The hospital cot was her cradle, the beeps of the monitors her rattle sounds, stethoscopes her toys, the doctors and nurses her family. For Vani, the hospital was her home. Her parents had forgotten the joys of youth, the gay abandon their age would warrant.  They had suddenly grown up, sobered and quietened by the burden and enormity of Vani’s illness. Nothing could have prepared them for the suffering they would go through together.Like all new parents, they had been overjoyed by Vani’s birth, she was God’s gift to them. Full of dreams to raise her as their princess, buying her frilly frocks and fancy pink clips, they brought her home. But only if yellow would give pink a chance….A few days after her birth, they noticed that she had yellow eyes and urine. Her stools were clay white. The idea of routine newborn jaundice that resolves in a few days was reassuring,  but they began to worry when she was still jaundiced well into her second month of life. Medical tests confirmed that she had biliary atresia. She needed urgent surgery and was operated at 57 days of life. Thus began her war with the disease.The cure that had been anticipated with her surgery was never to be. It only left her worse with repeated episodes of infection in her gut as it had been connected to her liver. She received multiple courses of antibiotics for the next few months. She would get a little better and be discharged from hospital, only to be back again in a week or so. This happened half a dozen times. Finally she was then brought to Indraprastha Apollo Hospital, Delhi, frail, emaciated and struggling for her life.She was put on ventilatory support as her blood grew deadly bacteria for which she was treated with heavy antibiotics. Thankfully, she responded well and her infection was controlled. But her doctors knew that her only chance for survival was to have a liver transplant. However, she weighed just 6 kgs, had been ill for what seemed forever, her liver had failed and infection would return any time.  They could not wait for her to gain weight and grow stronger for the surgery. This was the only window of opportunity. She was on top of her infection and a very high risk liver transplant was performed.Out went her diseased liver with all its hidden foci of infection and along with it her misfortune. Worst fears of her not coming out alive from the surgery were allayed when she was wheeled out of the operation theatre after the 12 daunting hours of surgery.  She was a fighter, she looked better as each day passed and the real Vani surfaced. Vani with white eyes, soft belly with no distension, kicking her way to good health. Within 3 weeks she was home, never to be hospitalised again in the 7 years that have elapsed after her transplant.Life had triumphed, had given her the joy of childhood in her parental home, with many more to grow up for. A pink wedding dress, perhaps?The Clinical Perspective Vani had been ill for too long, was very weak due to her chronic liver disease, repeated infections and prolonged hospitalization. This made her transplant very high risk and early complications like flare up of infection and vessel thrombosis were feared. However, she had a dramatic recovery after receiving the new healthy liver.

An unemployed alcoholic gives up drinking to become a liver donor for his son who in addition to a new liver gets back a responsible loving dad saved from doom that alcohol had led him to  The doctors measuring tape doubled up as a tailor’s tape for taking measurements for Vinay’s clothes. He was being discharged and his doctors, along with giving him a new liver, wanted to dress him up in new clothes. “Please don’t bring anything in red”, he whispered in his mother’s ear to convey to his doctor who was now off from the ward round to proceed for the mall round shopping for Vinay.Some people evoke sympathy, others evoke empathy. Vinay was one who evoked pure love and deep affection. He was too blessed to be sympathized with.  Despite his illness, there was never a moment where you could catch him awake without a smile on his face. Ever radiant, ever beaming, ever content, the gleam in his eyes never gave away his tale of suffering.All of 11 years, he had been in and out of hospitals multiple times over in the last 4 years. The first episode had occurred when he was barely 3 years of age. These repeated episodes of fever, jaundice, pain abdomen and vomitings brought him from a small village near Jalandhar to Ludhaina and then to the Post Graduate Institute of Medical Education and Research(PGIMER), Chandigarh in his quest for a cure. A diagnosis  of primary  sclerosing cholangitis was arrived at, a condition in which the draining channels for bile become beaded and narrowed leading to bile accumulation in the liver and subsequent tissue damage. With the non complaining temperament that he had, Vinay patiently endured 7  endoscopic attempts by his doctors to put in a stent across his main blockage. As a last resort, an external diversion was created that drained his bile into a bag attached with a tubing to his gall bladder.To live with a bag attached, liver already damaged and shrunken, no school, no play – was this to be Vinay’s fate? He deserved better and the universe ensured he got his due.He needed a liver transplant, that was his only chance of a life worth living. An alcoholic out of work father, 2 elder school going sisters, a mother who supported the family with her peon’s salary that barely made both ends meet…. Where were the means to salvage Vinay?His doctors needn’t have despaired. The entire universe had conspired to help Vinay. The liver transplant team at Indraprastha Apollo Hospital offered a free transplant in which the bed charges and fees would be waived off with the patient needing to pay only for medicines and consumables. That would cut the cost to about half (6 lacs), but that too was beyond their means. In true community spirit, his village was like an extended family and the panchayat took on the challenge to raise money. A public appeal was issued, several rounds of Kabaddi matches were organized to raise funds and sanctions were obtained from the Punjab Chief Minister’s relief fund. Rupees one lac each were donated by the kind parents of 2 patients.  Soon the required sum was in the kitty.With the funds arranged, evaluation of the mother as a donor was started. After all the positivity, no one was prepared for this setback – even though she had no symptoms, her main vessel supplying the liver was found to be blocked making her unfit to donate. Both the sisters were not yet adults. Tears rolled down her eyes as she foresaw all her efforts go down the drain.Little did she realize, God had grander plans for her. A new life awaited not only her son but also her husband whom this challenge reformed completely. To be able to donate a part of his liver, he would have to abstain from alcohol for at least 3 months. Post donor surgery, if that happened, alcohol would be taboo as it would harm his regenerating liver. Love for his son proved stronger than the love for alcohol. What years of coercing and pleading by his wife and children could not achieve, the desire to see his son live did. Not a drop of alcohol went down his throat in the next 3 months and he was then cleared as a donor by his surgeons.What could go wrong with Vinay after having surmounted odds of such gravity? All went well, Vinay went home looking dapper in his new clothes. He now goes to school, his father – now a teetotaler earns reasonably as a carpenter, his mother and sisters have never been happier and the village panchayat never felt prouder. From the greatest adversities emerge the greatest success stories, such are life’s ways!   Clinical perspective:Vinay and his family had suffered for almost 8 years due to his illness. Recurring at progressively decreasing intervals ever since he was three, for the last 4 years he had been ill every 2-3 months. By the time he was diagnosed, he already had portal hypertension. As stenting had failed despite repeated attempts, a cholecystostomy had been done that was an open channel for infection and also tended to block.Vinay’s liver transplant was a success- medically and socially. He became a model for other patients from the economically deprived strata of society, bridging them from despair to hope.

