Best Pediatric Liver Specialist in
Delhi NCR

She is pioneer in India to develop pediatric liver transplant and pediatric hepatology and was recognized by Medical Council of India for this and was decorated with B.C. Roy National Award, the most prestigious award in medicine in India, in recognition of the best talents in encouraging the development of specialties in different branches in medicine. She is credited with few world records and several firsts in India in liver transplant

Pediatric hepatologist sees:

Jaundice, viral hepatitis (A,E, B,C etc.), Poor appetite / lethargy /weakness, Liver disorders due to any condition, Liver enlargement, Portal hypertension, Vomiting of blood / blood in stool, Liver tumors, Liver failure (Acute / Chronic )

Liver transplantation is done when in liver fails for any reason or in liver tumor or inborn errors of metabolism where liver is the culprit

Dr. Neelam Mohan has the largest experience of best pediatric liver transplant in India and has performed liver transplant in small babies too (world lightest baby is 2.1 kg was from her team).

Her extensive clinical experience and vast academic background (>950 presentations, >200 publications, >50 chapters in book) accompanied with a God’s blessing of “Third eye in diagnosing problems has brought her to the top position her filed.

When it comes to treating any type of liver illness or liver failure, a liver transplant is the last resort. If the need arises, Dr. Neelam Mohan is the Best Pediatric Liver Specialist in Delhi NCR.

Her extensive successful experience with many types of liver transplant surgeries sets her apart from all other best pediatric liver specialists in Delhi NCR.Best liver transplant surgeon in India

Functions of Liver

Liver is the largest organ of body. It weight about 150gm in new born to 1.5kg in adults. It is located in upper abdomen on right side. It has 2 lobes (right and left) and produces bile which flows into small intestine (duodenum) via bile duct.

Liver performs a myriad of metabolic functions unmatched by any other organ in our body.

The main functions of liver are:

- Produces bile which helps in digestion of fat
- Synthesis and breakdown of carbohydrates (glycogen)
- Excretion of ammonia as Urea
- Metabolism and excretion of drugs and toxins
- Storage of fat soluble vitamins

Indications

The common indications of liver transplant in children include cholestatic liver disease (most common of which is biliary atresia) and metabolic liver disease followed by acute liver failure. Occasionally it is indicated for liver tumor and certain rare condition.

What are the indications of liver transplantation in children and adolescents?

-Cholestatic liver disease: Biliary atresia, Alagille’s, syndrome, Progressive familial intrahepatic cholestasis(PFIC), Neonatal hepatitis.
-Metabolic liver disease: Wilson’s disease, Tyrosinemia, Glycogen storage disorder, Galactosemia, Fatty liver disease, Fatty acid oxidation defects, Bile acid disorders, a1 anti trypsin deficiency.
-Hepatitis: Viral hepatitis (A,E,B,C others), Autoimmune hepatitis, Drugs and poisoning ( including paracetamol poisoning/ toxicity secondary to antituberculosis/antiepileptic drugs).
-Metabolic and Genetic disorders: Metabolic disease where liver is the culprit. Criggler-Najjar syndrome type-1, Organic acidemias, urea cycle defects like maple syrup urine disease (MSUD) and Primary oxalosis.
-Liver tumors: Benign tumors that have replaced the whole liver, Unresectable malignant, without extrahepatic metastasis.

Certain rare condition such as factor VII deficiency, Protein C and Protein S deficiency and familial hypercholesterolemia.

Why is CT scan Triphasic Angiography carried out on the donor?
A CT scan triphasic angiography provides information on the vascular anatomy which is important for the surgeon to know and volumetry is performed on donor liver by using special software which calculates the volume of various parts of the liver.

How much liver is to left behind with the donor?
At least 35% of the liver is left behind with the donor. For this volume calculation CT volumetry is very important.

Who can Donate Liver

Willing, family donor with matching blood group. The donor should provide an informed consent and also must undergo psychological evaluation. The donor should be 18-55 years old, weighing 55 – 85kg but not fat, should be healthy with normal liver and kidney functions, HBsAg, HCV and HIV negative. It is very important that the donor liver is not fatty therefore a plain CT scan is performed first to calculate the LAI (liver attenuation index). This should normally be more than 6. One would accept a liver with a positive LAI (as compared to spleen). Occasionally a liver biopsy may be done to rule out fatty liver. The donor undergoes complete evaluation of heart, lungs, kidney and other organs., besides a psychiatric evaluation. A CT scan is carried out on the donor to evaluate vascular anatomy and graft volume. MRI (MRCP) provides information of the biliary ducts.

