Trinidadian Infant with Rare Liver Disorder Undergoes Life-Saving Transplant at Indraprastha Apollo Hospitals, Delhi

Seven-month-old Erik Ramsook from Trinidad and Tobago, weighing less than 4 kg, received a life-saving liver transplant at Indraprastha Apollo Hospitals, New Delhi, after rapidly progressive liver disease left him critically ill. What initially appeared to be prolonged neonatal jaundice progressed to end-stage liver failure. By the time he arrived in New Delhi, he was suffering from severe malnutrition, ascites and portal hypertension.

Given the severity of his condition and his extremely low weight, doctors expedited his evaluation and concluded that a liver transplant offered his only chance of survival. Erik’s father was initially assessed as a potential living donor but was found unsuitable. His mother subsequently donated a portion of her liver.

The transplant was performed within a week of the family’s arrival in New Delhi by a multidisciplinary team led by Dr. Neerav Goyal, Liver Transplant Surgeon, Indraprastha Apollo Hospitals. A post-transplant genetic evaluation identified a mutation in the TJP2 gene, a rare cause of progressive cholestatic liver disease, also associated with Progressive Familial Intrahepatic Cholestasis Type 4. Only a few dozen children worldwide are reported to have undergone liver transplantation for this condition.

Dr. Goyal noted the rarity of the case, stating that only two of the 600-plus pediatric liver transplants performed at the centre have involved children with a TJP2 mutation. Dr. Preetha Reddy, Executive Vice-Chairperson, Apollo Hospitals, highlighted how Genomic Medicine enabled the precise identification of Erik’s TJP2 mutation, while coordinated multidisciplinary care facilitated rapid evaluation and treatment. She also acknowledged Erik’s mother as a living donor and the dedicated teams involved in his care.

Erik was discharged on day 15 after his transplant and was reported to be recovering well.

His case demonstrates how rapid evaluation, living-donor transplantation, genetic testing and coordinated multidisciplinary care can help manage exceptionally rare and complex pediatric liver disease.