A child born of a precious pregnancy undergoes renal transplant due to kidney failure 2 years after a liver transplantDoctor! doctor! See! Sroy is dancing! He is hiding and peeping from behind the curtains! Look at him!…The sister was beaming with joy as she ran through the ward corridor to share the news. He was quick to capture the moment in a video on his mobile and the mother was in tears, this time, of happiness.Countless tears had she shed on countless occasions as she had struggled to save her only living child. Four miscarriages, a child lost in infancy to an undiagnosed illness, a broken marriage, all alone in a foreign land with a child ill from birth……the strongest of humans would break in such a predicament, but not this lady. Not this lady, for she had the strength that comes from love. One of the biggest joys in life is to love and be loved. Sroy was the  one to love her back and she would do all in her power to have him live.She first come to India from Cambodia when Sroy was about a year and a half. He had biliary atresia. Sroy had a corrective surgery at 2 months of age at Singapore but his liver functions continued to deteriorate. He had repeated episodes of jaundice with fever and when he began to vomit blood, he was advised for an urgent liver transplant. Fortunately, funds were not an issue. The family chose to come to Delhi.Sroy underwent a liver transplant and was discharged within 3 weeks. His liver functions improved rapidly and we sent home this little bundle of joy, his eyes sparkling with the hint of mischief, his laughter so infectious that the hospital gloom would be uplifted within seconds of being with him.But the troubles he was born with didn’t go away with his liver. After remaining well for about 20 months, Sroy developed swelling all over his body and was detected to have kidney dysfunction. He was back with us, his blood pressure was high and is normally cheery nature was drowned in his restlessness.Anxiety was writ large on the faces of the transplant team. Their worst fears were confirmed with the medical and kidney biopsy reports… Sroy had developed chronic renal disease due due to transplant associated thrombotic microangiopathy, a condition where the small blood vessels get occluded due to damage to their inner lining. This is a very rare but devastating complication of transplantation with mortality ranging from 60-90%.Medications were changed, treatments instituted but to no avail. Sroy’s kidney function continued to deteriorate and soon he was on hemodialysis with no option but to undergo a renal transplant. One of his maternal uncles came forward to donate his kidney and the mother steeled herself to consent for his high risk surgery that fortunately, went off well. But Sroy’s troubles were far from over. He continued to have renal dysfunction and had multiple sessions of plasma exchange, intravenous steroids and high end novel therapies were instituted to save the new kidney. He picked up a urine infection, developed spiking high fevers requiring prolonged antibiotics. He was in the intensive care unit on his birthday, had fever when he cut the cake, yet was happy playing with the toy car his doctors had bought him. The injections, the monitors, the nurses had somehow integrated into his life and the pain couldn’t subdue his joyous spirit. That was what triumphed ultimately when his new kidney worked well, his complications controlled, he danced in his room, his pranks were back and so was the long lost smile on his mother’s face. He had won, a mother’s resilience had paid off and he went home after a 4 month long hospital stay, all hale and hearty.The Clinical Perspective Thrombotic microangiopathy has been reported frequently after stem cell and bone marrow transplants but is exceedingly rare after liver transplantation. After one organ transplant, he needed another – a nightmare for any family and treating unit. He needed strategizing on multiple therapies to control the angiopathy and make the kidney transplant feasible and successful whilst also protecting the grafted liver.  The situation was very challenging and we really feared losing Sroy.

