Man gets parts of liver from two in rare surgery

Thirty-one year old Satish Sonawane is not just lucky with life but also the first person in Maharashtra to have undergone a rare liver transplant surgery. What makes Sonawane's case special is that he received a portion of the livers of his sister and uncle.

The complex procedure, known as dual lobe liver transplant (DLLT), was first performed in Korea in 2000. It is being practised in India for the last two years and only a handful of surgeries have been done so far. For a healthy adult, 25% of his liver is adequate for normal function and rest can be donated for transplant. Also, the organ has the ability to regenerate.

How big was the procedure?
The surgery was conducted by a team of doctors at Global Hospitals on January 2. Since the entire procedure involved three persons, the authorities engaged nine liver transplant surgeons, five anaesthetists and 20 technicians for the big job. It started at 6 am and went on for 15 hours.

"Three surgeries were carried out in three operating rooms simultaneously. It involved removing his old liver which was severely diseased and transplanting two liver lobes. The right lobe was harvested from his sister while the part on the right was taken from Sonawane's uncle. We had to join all the blood vessels and bile ducts of the donated liver portions to the patient's blood vessels and bile duct," said Dr Samir Shah, head of hepatology and Liver ICU.

What was the patient suffering before surgery?
Sonawane was admitted to the hospital with swollen feet and fluid accumulation in the abdomen and around the lungs. He was breathless and had persistent cough. "Tests revealed that he had advanced liver
cirrhosis with a very high bilirubin and high risk of bleeding," said Dr Shah. Family members said excessive intake of alcohol had led to the condition.

What did doctors tell Sonawane first?
Living donor transplant with one of family members donating a part of their liver. "Since he was overweight, he needed a large liver for a successful transplant. He lost weight from 95 to 80 kgs for the operation," said Dr Ravi Mohanka, head of liver transplantation, who along with Dr Mohamed Rela, led the team of doctors for the surgery.

What was the stumbling block?
Doctors said the bulky patient needed a bigger liver for transplant. While Sonawane's sister and uncle were found compatible for the surgery, their livers were smaller than the required size. Left with no option, doctors put him on a cadaveric transplant list – in the hope of harvesting the entire liver of a dead person.

However, body fluids continued to accumulate in Sonawane's lungs, necessitating administration of oxygen even for daily activities. His blood too way too long to clot, putting at high risk for serious internal bleeding.

How did the doctors find a solution?
As Sonawane's health went on a downslide, doctors advised the family to go for the dual lobe liver transplant. "He had been hospitalised for nearly three months and it looked difficult for him to survive. We then gave the family the option of DLLT," said Dr Somnath Chattopadhyay, liver surgeon.

How was the recovery?
Both the donors remained in the ICU for one day and 5–7 days. Sonawane was weaned off the ventilator a day after the surgery, and was shifted out of the ICU on the 5th day. He was discharged 15 days after the transplant with a well functioning liver.

Sonawane, who hails from Bhadgaon in Jalgaon district, is back home and has promised to give up alcohol. "It is my second life and I value it more. I have promised my family to quit tobacco and alcohol."