CARE hospitals, Hyderabad has successfully performed an unusual ‘Switch Liver’ transplant for the first time in India. This is the first such rare operation after the hospital opened its state-of-the-art liver surgery unit last year.

This landmark operation in Hyderabad suggests that we are now ready to do very complex liver surgery here within our city itself. Moreover this case proves that transplantation can be performed in these very sick patients with good results. Finally it shows that with good medical planning, even cases previously thought to be non-transplantable can be operated successfully, said prof. Tom Cherian, head of liver transplant surgery at CARE hospitals.

While explaining about the critical aspects of the surgery the professor explained that as the majority of the blood flow into the liver comes from the portal vein, a complete block of the portal and mesenteric vein inflow (called porto-mesenteric vein thrombosis) normally does not allow liver transplantation surgery.

However after careful examination and a high resolution CT Scan, the professor felt that the young age of the recipient plus his slender built would allow for completion of the surgery and respiratory wean. Finally the surgery was performed when a cadaveric organ became available. However at dissection a complete porto-mesenteric thrombosis was found despite recent imaging. Hence after discussion with experts from around the world Prof Cherian decided to perform a cavalswitch operation where instead of the portal vein, the cava was used to bring blood into the new liver. As this modification needed to be completed before the vulnerable liver graft died from prolonged lack of oxygen, there was additional stress on the team. The surgery lasted 13.5 hours and went well despite the blocked vessel, and the new liver started to work.

“On the day of surgery I had a word with the family about the high risk of transplantation in this particular case, especially of becoming ventilator dependent, and hence I am very relieved that by God’s grace all has gone well,” remarked Prof. Tom Cherian.