The first successful paediatric liver transplant in Sri Lanka

(Living-donor liver transplant)

A transplant team headed by the staff of faculty of Medicine and NCTH, Ragama together with expert doctors scattered across the country, was able to perform a living-donor liver transplant for a 9-year-old girl who had cirrhosis of the liver. The surgery was performed on 14^th of July 2020 and the donor was the mother of this little girl. Both the mother and the child are doing well at present and going through a smooth recovery.

This marks the first successful liver transplant performed for a child in Sri Lanka. Furthermore, with this transplant, NCTH liver transplant team has reached a milestone of doing 50 liver transplants where the rest were in adults.  

Kishanu is a young girl from a remote village in Jaffna who was diagnosed with liver disease when she was a toddler and the aetiology of her liver disease is a rare, genetic one named PFIC type 3 (Progressive familial intrahepatic cholestasis). She was gradually deteriorating with her liver disease and she required frequent admissions to ICU during the last 1 year. Paediatricians clearly mentioned that this little girl urgently needs a liver transplant in order to survive. However, there was no paediatric liver transplant service available in the country to help her. The only option the family had was to seek medical care from overseas. This was  a nightmare to Kishanu’s parents as the cost of taking their daughter overseas was unimaginable. In this context, she was referred to NCTH liver transplant service by Dr V. Thusyanthan and Dr K. Arulmoli, Teaching hospital, Jaffna, to explore the possibility of liver transplant in Ragama.

She was assessed and identified as a candidate for liver transplant where her mother who is a 38 year-old, healthy woman. She was more than happy to be the donor to save her daughter’s life. The team headed by Prof. Rohan Siriwardana, a professor in Surgery planned the surgery and her life saving liver transplant was carried out on 14^th of July 2020. The operations carried out in the child as well as in the mother were complex which lasted over 12 hours. It was performed with the help of expert doctors scattered across the island.  Subsequently, the child was transferred to Hemas hospital Wattala as there was no dedicated transplant ICU care at NCTH, Ragama. The child stayed in the ICU for 7 days in Hemas hospital which was offered totally free of charge. She is now warded at NCTH, Ragama, and being ready to go home in few days. The mother has also recovered and is enjoying the company with her daughter who received a new life from her. The family is immensely grateful to the transplant team who saved their daughter’s life by taking on this mammoth task.

Cirrhosis or severe liver disease in children causes death invariably unless they are transplanted. In contrast, if they are transplanted, they will grow into adulthood as a normal individual and sustain a normal life.  Liver transplant surgery is a very complex surgery and is further complicated when dealing with two lives in living-donor transplantation. Children are unique and different compared to adults and performing liver transplant surgery is more challenging in these little ones. When an adult donates a part of the liver (nearly 40%), the remaining portion will regenerate and will be sufficient for the adult to live a normal life. Similarly, the portion received by the child will grow and give a new life to the child where he/she could grow up as a normal adult. Thus far, children with liver disease had to travel abroad incurring a huge cost of around Rs. 10 million to be cured. However, while this is only a dream to most families, these children die at a young age leaving families and medical staff desperate at being unable to offer the best of care.

The country is in a dire need of having a centre of excellence to perform liver transplant surgeries in children as well as in adults. We are confident that we have the full team with necessary expertise in NCTH Ragama to carry out this complex task. However, we lack necessary facilities and infrastructure such as dedicated theatres, surgical and anaesthetic equipments, intensive care units and ward facilities to offer the appropriate standard of care. We are very hopeful that authorities and generous donors would support this noble service by helping us to improve the infrastructure and to establish a well-equipped liver transplant unit.

We would like to convey this little message from 9-year-old Kishanu;

‘Thank you for giving me a new liver and a new life

I promise I will do my best to the world

Please help my friends, just like you did for me

We all deserve another chance!’

The following team members contributed tirelessly to make this a success

Surgical team:

• Professor Rohan Siriwardana
• Dr Suchintha Tillakaratne
• Dr Aruna Weerasooriya
• Dr Ruwan Dissanayake
• Dr Prabath Kumarasinghe
• Dr Buddhika Dassanayake
• Dr Buddhika Uragoda
• Dr Chanaka Ekanayake
• And the medical officers of surgical team , nursing team led by Mrs L N Damayanthi and Mrs P A M Perera

Anaesthetic team:

• Dr Bhaagya Gunetilleke
• Dr Chamila Liyanage
• Dr Dakshi De Silva
• Dr Nilmini Wijesuriya
• Dr Oliver Pathmaperuma
• Dr Nilmini Manawaduge
• Dr Nadeeshya Welikala
• Dr Vishaka Kerner
• Dr Shehan Wijesiriwardana
• And medical officers of anaesthesia

Paediatric team :

• Dr Meranthi Fernando
• Dr Asanka Rathnasiri
• Dr Thabitha Hoole
• Dr Arunath Visvalingam
• Dr Oshini Muthukumarana
• Dr Ishara Kumarasiri
• Dr Heshala Nawagamuwa
• Dr Renu Kalansooriya
• the nursing and supporting staff led by Nursing sister Mrs Wasana Palpagama

Radiology team:

• Dr Chinthaka Appuhamy
• Dr Eranga Ganewatte

Theatre nursing team:

• Mrs DPBS Sandamali
• Mrs HAG Dilrukshi
• Mrs AMNNK Wickramasinghe
• Mrs EMM Ethugala

Referring Consultants from Jaffna:

• Dr V Thusyanthan
• Dr K Arulmoli

Fund raisers for the family:

• Dr Thabitha Hoole
• Dr Arunath Visvalingam
• Dr Paul Bright

Generous team at Hemas Hospital, Wattala

• Mr Murtaza Eusufally
• Dr Lasantha Karunasekera
• ICU medical and nursing team

A ceremony was held on 24th July 2020  to commemorate first successful paediatric liver transplant (living related) and 50th liver transplant by the NCTH transplant team.