Biliary Atresia-Challenges of Liver Transplantation

 Suresh Krishnarao*

Citation: Suresh K. Biliary Atresia-Challenges of Liver Transplantation. Medp Public Health Epidemiol. 2022; 1(1): mpphe-202210002.

Abstract

   Objective: Biliary Atresia is a rare condition in early infancy in India, as nearly 2500-5000 such children are born each year. Liver transplantation is a highly successful treatment for biliary atresia, as survival after surgery has increased dramatically in recent years. However, the poor awareness about needs and urgency for liver transplantation for young infants born with Biliary Atresia, availability of donors and lack of facilities for transplantation surgeries, and socioeconomic inequities in accessing the service across the world including advanced countries like USA and UK lead to children experiencing long waiting times for procedure. The objective of this publication of clinical cases is to describe epidemiological risk factor; ordeals of liver transplantation in India and raising an alert for better preparedness of the health system and other stakeholders. 

   Location: Case reports of two liver transplants in Mumbai and Bengaluru in August 2022. 

   Participants: In this review 2 liver transplant surgeries one each in Mumbai and Bengaluru, India in August 2022 are discussed to drive the need for a comprehensive effort from the Government, families and the health insurance companies. The first case was of an infant of 9 months old boy, who underwent within two weeks of birth a corrective surgery (Kasai procedure) to allow for bile drainage, but the surgery failed and resulted in decompensated chronic liver disease with jaundice and other complications needing liver transplantation. He had to undergo an incompatible liver transplant with an aunt’s donated liver as parents were unsuitable. The second case was of a 11-month-old boy needing primary liver transplant due delayed manifestation (at 6 months), diagnosis and mobilizing resources. 

   Measurements: The operating procedures and the outcome in the first month. The financing mechanism for the procedure and limitation of country’s health assurance scheme. 

   Results: The immediate outcome of both the liver transplants were encouraging. 

   Conclusion: liver transplantation for Infants with Biliary Atresia is an urgency, but as of now must wait for long. families, government, insurance companies and even the facilities and surgeons need to join hands for this arduous process. Unless exceptional attention is granted it is difficult to save the children. 

   Materials & Methods: Reports on the ordeals of two cases of Liver transplants one in Bengaluru and another in Mumbai, India in August 2022. 

   Key Words: Bile Duct; Biliary Atresia; Liver Transplantation; Porto-Enterostomy; Ayushman Bharat; State Health Assurance Schemes.