Doctors at the Institute of Child Health (ICH) Kolkata conducted a rare procedure on a 15-year-old with acute liver failure, saving the boy from undergoing a liver transplant surgery. Termed as high volume plasma exchange with sustained low-efficiency dialysis (SLED), the rarely used procedure can be a promising alternative treatment for patients with acute liver failure, said doctors at ICH.Abhas Mitra of Chowbagha Road was brought to ICH on June 18 and he was detected with acute liver failure that had in turn caused a kidney injury. Even as doctors started the treatment, the boy went into hepatic coma due to high ammonia in his blood induced by the liver failure.
“The patient fulfilled the liver transplant criteria. But liver transplant in a child and that, too, in a case of acute liver failure can’t be easily done in our state. Also, the parents could not afford the costly transplant procedure, so we tried this rarely used method to save the boy,” said ICH associate professor Prabhas Prasun Giri.
The boy was put on ventilation and fresh plasma units were given to him in three cycles on three consecutive days to remove the ammonia that had shot up to around 500 and salvage the brain from the toxic side effects.
“The patient had acute kidney injury and had dangerously high creatinine level and he was very sick to tolerate normal dialysis. The SLED procedure is meant for children where we use a specialised machine,” said paediatric nephrologist Rajiv Sinha.
Giri said that the liver in the children suffering from acute liver failure due to hepatitis A infection has some potentiality for spontaneous regeneration. But in most cases patients die before that recovery due to bleeding and high ammonia, if no transplant could be done.
“A few medical papers also support that high volume of plasma exchange has some liver regeneration properties. We tried this and it had been successful,” said Giri, a paediatric intensivist.
The patient’s condition started to improve slowly after the procure and he was discharged from the hospital two days ago. “My son had been in coma for 14 days. Doctors initially suggested a liver transplant that we could not have afforded. Now he is doing well at home,” said the boy’s father Apurba, a musician with a band in a city pub, who has not found any work during the pandemic.
Source: Times of India