What does Pre Transplant Evaluation include?

Immunizations Pre transplantation:
Most units including ours consider live vaccines to be contraindicated after liver transplant because of the risk of dissemination secondary to immunosuppression. It is therefore better to complete normal immunizations before transplant. These include – BCG, DPT + Hib, Hepatitis B, Measles, MMR. Its suggested to give even optional vaccine such as Hepatitis A, Typhoid, chickenpox, influenza rotavirus and pneumococcal vaccines. The vaccination schedule may be expedited and may differ from the normal recommendations

Management of hepatic complications:
It is important to ensure that specific hepatic complications are appropriately managed while the patient waits for transplant. These include portal hypertension, oesophageal varices, ascities, hypoproteinemia etc.

Nutritional support:
It has been demonstrated in several studies that nutritional status at liver transplant is an important prognostic factor in survival, that is better outcome is seen in patients with good nutritional status. The patient needs to be on a high calorie diet (150- 200% calories with good protein intake) with two times the RDA of multi vitamins and in patients with cholestasis supplementation with fat soluble vitamins like vitamin A,D,E,K is done. In patients with cholestasis,MCT oil as in coconut oil is used for cooking. If a child is not able to feed well orally then tube feed supplementation is done, which could be for overnight feeds or during the day as per the need.

Our Experience

We have completed >200 Pediatric Liver Transplants in small children and are the busiest center in India with success rate of 92% at 1 year and overall success rate of over 90% on a median follow up of >4 years.

- Cholestatic liver disease is the commonest cause of Liver Transplantation. This includes Biliary atresia, Caroli's disease, Alagille Syndrome, Progressive familial intrahepatic cholestasis (PFIC)Sclerosing cholangitis including Langerhans cell histiocytosis (LCH). Langerhans cell histiocytosis (LCH) is a rare condition of Liver disease secondary to Sclerosing cholangitis and we have 5 year survival of 100% in these patients

- Metabolic Liver Disease – Wilson Diseases is the commonest cause in Metabolic Liver disease that have been transplanted. We have a large experience of other metabolic conditions such as Tyrosinemia, Glycogen storage disorder (GSD), Maple Syrup Urine Diseases (MSUD), Progressive familial intrahepatic cholestasis (PFIC), factor VII deficiency & protein C and S deficiency

- Our team has a good experience of Combined Liver Kidney transplantation in Primary Hyperoxaluria in children with 100%results

- We have experience in Liver Transplantation in Metabolic inborn errors of metabolism such as MSUD, Citrullinemia etc

- Acute Liver failure (ALF) and Acute on Chronic liver failure (ACLF) constitutes one third of our total transplants. We have advanced Management Strategy to care in ALF & ACLF patient like Intracranial Bolt in ALF, hemo-dialysis, CRRT, plasma- pheresis, MARS etc. Common causes of ALF are Viral Hepatitis A/E, drugs (ATT) and ACLF are, Wilson disease, tyrosinemia and autoimmune liver disease

- We have also large series of liver transplant with autoimmune liver disease including autoimmune sclerosing cholangitis

- We have done surgical innovations to answer shortage of organs such as: 
1) ABO incompatible Liver transplantation – where blood group of donor and recipient is not matching
2) Swap liver transplants– It is a method to match the blood group incompatible donor and recipient couples with another donor and recipient having similar issues
3) Domino liver transplants– In a domino Liver transplant, the explanted liver from a patient who has an illness curable by liver transplant, is used as domino graft for some other patient, as the explanted liver is otherwise well

- Hepatopulmonary syndromeis a rare complication of Portal hypertension where there is lung failure in association with liver disease. We have transplanted 8 such cases with excellent results

Book An Appointment

Get The Right Medical Care

Call Us: 
+91 9818200582 / Helpline no. : 01244141414

VISIT US:
Medanta the Medicity:
Sector 38 – Gurgaon; 122001, Monday to Saturday; from 11:00 am to 4:30 pm,
Contact no. 0124-4141414

Medanta Mediclinic, E-18, Golf course road, Gurgaon-110024, Days & Time: Tuesday & Friday, 4:30 pm to 5:30 pm,
Contact no. 011 44114411 / 9818200582

Email: drneelam@yahoo.com
            mohanpedgastro@gmail.com