I am really glad to share our experience with Dr. Paari Vijayaraghavan, highly qualified healthcare professional, who goes for an extra mile to look after his patients with utmost personal care. In our case, we had to go through a tough phase with my mother’s liver cirrhosis treatment and that’s where, we got an opportunity to meet and consult Dr. Paari sir who was working in leading multi specialty hospital in Chennai. He reassured the treatment plan and took immediate steps to ensure the right assessment and medical procedures were carried out at the right time as our only hope was liver transplant surgery at that time. He led the transplant surgery with his team and made it successful, the quality of service and care we received during surgery, pre and post surgery was top class and most importantly we were impressed with his transparency and clarity throughout the entire process. No doubt, my mother has to go through one of the most difficult recovery phase physically and mentally, but she still believes it was possible only because of Dr. Paari sir and recalls how well his personal care was helpful post surgery during her rehabilitation process. I still contact him (last 7 years and more) for review and consultation about my mum’s health and he always responds quickly and gives his opinion on time. We are truly amazed by his professionalism and dedication. We are always grateful for his care and support to my mother & family, we wish him best wishes and good luck for his career and continued success.

He is born 6 months ago in Zanzibar was detected to have jaundice and bleeding tendency 15 days after birth. Various medical treatments in their native place did not yield results. By 4th month of age, the baby started deteriorating fast, with fluid accumulation in the belly, increasing jaundice, poor feeding, white clay like stools and poor growth. Further tests showed irreversible damage of the liver due to a peculiar disease of bile ducts, where the bile ducts are malformed since birth. She was referred for further treatment to India. Our evaluation showed that the liver damage was too advanced for any corrective surgery and that the liver transplantatiohe only hope of cure for the child. The procedure of liver transplantation would be a challenge in any child due to very tiny nature of the blood vessels to be attached to the new liver and the immature systems of the babies to withstand the major operations. In this case, the challenge was even more as the child was weighing only about 6 kg and due to liver damage since birth all the systems in the body were fragile.

More-over, even the size of the small portion of the liver that the child's mother came forward to donate was too big to fit inside the tiny abdomen cavity of the child. As it was the only life saving option for the baby, the challenges were explained in detail to the family who understood and were keen on going ahead with the liver transplantation. After adequate pre-operative preparations, the child underwent liver transplantation at about 7 months of age. About 20% portion of the left side of the mothers liver ( 350 gm) was removed and further reduced in size through a complicated procedure without disturbing the blood vessels and bile ducts to achieve a size of about 240 gm. This reduced size liver graft was fixed to the babies abdomen after removing the old damaged liver. The child and the mother had very good and rapid recovery. The baby started feeding well right from the third day after surgery. The jaundice completely disappeared and the stools became normal .The baby is completely cured and is about 5 years old and healthy now and happily attending his school like other kid.

She was born with a condition called biliary atresia where the bile ducts are absent and the children are jaundiced since birth. The child had undergone a corrective surgery for the same at 6 weeks of birth in Sri Lanka. The surgery for biliary atresia usually works only for a few years before the liver becomes irreversibly damaged. So by the time the child was 2 years of age, her liver had become irreversibly damaged and she became deeply jaundice with recurrent attacks of fever. The child’s growth became stalled and the feeding became very poor. She was diagnosed to have end stage liver disease at the hospital where the previous surgery was done and was referred for liver transplantation to us. The child's mother was willing to the liver donor and was found to be fit. The child underwent liver transplantation surgery where a small portion of the mother liver was removed and transplanted to the child.

The surgery in this child was specially challenging due to the dense and severe adhesions that develop after the previous surgery, which makes it sometimes impossible to safely remove the damaged liver and the poorly developed blood vessels of the liver. With meticulous surgical technique the adhesions to the liver were released and through a special 'patch' technique the blood vessels' size was enlarged and the liver transplantation was completed successfully. The baby had a rough post-operative course in the first week after the transplantation which was successfully managed. The baby fully recovered from the disease and surgery and she is back in her native country and is living a completely normal, active and healthy 7 year old school going kid.

He is a 7 ½ year old fist child of a corporation sanitary immigrant workers from Andhra Pradesh. The otherwise healthy child started having loss of appetite, weakness and continuous vomiting for 4 days. By the time help was sought in the nearest hospital, he had developed deep jaundice and his body and face began to swell with extra fluid and low proteins in the body. The first look at the liver function tests and blood clotting tests show gross derangement and the child was referred to our liver unit at the earliest for further care. A quick work up in our unit showed the child had developed a particularly severe form of acute (sudden) liver failure known as acute Wilson’s crisis. In this condition, due to an inherited defect in body’s Copper metabolism, free copper gets released into the blood stream and inflicts damage to the various organs in the body, mainly the liver, brain, kidneys and the red blood cells. So the child was having on going red blood cell breakdown causing blood in the urine; the liver had almost completely failed and the bilirubin levels were about 25 times more than the normal and the clotting strength of the blood was decreased by more than six fold.