An NRI woman travels all alone with her son for his liver transplant in her homeland“Maanvan, thandian chaavan” goes a popular saying in Punjabi that describes a mother as a shade that cools and protects from the sweltering heat. Search for this solace was perhaps what brought this young lady, hardly in her mid-twenties, to her homeland India. Born and brought up in South Africa, she was of Gujarati lineage. Her parents had migrated before she was born but distances only bring hearts closer. As she landed in India, uncles and aunts,  gathered around her to cuddle her infant son, Hamza.Hamza was a happy baby, his large round eyes lit up as he was showered with gifts, his “shagun”. His mother’s eyes, however, were sad as she looked at him- he was perfect but only for his deeply yellow eyes….Hamza had jaundice since a few days after birth as he suffered from biliary atresia that had caused his liver failure. Why a child develops biliary atresia soon after birth, medical science has yet to fathom. All we know is that it’s universally fatal unless a partially corrective surgery is done within 2 months of life. The success rate for this surgery varies and liver transplant has over the last few decades revolutionalised the management of this otherwise dismal disease by providing the only definitive cure. Hamza’s corrective surgery had failed and his mother had come to her motherland seeking life for her son from the land that gave her hers.Her husband had stayed back to look after their other 2 children and her relatives from Gujarat were her pillar of support here. If God had given her this challenge, he had also bestowed her with tremendous support. She was fortunate to have a family that was so closely knit, it was her sister’s husband who came forward to donate a part of his liver as she and her husband had been rejected as potential donors on medical grounds.Moving from one hospital corridor to the other, she held his hand tightly as Hamza went through the tests and assessments.  Her soft voice and calm eyes spoke volumes for her inner strength as she watched her son being wheeled in for the transplant. Her usually difficult to restrain little one was engulfed in tubings, deep asleep under the effect of anesthesia when he returned after the 10 hour surgery. But he would soon return to his naughty self as his anesthesia effect wore off. He was off the ventilator within a few hours, smiling reassuringly at his mother. It was as if he could sense the turmoil in her heart that she concealed from the outer world. Like mother, like son. Hamza was a brave little lad and would cry briefly when pricked for blood samples and then return to his calm demeanor. Only hunger would unsettle him and he was cheerful once feeds were started 3 days after the surgery. He became the darling of the nurses who wouldn’t tire of playing with him.The Gods favor the humble and Hamza recovered well. He was discharged in 3 weeks time, his eyes perfectly pearly white, carrying only the surgical scar on his tummy as a momento of the terrible illness he was born with and conquered in his native land.The Clinical Perspective Hamza thankfully did not develop any major complications. He had intermittently high potassium levels for which he required a potassium binder. Hamza easily drank the medication mixed with his feeds and was an exceptionally co-operative and easy to manage baby.

A brain haemorrhage post liver transplant surgery instills fears of permanent damage in a child so overwhelmed by the surgery that she does not speak for days together in hospitalTrue to her name, Apoorva, is her story. Apoorva, that has never been seen before, that is unprecedented, never heard of.Lord Krishna is fondly called “Yashoda’s Nand Lal” because the mother who brought him up is revered as a greater life force than his biological mother. Apoorva also had 2 sets of parents – the ones who gave birth to her and the one’s who adopted her. She was adopted within her parents family by their elder brother and his wife who could not beget a child of their own. She was everyone’s darling, doted on by one and all.Just as the joy of her existence was manifold, so was the pain of her suffering. The entire family was in gloom when she was diagnosed with Budd Chiari Syndrome, a condition caused by occlusion of the veins of the liver, in the first year of her life. She had developed fluid collection in her abdomen and an ultrasound showed blockages in the hepatic veins. This would lead to chronic liver disease and she was put on regular medications. True to its nature, the disease progressed and by 4 years of age she had developed cirrhosis and its many complications. There was increased pressure in the veins supplying the liver leading to fluid accumulation in her belly and increased risk of bleeding. She had developed hepatopulmonary syndrome (lung dysfunction secondary to liver disease leading to shortness of breath and breathing difficulty more so in the sitting position). She had become blue and oxygen dependent. Liver transplantation was the only cure.It is said that the strength of parenthood can even defeat nature. Why wouldn’t her disease be defeated when she had 2 sets of parents ready to donate their livers for her? But here lay nature’s irony. While most transplanted children receive livers from either of their parents, Apoorva was like a thirsty person in a sea of salty water. Her biological mother was in an advanced stage of pregnancy and the other three were all rejected as donors due to medical reasons. There was no donor for Apoorva.A cousin of her parents came forward. He was a young lad who had lost his father as a child. His mother showed exemplary courage and magnanimity by keeping familial bonds and humanity above the instinct for self preservation.Apoorva’s transplant went off well. For a few days, all seemed blissful till disaster stuck. She had a genetic condition that gave her blood an enhanced tendency to clot and necessitated medication to keep it thin. Its’ a double edged sword, too thin blood could cause internal bleeding. She had just received one dose but in the backdrop of intermittent blood pressure fluctuations post surgery, she developed a massive brain haemorrhage.Apoorva was immediately operated upon and the clot in her brain removed. Gradually, she improved and the half body paralysis that had occurred showed rapid recovery. The immensely worried team began to relax as she showed progress. She became extra special and everyone wanted to chat her up. But lo and behold, not a word was forthcoming! She would make eye contact, acknowledge with minimal gestures but was completely silent and withdrawn. Days passed, her physical recovery was almost complete. She was ready to go home but her voice was not to be heard. Her team feared she had developed aphasia which is loss of speech due to her brain injury but the neurologist disagreed. “The hospital environment has shut her up”, he said.  After repeat CT scans of her brain were reassuring, she was discharged.To our utmost joy, she came to the outpatients for follow up visits walking well, talking even better. She was the normal chatterbox her parents had known, making one demand after another, now music to their ears. She was indeed one of a kind, Apoorva!The Clinical Perspective Brain haemorrhage is a devastating complication to have after any surgery. The liver surgery had been successful, but to send home a child cured of liver disease but paralysed is a predicament no team can allow. There was no plausible explanation as to what precipitated it. A single dose of antiplatelet drugs should not cause it, nor should mild intermittent hypertension. Her phase of aphasia made us feel helpless, are we so intimidating to the patient? Her full recovery brought immense relief.  

