Chennai,  May 2023: A 50-year-old businessman from Puducherry has been overweight since childhood and he had developed diabetes, hypertension, and fatty liver disease as complications. His weight when he was healthy was around 130 kg, but it had increased to 170kg when he developed end-stage liver disease and multiple complications. The Patientvisited Gleneagles Global Health City, Chennai in the mid of November 2022 in critical condition. The Expert liver teamspearheaded by Dr. Joy Varghese and Dr. Mettu Srinivas Reddy examined the patient’s condition and concluded that a liver transplant is the only option for his survival and his family was informed of his condition. 

After undergoing tests to assess his fitness, he was placed on the cadaveric liver transplant waiting list on 24th November. However, his condition continued to deteriorate rapidly, and he developed multiple complications of liver failure including kidney failure and fluid overload in his body and lungs.  The liver failure was affecting his brain function because of which he was becoming confused and drowsy- called Hepatic encephalopathy, in medical terminology. In January of 2023, it was decided that his best chance of survival was an urgent living donor liver transplantation instead of waiting for a cadaveric donor liver as his condition was deterioratingrapidly. 

These were extraordinary circumstances as living donor liver transplantation for a patient weight more than 160 kgs has never been described before. Finding a suitable donor in the immediate family was also an immense challenge.  Fortunately, the patient’s nephew a college student came forward to donate his liver. As a backup, the patient’s wife was also tested as the second donor if a dual lobe transplant was necessary. The successful surgery using the partial liver from a single donor took just over 10 hours was performed by a team of doctors led by Dr. Mettu Srinivas Reddy, Director of Liver Transplantation and HPB Surgery; Dr Rajanikanth Patcha V, Clinical Lead & Sr Consultant – Liver Transplantation and HPB Surgery, Dr Selvakumar Malleeswaran, Head – Liver Anesthesia & Critical care andDr Joy Varghese, Director – Hepatology & Transplantation Hepatology. After the surgery, the patient stayed in the hospital for 40 days as he needed very intensive treatment in the ICU to support his recovery.

“It is now three months since his surgery. He has lost most of the excess water in his body as the new liver is now working well now. His weight has already reduced to around 130 Kg now at the time of discharge from the hospital,” said Dr. Joy Vargheese, Director of Hepatology & Transplant Hepatology, Gleneagles Global Health City

We are breaking boundaries here– and the world is learning from us! Living donor liver transplant is not recommended in patients weighing over 100kgs – so performing it in a 170kgpatient is really unheard of. Most centers recommend a liver graft weight least 8% of the patient body weight for a successful outcome. However, over the years we have gained experience in performing liver transplantation with grafts which are just 5-6% of body weight using special surgical techniques. The liver graft which patient received was just 4.9% of his body weight, which is a milestone by itself said Dr. Mettu Srinivas Reddy, Director of Liver Transplantation and Hepatobiliary & Pancreatic Surgery

These patients need dedicated operating table arrangements, airway protection techniques and effective post–operative ICU care to handle obesity related complications. Additionally, the small new liver has to be nursed like a pre-term baby in the ICU so that it quickly grows to meet the requirements of the patient. Such work needs exceptional levels of commitment from both the medical and nursing teams– said Dr Selvakumar Malleeswaran, Head of Liver Anesthesia & Critical Care.

“One must be aware that Fatty liver disease is becoming more common in India these days due to changing lifestyles. Some families are more genetically prone to it. But there are no specific genes identified to cause fatty liver disease. Severe fatty liver disease can gradually deteriorate into cirrhosis, in which case the liver becomes very hard, and its function gets affected,” Dr Joy Varghese.

 “I congratulate the experienced team of Doctors we have at Gleneagles Chennai to have performed this extremely risky yet India’s first living donor live liver transplantation on a 170 kg patient. This transplantation not only saved the patient’s life, but the Doctors used just 4.9% of the donor’s liver instead of the 8% that is grafted. Obesity is a serious disease that must be tackled head-on and is the root of a lot of lifestyle diseases. We at Gleneagles Hospital remain committed to giving our patients the best of medical care always” said Dr Alok Khullar, CEO, Gleneagles Global Health City.