In what could be Asia’s first en bloc heart and liver transplant, K.P. Ponnar, 30, from Tiruchengode received both organs simultaneously in a surgery at Apollo Hospitals recently. He is back on his feet.
This technically demanding surgery, doctors at Apollo said, has only been performed a handful of times in the world, and involves taking the damaged heart and liver out, and replacing them with a new heart and liver, which are still connected by a blood vessel.
Since both organs have completely different surgical physiologies, the procedure required both heart and liver transplant surgeons and their teams to work together in an eight-hour session, said Anand K. Khakhar, programme director, Centre for Liver Diseases and Transplantation at Apollo Hospitals, at a press conference on Friday.
The patient, who has a master’s degree in engineering, had a congenital heart anomaly that had led to his heart failing. This put pressure on his liver, which too, eventually collapsed, said Paul Ramesh, senior consultant cardiothoracic surgeon at the hospital.
All organs donated in the State are usually allotted individually to hospitals based on priority, but the Transplant Authority of Tamil Nadu has a special provision for combined organ transplants, said J. Amalorpavanathan, member-secretary.
“The hospital gave us a synopsis of their case and we took consent from all liver and heart transplant centres in the State before allocating the organs to them,” he said.
The cost was Rs. 43 lakh, cardiothoracic surgeon T. Sunder said. “However, it is 1/30th of the cost in the United States where such a surgery costs Rs. 12 crore,” he said.
Mr. Ponnar, who is on the road to recovery, thanked his doctors, the nurses and all the staff at the hospital, as did his sister.
Epic surgery restores life after multiple organ failure
K.P. Ponnar has been to hospital after hospital over the past six years after his heart began to fail and his liver too started to malfunction. “One hospital outright rejected his case file,” his sister N. Krithika said at a press conference in Chennai on Friday.
When he arrived at Apollo Hospitals and the doctors found that he needed both a new heart and a liver, several procedures were considered. “The en bloc surgery was finally decided upon as we felt this had the best risk-benefit ratio,” said Paul Ramesh, senior consultant cardiothoracic surgeon at the hospital. Another way of doing this surgery is sequentially – the heart is replaced first, and then the liver while the patient is under the same anaesthesia. “But given Ponnar’s condition, we felt that would be riskier,” said Dr. Ramesh.
The advantage of an en bloc surgery, he explained, was that it reduced the amount of time organs spent outside the body, thereby improving the outcome and also reducing the amount of toxins secreted from the liver that could affect the heart if the organs were implanted one after the other.
And so, an en bloc was decided upon. “But we warned Ponnar’s family that this had never been done before here. They gave us the go ahead,” he said.
After about six months of waiting for an organ from April, Mr.Ponnar’s chance came through on October 14. Thanks to the family of a brain dead victim, a heart and liver were obtained together and four teams of surgeons, nurses, technicians and others worked simultaneously – two teams removing the heart and liver from the donor and two teams preparing the recipient – for the procedure.
“The heart is in the chest and the liver is in the abdomen – two different cavities, separated by the diaphragm,” said cardiothoracic surgeon T. Sunder. He explained that the two organs were connected by a blood vessel, the inferior vena cava. The organs had to be carefully removed and then replaced and intricate connections made for them to begin functioning again.
Both the organs have completely different surgical physiologies and doing them together required much planning in advance, said Anand K. Khakhar, director, Centre for Liver Diseases and Transplantation.
After eight hours of synchronised working together, the surgery was completed. The heart began beating, and the liver began functioning.
The cost, Dr. Sunder said was Rs.43 lakh. “However, it is 1/30th of the cost in the U.S. where such a surgery costs Rs.12 crore,” he said.
J. Amalorpavanathan, member secretary, Transplant Authority of Tamil Nadu, called this a “commando surgery” and lauded the hospital for its effort. “In the last six years, of the 714 cadavers donated in the State, 227 or 31 per cent of them have come from Apollo,” he said. He also said the authority would ensure the highest quality of outcomes and ethical conduct in all transplants performed.
Mr.Ponnar, who is on the road to recovery, thanked his doctors, the nurses and all the staff at the hospital, as did his sister.
Chairman of the hospital, Dr. Prathap C. Reddy, and vice-chairperson Preetha Reddy also participated in the event.
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