Living under phototherapy since birth, liver transplant enables peaceful sleep in the dark in a cozy bed – finally nights dawn in the life of a girl with Criggler Najjar syndromeWhere there is despair, hope….where there is darkness, light…..goes the famous prayer by St. Francis of Assissi. But what if light becomes one’s despair and a peaceful night’s sleep in the dark someone’s biggest hope? How many of us know that snuggling up in the sheets for a peaceful night’s sleep, something we all take for granted, is denied forever to patients with a disease called Criggler Najjar Syndrome?This was Amal Abubakkar Sayeed’s predicament.….she was to remain under direct light for hours together, ever since she was born, for she was born with this rare disease that affects about 1 in a million. A disease in which an enzyme deficiency in the liver causes impaired excretion of a pigment called bilirubin that accumulates in the body causing severe jaundice starting within a few hours of birth. Untreated, the high bilirubin enters the brain causing fits, permanent brain damage and hearing loss. To prevent this, the jaundice needs to be controlled by keeping the baby naked, with only the eyes and genitalia covered, under lights of a specific wavelength through specially designed phototherapy machines. Phototherapy metabolizes the bilirubin allowing it to be excreted in the urine. Beyond a limit, to protect the brain, the jaundiced blood is removed from the body and simultaneously replaced with normal blood in a process called exchange transfusion.This is the life that was given to Amal. On the day she was born, she developed severe jaundice and the phototherapy unit became her destiny. The comfort of her mother’s lap was not meant for her, for she had to be under the lights, taken out only for feeding. For 2 months she was in hospital, undergoing repeated exchange transfusions and intensive phototherapy.And then she came home, along came her phototheray unit. For 16 -18 hours in a day she would remain under the lights. Born in Yemen, the first child of young consanguineous parents,  who never got a day to enjoy their parenthood. This light was their curse, they learnt to live with their curse.At around 1 ½ years of age, Amal was brought to India. The only cure was a liver transplant that could provide a healthy liver capable of producing the deficient enzyme. The parents were prepared but none of them was a suitable donor. For lack of a donor, they opted for stem cell treatment – an experimental therapy for the disease, at another city in India. Her jaundice decreased partially for a few months decreasing the need for phototherapy, but she was back to square one within 6-8 months.She was 2 years and 3 months of age when they returned to India to Apollo Hospital, Delhi. By now, she had developed some slurring of speech, difficulty in walking and weakness in both the legs indicating early brain damage. Our pediatric neurologist, an authority in her field, opined that her MRI changes could possibly reverse after a liver transplant. Any further delay and she would be a cripple forever. Her hearing was intact.A liver transplant for this disease had never been performed in India. Amal’s maternal aunt volunteered to donate. Amal became the first successful liver transplant recipient for Criggler Najjar Syndrome in India. Within 2 weeks, her jaundice had normalized and for the first time in the 27 months that she had lived, her eyes were white instead of yellow.More than 12 years down the line, she is like any normal girl going to regular school, growing normally, her speech and gait perfect. Only her mother’s moist eyes when she puts her to bed, kisses her goodnight and switches off the lights, speak of her extraordinary tale. She has finally been blessed with darkness.The Clinical Perspective This was the first case of liver transplant for Criggler Najjar syndrome in our country. We were skeptical of the neurological prognosis fearing the deficits, though they were mild, would not improve. Her totally normal development and neurological recovery were well predicted by our pediatric neurologist.

Dr. Sanjay, India’s first successful pediatric liver transplant recipient in 1998 paves the way ushering in a new era in Tranplant SurgeryDead ends force us to seek new routes and history has shown us that adversity brings out the best in humanity. The potential of the human mind is beyond measure. To be a catalyst in the chemistry of breakthrough is a great honour. Just as the world celebrates Louis Brown as its first test tube baby, India celebrates Sanjay Kandasamy as its first successful pediatric liver transplant recipient.Sanjay was born with biliary atresia, a disease of infancy that affects about one in 15,000 babies. When a baby has biliary atresia the flow of bile from the liver to the intestines is absent or blocked. The biliary system is a network of ducts and channels that drains bile from the liver cells to the gall bladder. Bile is then released to the intestines. Bile helps to digest fat and carry waste products for excretion. In biliary atresia, it gets trapped inside the liver causing damage and scarring that leads to cirrhosis. As the liver becomes scarred, it presses against the walls of the veins and blood cannot pass through them properly. The result is portal hypertension (high blood pressure in the portal vein). Biliary atresia in 1997 was a death sentence in our country and most parts of the world.Survival beyond 1-2 years was unfathomable.  The only hope was a Kasai surgery that helps re-establish bile flow from the liver to the intestine by joining the two directly. It has a dismal success rate if delayed beyond 2 -3 months of life.  