need to rule out various extensive diagnoses (neurologic examination, infections, metabolic abnormalities, drug intoxication, and intracranial haemorrhage etc.) before arriving to the cirrhotic state.

It has been shown that liver transplantation can improve both neurological manifestations apart from maintaining a stable liver function.

Conclusion

This case highlights the successful Living Donor Liver Transplantation (LDLT) using a right lobe modified graft, reflecting the advanced level of care in Chronic Liver Failure Treatment in Hyderabad, India, enabling the restoration of normal liver function.