HYDERABAD: In a landmark pediatric liver transplant, a six-week-old baby weighing just 2.9 kilograms has successfully undergone a living-donor liver transplant at Rainbow Children’s Hospital, Banjara Hills, after developing rapidly progressive liver failure due to a rare condition called Gestational Alloimmune Liver Disease (GALD). The baby received a 62-gram liver graft donated by his mother and, after a complex recovery, was discharged breathing without oxygen and taking full feeds by mouth, with the transplanted liver functioning well.
The baby developed jaundice in the first week of life and progressed to severe liver failure by three weeks. The Pediatric Gastroenterology and Hepatology team rapidly investigated the cause and suspected GALD after excluding important infections, metabolic disorders and genetic causes. When intravenous immunoglobulin and two exchange transfusions failed to stop the deterioration, the team moved swiftly to liver transplantation.
At just 2.9 kilograms, the baby’s extremely small blood vessels and limited space in the abdomen made the transplant particularly challenging. The mother’s liver graft was carefully reduced to 62 grams to match the baby’s size. Connecting the tiny arteries and veins and positioning the graft safely required exceptional surgical precision and expertise in pediatric liver transplantation. Despite the complexity of the procedure, the transplant was successfully completed.
The post-operative period was equally challenging. The baby developed severe lung problems requiring advanced breathing support, including high-frequency oscillatory ventilation and inhaled nitric oxide. Bronchoscopy was used to clear secretions and treat areas of lung collapse. He also developed serious infections caused by bacteria resistant to several antibiotics. In addition, a leak developed near one of the surgical joins (anastomotic site) in his intestine, which led to a second surgery and the creation of temporary stomas, openings on the abdomen that let the bowel rest and heal. The baby was managed with prolonged intravenous nutritional support and oral feeds were gradually restarted and increased under close monitoring until he was able to take full feeds by mouth.
Dr. Prashant Bachina, Pediatric Gastroenterologist and Hepatologist, said: Dr. Prashant Bachina, Pediatric Gastroenterologist and Hepatologist, said: “In a newborn with rapidly worsening liver failure, early diagnosis and timely transplantation can make the difference between life and death. This is possible when a child is cared for in a specialised pediatric centre where all the required expertise is available under one roof. The recovery after transplant was equally challenging and required close monitoring and multidisciplinary care. Close postoperative monitoring, nutritional support and timely management of complications were essential to protect the new liver and help the baby recover.”
Dr. Srinivas Reddy Mettu, Pediatric Liver Transplant Surgery, said: “A liver transplant in a baby this small is a highly complex procedure and requires a high level of surgical expertise and precision. At 2.9 kilograms, the baby’s blood vessels were extremely tiny, while the limited space in the abdomen added to the surgical challenge. The mother’s liver graft also had to be carefully reduced to 62 grams to match the baby’s size. Safely connecting the tiny blood vessels and positioning the graft required meticulous planning, fine surgical skill and close teamwork.”
The baby’s recovery involved close coordination between Pediatric Gastroenterology and Hepatology, Pediatric Liver Transplant Surgery, Pediatric Anesthesia, Pediatric Intensive Care, Neonatal Intensive Care, Pediatric Surgery, Radiology, Nutrition, Physiotherapy, Infection Control, transplant-trained
nursing staff, fellows and transplant coordinators, supported by Rainbow Children’s Hospital’s dedicated Pediatric Liver Transplant Intensive Care Unit.
Rainbow Children’s Hospital has established one of India’s leading pediatric liver transplant programmes, with centres in Hyderabad, Chennai and Bengaluru together completing 107 pediatric liver transplants with an overall survival of 95%. The programme brings together advanced transplant surgery, pediatric hepatology, intensive care, nutrition, infection management and rehabilitation, enabling even critically ill and medically complex children to receive comprehensive care through one specialised pediatric transplant team.
About Rainbow Children’s Medicare Limited
Rainbow Children’s Medicare Limited network comprises of 26 hospitals, 6 OP clinics and 2 Dedicated IVF clinics in 11 cities with a total bed capacity of 2,565 beds. Our Pediatric services operating under the brand “Rainbow Children’s Hospital” includes newborn and pediatric intensive care, pediatric multi-specialty services, pediatric quaternary care (including organ transplantation); whereas our women care services under “Birthright by Rainbow” offers perinatal care services which includes normal and complex obstetric care, multi-disciplinary fetal care, perinatal genetic and fertility care along with gynecology services.
Rainbow Children’s Hospital built on strong fundamentals of a multidisciplinary approach with a full-time consultant led clinical service along with 24/7 commitment in a child centric environment. The company follows a hub-and-spoke operating model where the hub hospital provides comprehensive outpatient, inpatient care, with a focus on tertiary and quaternary services, while the spokes provide 24/7 emergency care, large outpatient services and comprehensive obstetrics, pediatric inpatient and level 3 NICU services. This model is successfully operational at Hyderabad and Bengaluru. The endeavor is to replicate this approach in Chennai and across the National Capital Region. Subsequently Rainbow intends to expand into tier-2 cities of Southern India.
Rainbow Children’s Hospital embraces a unique doctor engagement model, where doctors work exclusively on a full-time, retainer basis. The doctors work in teams and have 24/7 commitment, which is particularly important for children’s emergency, neonatal, pediatric intensive care services and to support pediatric retrieval services. The Company also operates the country’s largest pediatric DNB training programme in private healthcare, offering post graduate residential DNB and fellowship programme.
