Noida, 11 March 2015: In a rare case of clinical excellence, Fortis Hospital, Noida, saved the life of a 47 year old patient, George Ikuje Obe, from Nigeria, suffering from the Budd-Chiari Syndrome (BCS) since the last 12 years. The surgery was led by Dr. Vivek Vij, Director, Liver Transplant at Fortis Hospital Noida along with a team of eight surgeons and 14 doctors including anesthetist and cardiac thoracic surgeon. The 14 hour long surgery comprised of joining the liver with the heart through a passage created from the vein of the liver along with conducting the liver transplant. This is the first such surgery in India and only three to four such surgeries have been conducted in the world. The patient is doing well and will remain on anti-coagulation drug for life to prevent any blockages in the future.
Budd-Chiari syndrome is a condition caused by blockage of the hepatic veins that drains the liver. It presents with the classical set of symptoms such as abdominal pain, ascites and liver enlargement. The syndrome can be sudden, acute, chronic, or asymptomatic. If left untreated, it can lead to death from progressive liver failure. It occurs in one out of a million individuals.
George was suffering from BCS since 2003. He was poorly nourished and led a bad quality of life, unable to perform daily functions, including walking. His liver was severely enlarged, weighing almost 4.5 kilos as compared to a normal liver weight of 1.5 kilos. He had to make frequent visits to the hospital for tapping of ascites (draining fluid accumulated in the abdomen).
After the initial prognosis, he was diagnosed with clotting in veins and was put under heavy medication. Over time, the medication ceased to be effective. In search of a treatment for his illness, George visited many countries including USA and Iran but returned disappointed due to refusal of further treatment owning to the complexity of his illness. In 2014, almost a decade later, George went to a hospital in UK where it was diagnosed that his whole Inferior Vena Cava (IVC) was blocked. The IVC is the large vein that carries deoxygenated blood from the lower half of the body into the right atrium of the heart. The patient was put through a radiological interventional procedure (TIPS procedure) to remove the blockage. However, owing to complexity, the procedure in UK was abandoned halfway through. The doctors identified the need for liver transplant but due to the complete blockage of IVC the option did not seem viable.
When the patient approached Dr. Vij, his abdomen was filled with water along with liver dysfunction and his Inferior Vena Cava was completely blocked. Despite the severe complexity of the case and owing to a successful history of 240 successful liver transplants, Dr Vij and his team decided to take up the case.
In a normal course of liver transplant, the transplanted liver is connected to IVC and the draining of blood resumes its normal course. Due to the blockage in the vein, Dr. Vij and his team had a huge challenge on their hands. The only option to Dr. Vij was to directly connect the liver to the right chamber of the heart, right atrium, which in normalcy is connected to IVC. This involved a lot of complexity and intense expertise. The surgery was not just an unusual decision since it involved exposing the heart from the abdomen and required support from cardiac thoracic surgeons. The donor was the patient’s 38 year old brother, Samuel Aba Obe.
Dr. Vivek Vij, Director – Liver Transplant, said, “When the patient was presented with complications that were turned away from treatment, it also presented a huge risk and challenge to the team. We took up this challenge with a resolve that the patient should have a good life after the decade of suffering he has been through.”
Gagan Sehgal, Zonal Director, Fortis Hospital, Noida, said, “With such a rare liver transplant surgery performed by Dr. Vij, and our competent team of doctors, we have achieved yet another milestone in clinical excellence. We hope to continue to offer new and better clinical outcomes for our patients. ”
The patient, George Obe expressing the gratitude he had towards Dr. Vij said, “I had been living a life fraught with pain and with no hope for a road to recovery. With repeated refusals from doctors in other parts of the world, I was depressed on several occasions but did not give up hope. I owe my life to Dr. Vij and there are no words to express my gratitude for him.”