By the time a diagnosis was arrived at, most children would be too old for a favorable outcome. Even with a successful surgery, the child would ultimately develop liver failure over the years in almost 70-80% of the cases.Sanjay developed jaundice a few days after birth. As the jaundice increased, he underwent investigations and a diagnosis of biliary atresia was made. He was referred for a Kasai operation and had the surgery at 62 days of life but his liver had already been damaged. He continued to have jaundice and also developed recurrent episodes of fever and abdominal distension. By 18 months of age, he had severe growth failure, was severely jaundiced, all swollen up because his diseased liver failed to produce appropriate protein leading to fluid accumulation in his body.His only hope for survival was a new liver. His parents knew he didn’t have more than a few months at the most. Their doctors had mentioned the possibility of undergoing a liver transplant abroad. That option was way beyond their financial capacity. A liver transplant programme had been started at Apollo Hospital, Delhi around that time but the only child transplanted (who had received a cadaver liver which did not function) had not survived.They were in a dilemma. Though the financial hurdle was overcome as the hospital was willing to do away with the charges, they were still unsure. They did not want their child to die suffering in hospital, far away from his native place and family. Should they allow him to live peacefully as long as he could? The thought that they could end up losing the few weeks that he had was heart wrenching. Would they be able to live with that guilt? A parent would have to undergo a major surgery to donate a liver segment. To subject oneself to a surgery that had never been done in India was walking a dark, unknown path. What if they ended up losing both their son and their partner?Liver transplant was a difficult and unsure path, nevertheless, it was the one that showed a bleak ray of promise. Hoping against hope, they clung to that miniscule ray. With tremendous courage they swallowed all their fears and chose to risk all they had to give Sanjay a chance. After all, great love and great achievements involve great risk.It was a decision they celebrate to this day when their son hugs them. His mother still finds it difficult to hold back her tears when she recollects his days in hospital. Sanjay had a very complicated postoperative course and was in hospital for 4 months after his transplant. He required prolonged ventilation, developed repeated perforation of his intestines undergoing surgery five times. He required high dose medications to treat liver rejection as his body’s immune system fought the new liver. Repeated surgeries and prolonged ventilation led to infection that was another challenge to overcome. But overcome he did, each and every hurdle that was thrown his way.Today, 22 years down the line, he aspires to be a surgeon himself having already completed his medical graduation to become a doctor. He continues to inspire families facing the transplant option and doctors when tough clinical scenarios daunt them. He is truly the path breaker.  The Clinical Perspective Sanjay was the first child to undergo living related liver transplant in India. He developed one complication after another. The transplant surgery itself had been successful with the graft and blood vessels well taken. To lose a patient to surgical issues in other organs would have been very painful. Sanjay underwent multiple other abdominal surgeries, each a potential threat to his life and our transplant programme.

Twin blessingsTwo sisters save their brother by donating a part of the liver and a kidney in a child from Ethiopia, requiring a combined liver-kidney transplantMukhtar Ahmed Ali Gadkarim, a 13 year old boy from Sudan was brought to Indraprastha Apollo Hospital, Delhi with end stage renal failure. He had been passing stones in his urine since the age of 7 and had damaged both his kidneys requiring hemodialysis thrice a week for a year. He was in complete renal shutdown with no urine output for 12 hours and generalised swelling of the body due to fluid retention.  He was hypertensive, his kidney tests were deranged with a serum creatinine of 5 mg/dl (normal 0.3-1.2 mg/dl) and ultrasound of the abdomen revealed bilaterally calcified kidneys.He was detected to have very high oxalate levels in his blood and bone marrow leading to the diagnosis of a very rare genetic disorder, primary hyperoxaluria. This has a prevalence of only 1 to 3 per million and results due to a biochemical defect in the liver. A deficient liver enzyme leads to excessive production of oxalate that complexes with calcium to form calcium oxalate crystals which accumulate in the kidneys, bone, heart and other organs.  Earlier, a definitive diagnosis required documenting the deficient enzyme in liver tissue by obtaining a liver biopsy. But with the availability of genetic studies, we can isolate the aberrant gene by gene sequencing, thus avoiding a liver biopsy. He tested positive for the AGXT gene that causes primary hyperoxaluria, thus confirming the diagnosis.Dialysis is inadequate treatment for these patients as it cannot overcome the ongoing oxalate production. A kidney transplant alone doesn’t suffice as the oxalates will reaccumulate and damage the new kidney as well. Cure occurs only if the deficient host liver is replaced with a liver that has the deficient enzyme, thus necessitating a combined kidney and liver transplant.Mukhtar was given multiple sessions of haemodialysis over a month and a half to deplete oxalate from the body before transplant. Fortunately, he did not have cardiac damage and was in a position to withstand the formidable surgery. His story is a glorious tale of human courage, bonds and sacrifice. His twin sisters aged 27 years were the donors, one for the kidney and another for the liver. One of the sisters is a doctor and played a crucial role in mentally preparing the family for the transplant.A team comprising of liver and renal transplant surgeons with expert anaesthetists performed the surgery that lasted nearly 12 hours, with the liver being transplanted first followed by the kidney. Mukhtar’s recovery was dramatic and he was off the ventilator within 24 hours. His renal parameters improved, his urine now did not show any oxalate crystals and he was discharged in 3 weeks’ time. Both his sisters also recovered well and the jubilant family returned to their native country with a new lease of life, overwhelmed with gratitude towards our country, our doctors, modern medicine and divine grace.     The Clinical Perspective Arriving at a diagnosis was the first challenge. Increased oxalate excretion in the urine is the usual first line test but Mukhtar wasn’t producing any urine at all. Oxalate crystals were detected in the eyes and genetic tests sent were confirmatory. That he had twin sisters was a blessing. He needed two donors, one each for the liver and the kidney. It was a huge help both for the family and the transplant team that one of them was a doctor herself.  On a follow up of 4 years, he has remained well with no significant post transplant complications.

