Apollo Hospitals, one of Asia’s largest integrated healthcare groups, has once again reiterated its position as the Leading Transplant Centre in the world by performing a complex combined heart and liver transplant (CHLT) on a 30 year old from Tiruchengode, Tamilnadu. Known as an en-Bloc CHLT, this complex procedure has never before been attempted anywhere in Asia. Dubbed by Stanford University as a“technically demanding surgical technique, best left in the hands of experienced surgeons”, only a handful of CHLT procedures have been performed anywhere in the world.
This is the story of Mr Ponnar, a quiet-spoken young man hailing from Tiruchengode, a small town in Namakkal District, Tamilnadu. Ponnar was an exceptional student who completed his Masters in Engineering and was a gold medallist. At 22, in the prime of his life, with all his hopes and dreams ahead of him and the world at his feet, Ponnar started noticing swelling in his abdomen, shortness of breath and found that he was turning yellow.
This was diagnosed as cirrhosis of the liver, leading to liver failure and he was advised a liver transplant, which his family was ready to get done for the young man. However, when he presented himself for Liver Transplant, it was discovered that Ponnar had a congenital condition called Ebsteins anomaly – a failure of the right side of the heart to develop properly, which was the cause of the liver failure.
This unfortunate mix of problems left Mr Ponnar with no other option but a combined heart and liver transplant. This is a procedure that involves surgery of the thoracic cavity (for the heart) as well as the abdominal cavity (for the liver), thus making it a highly risky procedure.
Ponnar – in his quiet and under-stated manner resolved to fight this to the end. His family and especially his sister, who was a pillar of strength for him, decided that they would leave no stone unturned to try and save the young man and brought him to Apollo Hospitals, Chennai, India.
“With the heart not functioning in an efficient manner, there was high back pressure on the liver causing destruction of the liver cells leading to jaundice and cirrhosis. Additionally, the transplant team had to take into consideration the risk of excessive bleeding in the case of simultaneous transplant and the risk of accumulated toxins in the liver, attacking the heart, if the two organs were transplanted separately.” recalls Dr Paul Ramesh, Consultant Cardiothoracic Surgeon, Apollo Hospitals, Chennai.
The CHLT can be done in three ways:
- First the heart transplant – followed by the liver transplant as a second operation once the patient has recovered from the first surgery. (Staged Transplant)
- First the heart transplant – followed by the liver transplant as an independent procedure during the same surgery where the patient is under one anaesthesia. (Sequential Transplant)
- Simultaneous heart and liver transplant, done with both organs taken as a single entity still attached to one another. (en bloc heart and liver transplant)
Only a highly successful heart transplant team and a highly successful liver transplant team, both working together as ONE team could hope to accomplish an en-bloc CHLT – a very rare procedure anywhere in the world.
“Over a decade of experience in solid organ transplants has enabled us with the skills and expertise needed to carry out a complex and demanding procedure like this. Our successful heart transplants and liver transplants performed individually, gave us the foundation, strength and operational excellence to successfully complete Asia’s first en-bloc CHLT. I am extremely proud of Ponnar and his family whose trust in the clinical team at Apollo gave us the inspiration to carry out this procedure and move the boundaries of clinical excellence a notch higher,” added Dr Ramesh.
Ponnar waited from April 2015 to October 2015 till a suitable donor was found. He underwent an en-bloc combined heart and liver transplant on 14th October 2015 and was discharged home within a week after the surgery. Today, Ponnar is well on the road to recovery and leading a normal life – he is happy that his skin-tone has lost its yellow hue and he can now enjoy the simple pleasures of life – like being able to see his own feet. With the trauma of over 8 years firmly behind him, Ponnar is all set to realize his hopes and dreams.
The medical milestone, a simultaneous en-bloc heart and liver transplant, (the first in Asia) is a tribute first and foremost to Mr Ponnar and his sister, who ignored all the naysayers. It is also testimony to the fact that both the heart and lung transplant team and the liver transplant team at Apollo Hospitals, Chennai, pulled off a feat which only a few of the transplant programs in the world have achieved. This would not have been possible without the fantastic work being done by the Tamilnadu Govt and the Organ Donation Program in Tamilnadu, which has been winning accolades internationally for the remarkable work they have done.
“This outstanding achievement is a testament to the world-class abilities of our surgeons, physicians, technicians, nurses and other staff who are committed to serving our patients and providing them with healthcare of international standards. The surgery is a result of days of meticulous planning by both our cardiac and liver transplant teams and showcases our strength in terms of infrastructure, and medical expertise. The collaborative efforts taken by both the transplant teams to analyse, strategize and orchestra the whole surgery is laudable.” said Dr Prathap C Reddy, Chairman & Founder of Apollo Hospitals.