The brain swelling was pushing him towards coma. The child needed an urgent liver transplantation to save the life. Child's mother came forward to donate a portion of her liver to save the child. An quick workup showed her to be fit for the donation. The liver ICU team was bending over backwards to keep the kid going and the infections at bay. The child underwent a successful liver transplantation wherein the left lobe of the liver from the mother was removed and fixed in place of the child’s damaged liver, which was removed. The usual 15 hour surgery was over in 9 hours. The child and the mother had a very smooth recovery. The child’s jaundice rapidly came down to normal by end of the first week; the appetite was back with a vengeance and he fully recovered. The mother also was discharged in a healthy condition. The Wilson’s disease has been cured for life for the kid. The poor family, who had never stepped into a private clinic for a routine fever due to financial constraints are grateful to the hospital which has performed this ‘mother-of-all-surgeries’ insurance without a paisa cost for the family.

Three and a half year old was born with a peculiar congenital disease where the liver was unable to excreate the toxic substance called bilirubin. So ever since his birth he was always jaundiced. He had intractable itching all over the body. He could not eat well and his weight gain and other regular developmental indices were grossly lagging behind. He was diagnosed and was being treated in government hospital where the maximum treatment possible was not helping the child. By the end of three years of age, his liver had failed and he started accumulating fluid in his belly. The bone started getting weak and bent due to liver failure and he could not walk well. Ironically his elder sister , the families only other child was also suffering the same problem. The family's struggle with the liver disease called 'Progressive Familial intra hepatic Cholestasis syndrome'( PFIC) peaked when they lost the elder child to the disease. The second child was going down the same path when they reported to our liver team. A quick work up by our team confirmed the diagnosis and also that showed the child to be in a terminal stage of liver damage. He required an early liver transplantation.

He was worked up for the same and listed with the state transplant waiting list. The problem in such kids, M was weighing a mere 12 kilograms and most of the available liver donations are from brain dead adults, where the liver would be too big to fit into his tiny belly space. So the family was counseled regarding the option of family member donating a portion of liver to save the kid. The parents were willing to donate but were found to have unmatchable blood group and hence were rejected for donation. The grand mother of the kid, a government noon meal cook came forward and after adequate medical evaluation was found fit to donate her liver for the kid. The child and his grand mom underwent simultaneous living donor liver transplant where the donors left portion of the liver was removed and substituted for the child's damaged liver. The surgery was a technical nightmare as the donor liver had multiple tiny blood vessels barely visible to naked eye. Using special operating microscope which could magnify surgical images 25 fold, the donor blood vessels were successfully attached and the new liver started working from the word go. The child and the grand mother an uneventful recovery and were discharged home. The grandmother has since joined back her work and the kid also recovered well from the surgery and cured of the disease. He started rapidly regaining weight ,height and the other developmental indices since the surgery.

26 year old lady, mother of a 5 year old child, was referred to us with 1 week history of jaundice for evaluation. The evaluation in outside hospital could not figure out the reason for the jaundice nor could arrest its worsening. She was admitted and underwent extensive evaluation by our liver team. She underwent special procedure called trans-jugular liver biopsy which clearly showed that the liver was severely damaged and required emergency liver transplantation. The patient’s father and brother came forward to donate a portion of their liver for transplantation but were not found suitable. So her mother was being worked up for living donor liver transplantation, which was planned for the same day night. Meanwhile the patient was rapidly deteriorating and was soon in coma and on life supports and ventilator.

The end was looking only a few hours away without a timely liver transplantation. A state wide alert for a super urgent allocation of any available organ was sounded by the state transplant authority. Fortunately, on the same evening, the family of a 31 year old road traffic accident victim who was declared brain dead came forward to donate his organs. The patient underwent an uneventful liver transplantation from this donor, in a surgery lasting 7 hours. The new liver started functioning immediately and the patient woke up from coma over the next 12 hours and was out of life supports within the 24 hours of liver transplantation. The serial Doppler scans showed perfect functioning of the new liver. By day three the patient was up and about, interacting with her family and on normal diet. The patient continues to do well and leading a normal life with another baby 7 years after the liver transplantation.

This 14 year old boy was referred to us with swelling of both feet, swelling of the abdomen, bleeding in stool. On evaluation, he was found to have a serious form of genetic liver disease known as Wilson’s disease. He also gradually developed neurological manifestation of Wilson’s disease, in the form of fits. Day by day, the disease was taking its toll and the patient was getting weaker and had to drop out of the school due to the disease severity. After extensive work up, it became clear that the liver was irreparably damaged and would require nothing less than complete replacement of the liver through a liver transplantation. He was placed on liver transplantation waiting list but it so happens that the children seldom get brain dead donors’ organs due to size match issues.

At this point, the patient’s mother came forward to donate a portion of her liver for transplantation. The patient underwent liver transplantation where his mother’s left portion of the liver was removed by an incredibly challenging operation and implanted into the boy’s abdomen. The mother’s gift began to perform well immediately in the son’s body and over the next 24 hours, the patient removed off the ventilator. He made rapid recovery over the next week and was discharged in another week from the hospital. The young man was doing well and had re-joined the school within the next 2 months. The genetic disease namely, Wilson's disease is fully curable by liver transplantation as the new liver litself functions as the 'gene therapy' and becomes the source of the new and normal enzyme which was defective in the patients old liver.