~ Health of the Nation 2021 Report gives unique perspective on trends of non-communicable diseases across the country, shows path for early identification and management using AI, ML and data analytics ~National, April 7, 2021: On the occasion of World Health Day, the Apollo Hospitals Group, Asia’s largest and most trusted healthcare group, unveiled a report on the Health of the Nation that puts a spotlight on how the last two decades have seen a steady rise in non-communicable diseases (NCDs).  The contribution of NCDs as the top causes of death in India has risen to a staggering 64.9% as compared to communicable diseases, maternal and other causes that dropped to 25%. The study provides a unique perspective drawn from Apollo Hospitals’ 37 years of experience and its vast footprint across the country and underlines how Artificial Intelligence and Big data analytics can help to predict risk and prevent NCDs. Given the pandemic, this is also important as individuals with NCDs such as diabetes, heart disease, hypertension, chronic kidney disease, and chronic liver disease have a greater mortality risk from COVID-19.Dr Prathap C Reddy, Chairman, Apollo Hospitals Group said,“Even before the pandemic began, we have been facing an unacceptable loss of lives due to non-communicable diseases (NCDs). The silent epidemic of NCDs was evident with NCDs behind 40% of all hospital stays. However, in dealing with the COVID-19 pandemic, the data from our Health of the Nation report made it clear that we have let another epidemic slip, the epidemic of NCDs – the impact of which we are already beginning to see around us. We can overcome NCDs together as a country, only if each and every one of us take our health seriously.“At Apollo, we have been working on preventive health for over 37 years. From the very first Master Health Check in the country, we have been constantly evolving our programs for early detection and better clinical outcomes. Apollo ProHealth is a proactive personalized health management program backed by cutting-edge technology – advanced diagnostics, artificial intelligence and predictive algorithms – to help identify your health risk. It coaches you to stay on the path to wellness until your health goals are achieved. With Apollo ProHealth, we hope to change the health check paradigm from a long checklist of tests to a meaningful conversation with the doctor on the status of your health, with a comprehensive plan to make you healthier tomorrow than you are today. Today, on World Health Day, on behalf of the Apollo Hospitals Group, I dedicate Apollo ProHealth to the health of our nation!”NCDs affect not just health, but also productivity and economic growth. The 2030 Agenda for Sustainable Development adopted by the United Nations recognises NCDs as a major challenge for sustainable development with the target to reduce premature mortality from NCDs by one-third by 2030. The pandemic last year has exacerbated the risks and impact of NCDs manifold, as also shown in the Health of the Nation report.Dr Sangita Reddy, Joint Managing Director, Apollo Hospitals Group said,“Apollo Hospitals’ commitment is to the health of the nation, with a vision to make our nation healthier. With the urgent need to respond to the challenge of non-communicable diseases, we cannot afford a pure treatment and curative approach to health. We believe that a focus on prevention will be transformative for the health of the nation. We are harnessing the power of technology to develop new methodologies for screening, detection, and patient risk profiling. We are using our pioneering experience of over 37 years and countrywide network to create and innovate new models of care to improve clinical outcomes. We have been the first to adopt Artificial Intelligence and Big data analytics to predict risk and personalize care.“Today, we are showcasing our insights into a vast amount of health data that will form the foundation of a healthcare model for our future. Many arms of Apollo Hospitals have worked together, collating their knowledge, data on the incidence of disease, and put that into one holistic report that is a representative study of the Health of the Nation.”NCDs account for 65% of all deaths in India. There is a need to look at new norms of preventive health management that allow us to detect and tackle risks from NCDs before they manifest, even more so in the context of the COVID-19 pandemic. The Health of the Nation report offers a unique perspective of the healthy and unhealthy – across occupations, economic segments, and demographics, and trends of non-communicable diseases across the country.The study will help put in place approaches to improve disease prevention, increase the accuracy of early diagnoses that will, in turn, lead to a more personalized and patient-centric treatment approach.Dr Anupam Sibal, Group Medical Director, Apollo Hospitals Group said,“The Health of the Nation study highlights the need to direct our efforts efficiently towards controlling NCDs through optimal use of our healthcare infrastructure.The highest prevalence of pre-diabetes and diabetes is seen in 45-60 year olds and is almost as high as the 60+ age group. Amongst the diabetics, around 50% also have hypertension and are above the recommended weight. Around 60% of these diabetics are also leading a sedentary lifestyle. The data also indicates that while women have lower incidence of NCDs, the difference is marginal. Hence, they must stay vigilant. The economically disadvantaged are also not spared, although with lower prevalence.”There is a significant diabetes population in the major metros and suburbs of India, especially the Delhi NCR – Punjab & Haryana Belt, Kolkata, entire Mumbai-Ahmedabad belt, Hyderabad and Chennai, Kerala and Tamil Nadu, as well as in the predominantly rural areas of MP, Maharashtra, UP, Bihar, parts of Orissa and Gujarat. There is a significant hypertensive population in major metros such as Delhi, Punjab & Haryana, Kolkata, Mumbai, Goa, Trivandrum and Hyderabad and in the predominantly rural areas in Tamil Nadu, Karnataka, UP, Bihar, Orissa and Gujarat.Prof. Nirmal Kumar Ganguly. Former Director-General, Indian Council of Medical Research and President, Apollo Hospitals Educational and Research Foundation said,“Our pilot community health model, Total Health, to reduce premature NCD-related deaths in rural areas was launched in 2013 in Aragonda, Chittoor district. The program saw 31,350 people classified as low risk, moderate risk and high risk, according to their ten-year risk of developing NCDs, and proactively managed