It takes two livers to save an obese patient

An obese man requiring liver transplant had to seek donation from two of his family members as the portion of liver donated by one was not sufficient.

Sameer Mitra, 46, weighed 93kg. Doctors had to take out 220 grams of the liver lobe from his brother-in-law, and another 550gm from his brother-in-law’s wife to conduct the life-saving procedure.

Doctors said such cases are becoming common due to rise in obesity and liver failure, which in many cases are correlated.

“A living donor can safely give 60% to 65% of his or her liver. Often, this volume falls short of the requirement for obese people. Mitra’s is not the first case. There have been at least three to four such cases in the past where multiple donations were required to conduct transplant on an obese patient,” said Dr Naimish Mehta, senior liver transplant surgeon at Sir Ganga Ram Hospital.

He said the recovery , revival of the transplanted organ and overall survival in morbidly obese patients who undergo liver transplant is also less successful as compared to non-obese.

According to the doctors, Mitra suffered from a cryptogenic liver disease for three years which necessitated transplant. “His wife and one of his brothers, who came forward to donate, had fatty liver, which is a contraindication for transplant. The blood group of his daughter was not matching. Finally , Mitra’s brother-in-law and his wife came forward to donate,” said Dr Mehta. He added, “Only a small part of liver–left lateral lobe–from his brother-in-law was taken because he himself is a kidney patient.”

But the challenges didn’t end there. Unlike the single graft, transplantation of multiple donor grafts in a patient has to be precise to ensure that the two grafts do not displace or obstruct the blood flow to the other while growing into a full organ.

Transplant surgeons said few such surgeries have been conducted in the country so far due to the complications involved, but if obesity and fatty liver problem continue to increase, more patients may have to go through the ordeal in future. “At present, nearly 30% of patients requiring liver transplant are obese or overweight. At least 10% are turned away either due to unavailability of donors in the family or the risks involved in surgery ,” said a surgeon.

A senior doctor at Institute of Liver and Biliary Sciences said in many cases, family members who are obese or have fatty liver condition are put on special diet and strict exercise regimen to be able to donate.

“In case of cadaver donors, we can take out as much of liver as required. But due to fatty liver disease there are many instances where liver harvested from a brain-dead donor is wasted as it is too fatty for transplantation. These grafts do not grow and the risk of rejection is very high,” said a senior doctor.