with regular follow up, investigations, medication, clinical interventions, counselling and lifestyle modifications for diabetes, hypertension and cancer. In addition, the program also addresses all other social determinants of health in the country (e.g., drinking water, nutrition, kitchen gardening, livelihood generation) to beyond just health to ‘Total Care’ for ‘Total Health’.Around 80% of mortality from NCDs is preventable with early detection and proper management. It is critical to continue to focus on regular health check-ups to detect NCDs along with AI-enabled tools that allow premature health events to be identified early.Under this program 1,980 diabetic and hypertensive patients have been put under regular follow up, who are under now control with proper investigations, medication, counseling and life style modifications. Also 5,391 rural women were screened for cancer and 17 early cancer cases (cervix and breast) were diagnosed and managed with appropriate health intervention services which were free of costDr Sujoy Kar, Chief Medical Information Officer said, “The study gives us the data that will allow the effective use of technology to predict risks and guide our actions to prevent and rein in the NCD epidemic. One such example is to evaluate and manage the High Sensitive Troponin-I (hsTnI)categorical CVD risk in subjects undergoing preventive health checks (PHC).  “AI and predictive algorithms can predict risk, prevent premature health events, and overcome chronic lifestyle diseases, when caught early. For example, we have developed a Cardiovascular Risk Score (AICVD) in the Indian population and it is now prospectively used and followed up on 33000 individuals as part of ProHealth to predict the risk of developing cardiovascular disease.There are various clinical tools using AI and data analytics ready for deployment as well as under research for various NCDs. These include tools and algorithms to identify medical issues early in CT scans, predict various risks including the risk of developing cardiovascular disease, asthma, liver fibrosis in NAFLD, breast cancer, pre-diabetes and stroke.Dr Sathya Sriram, CEO, Preventive Health, Apollo Hospitals Chennai said,“The Health of the Nation study has shown us the importance of shifting the paradigm in India from a curative to a preventive mindset. Apollo ProHealth, empowered by AI and predictive algorithms, is a personalized proactive health management program based on 22 million health checks, building on Apollo’s pioneering efforts in preventive care and led by medical experts committed to making individuals healthier. Apollo ProHealth includes personalized health risk assessment to predict health risks and diagnostics tailored to your profile, physician-led evaluation for a personalized treatment plan and wellness goals, and Health Mentors to regularly monitor your health parameters and help individuals stay on the path to wellness. Over the last 12 months, a cohort of ProHealth guests with diabetes have shown 33%-60% target achievement across multiple health parameters, such as blood pressure, cholesterol, physical activity and HbA1c. The Health of the Nation report is the basis on which NCDs can be managed proactively, with the data used for early identification and management of NCDs using AI and data analytics to enable India to follow an accelerated path to meet SDG goals by 2030.

 National, April 6, 2022: On the occasion of World Health Day, Apollo Hospitals, Asia’s largest and most trusted healthcare group, unveiled the Health of the Nation 2022 report highlighting the prevalence and distribution of non-communicable diseases (NCDs) across the country. Based on 16 million anonymized responses to the COVID-19 Risk Assessment Scanner by Apollo 24/7, the report gives critical insights on trends in NCDs such as diabetes, hypertension and heart disease, COPD & asthma, obesity in different regions of the country. The report also underscores the potential of AI and data analytics in prediction of risk and early identification as well as management of NCDs.           Dr Prathap C Reddy, Chairman, Apollo Hospitals Group said, “The last year saw the country steadily building a bulwark against COVID with a robust vaccination program that led to a steady fall in the number of COVID cases. As we emerge from the shadow of COVID, it is imperative to bring the focus back on the pandemic of NCDs, a focus that faced a disruption impacting diagnosis and treatment for millions of patients. It is the only way we will succeed against the multiple challenges we face today with the pandemic, a polluted planet, and an increasing incidence of diseases that form the theme for World Health Day 2022 – Our Planet, Our Health.“For a developing country like India, NCDs are a critical matter that need to be addressed. In India, NCDs kill 6 million people every year of which around 23% are between 30-70 years of age.[1] An analysis of the data from 3.8 Lakh responses to the COVID Scanner shows the criticality of addressing the NCD challenge using all the tools at our disposal. The data indicates a national prevalence for diabetes mellitus of around 7%, over 8% for hypertension, and around 2% for COPD & asthma. Considering our population of 1.2 bn., these are huge numbers that will increase the burden of disease and impact productivity and economic growth. We must address the NCD challenge through promotion of healthy lifestyles, early diagnosis and management. We must approach Health as investment and not as an expenditure”Key findings of the Health of the Nation 2022 report for Diabetes Mellitus show an increased prevalence in the southern and eastern parts of the country with an average national prevalence of 6.96%. Urban areas showed a higher prevalence at 7.01% as compared to rural areas with 6.70%. The study also showed obesity in women over 35 years of age leading to poor diabetes control and increasing risk of heart disease and other complications. Data also indicated poor diabetes control in women with high cholesterol with a 0.5 increase in HbA1c diabetes marker levels. In Hypertension, the study showed a national prevalence of high blood pressure at over 8.18% with a higher incidence in North and East India. Data also indicated that adult males between the ages of 36 to 50 years have a 36% higher chance of developing hypertension than adult females in the same age range. Urban areas at 8.6% showed a higher incidence as compared to rural areas with 7.58%.Chronic Obstructive Pulmonary Disease (COPD) and asthma showed an incidence similar to global numbers at 2%. Here, females between 36 to 50 years of age showed a 1.3 times higher chance of developing COPD as compared to males.NCDs pose devastating health consequences for individuals, families and communities with socioeconomic costs that can derail India’s achieving the target of reducing premature mortality from NCDs by one-third by 2030 in line with the United Nations Agenda for Sustainable Development. It is imperative, that only by adopting Artificial Intelligence and Big data analytics to predict risk and personalize care, we can help give an advantage to healthcare providers!Dr Sangita Reddy, Joint Managing Director, Apollo Hospitals Group said,“The theme of World Health Day this year is ‘Our Planet, Our Health’, which is a powerful reminder to put the health of individual and the planet at the center of our actions to create societies focused on well-being. Our annual Health of the Nation study collating a vast amount of real-world data on the prevalence, incidence and risks of disease has led to insights that will help us allocate resources in an optimal manner and develop the right strategy to tackle the NCD pandemic.”The Health of the Nation study also looked at corporate employee data of about thirty-five thousand, where the average prevalence of at least 1 NCD in employees is about 56%. The NCD risk factors of high cholesterol is prevalent in 48% of employees and obesity in 18% of employees. There is variability across sectors, indicating that more sedentary corporate settings should consider ways to help their employees proactively reduce these risks.Dr Sangita Reddy added,“NCDs are fuelled by many factors that include urban lifestyles with stress and unhealthy diets and an aging population. Study results, derived from 35,000 health checks done with corporates in 2021, has also shown a high prevalence of NCDs among corporate employees. These insights will help us use technology to gain an upper hand in ensuring a healthy workforce. Combined with our pioneering experience of 38 years, we have at our disposal new technologies based on AI and ML for predicting risk scores and developing structured lifestyle programs with new models of care that lead to improved clinical outcomes.”The AICVD risk score predicted a moderate or high risk of a cardiac event within 10 years in half of the 31-50 year olds. Other screening programs, especially for cancer, help with early detection and treatment for improved survival rates.Dr Sathya Sriram, CEO Preventive Health, highlights the silver lining, “On the positive side, the report also showed that structured programs help individuals who are at risk to implement and sustain lifestyle changes that reduce risk and slow the progression of the condition.” Enrollment in Apollo Clinics’ Sugar Program showed a mean HbA1c reduction by 1.2% between the first and fourth visits. Data from Apollo ProHealth, a proactive personalized health management program backed by advanced diagnostics, artificial intelligence and predictive algorithms, showed a mean HbA1c reduction for diabetics by 0.73% over 6-12 months, as well as an average weight loss of 3.9kg for 60% of those who engaged actively with the program.About Apollo Hospitals:It was in 1983, that Dr. Prathap C Reddy made a pioneering endeavor by launching India’s first corporate hospital – Apollo Hospitals in Chennai.  Now, as Asia’s foremost trusted integrated healthcare group, its presence includes over 12,000 beds across 72 Hospitals, 4500+ Pharmacies, over 120 Primary Care clinics and 700+ Diagnostic centers, 500 plus Telemedicine Centers, over 15 medical education centers and a Research Foundation with a focus on global Clinical Trials, epidemiological studies, stem cell & genetic research, Apollo Hospitals has been at the forefront of new medical advancements with the most recent investment being the commissioning of South East Asia’s very first Proton Therapy Centre in Chennai.Every four days, the Apollo Hospitals Group touches a million lives, in its mission to bring healthcare of international standards within the reach of every individual. In a rare honor, the Government of India had issued a commemorative stamp in recognition of Apollo’s contribution, the first for a healthcare organization. Apollo Hospitals Chairman, Dr. Prathap C Reddy, was conferred with the prestigious Padma Vibhushan in 2010.  For 37 years, the Apollo Hospitals Group has continuously excelled and maintained leadership in medical innovation, world-class clinical services and cutting-edge technology. Its hospitals are consistently ranked amongst the best hospitals in the country for advanced medical services.

“Dr Prathap Reddy, considered a living legend and an architect of modern health care in India, was conferred with Lifetime Achievement Awards 2022 by Forbes India, The Economic Times and Business Standard“In 1983, when most Indians were dependent only on charitable trusts and government-run hospitals, Dr Prathap Chandra Reddy saw potential in India’s healthcare sector and started the first professionally run 150-bed private hospital – Apollo Hospitals in Chennai, India.Over time, Apollo Hospitals has grown to become a pioneer in the corporate healthcare sector in India, with over 70 hospitals under its umbrella having more than 7,500 clinicians who treat 400,000 patients annually. The establishment of Apollo Hospitals stems from Dr Reddy’s dream to make world-class health care accessible and affordable to every Indian.For his courageous and colossal vision to provide world-class, high-quality hospital care in Inda, Dr Prathap Reddy was honoured with three prestigious Lifetime Achievement Awards consecutively from:FILA 2022 Lifetime Achievement Award from Forbes India for leadership ExcellenceBusiness Standard Lifetime Achievement for Corporate ExcellenceThe Economic Times’ Lifetime Achievement Award for filling a void in India’s healthcare systemDr Reddy has been providing quality healthcare in India, showing no signs of slowing down as he says, “health has no holiday.”The awards stand testimony to Dr Reddy’s tireless perseverance in establishing a pan-India group addressing the country’s growing need for high-quality advanced healthcare so patients do not have to go abroad for treatment.Under Dr Reddy’s astute leadership, the Group has established a landmark healthcare chain with a presence in pharmacies, diagnostics and retail healthcare, becoming Asia’s foremost integrated healthcare services provider. His contributions are widely recognized by patients, doctors, the healthcare fraternity worldwide, the community at large, and the Government of India.