Multidisciplinary Pediatric Care Enables Successful Liver Transplant for 3.5-Year-Old with Rare Liver Disease and Congenital Urinary Abnormality at Rainbow Children’s Hospital
Child presented with jaundice and was diagnosed with Langerhans Cell Histiocytosis with severe liver dysfunction, with bilirubin levels rising to 10-12 mg/dL
Modified low-dose chemotherapy achieved a 90-95% response, while recurrent UTIs led to the diagnosis and surgical correction of congenital vesicoureteral reflux before liver transplantation
Following liver transplantation, the child received four additional rounds of chemotherapy and is now free of LCH and recurrent urinary infections
Chennai, 30th September 2026: In yet another case highlighting the importance of a multidisciplinary
approach in managing complex pediatric conditions, doctors at Rainbow Children’s Hospital successfully performed a liver transplant on a 3.5-year-old child diagnosed with the rare systemic disorder Langerhans Cell Histiocytosis (LCH), whose treatment was further complicated by an underlying congenital abnormality of kidneys causing recurrent urinary tract infections. The child’s treatment involved multiple specialties and required the medical team to address one clinical challenge after another before the child could safely undergo transplantation.
The child was initially brought to Rainbow Children’s Hospital with complaints of jaundice. Investigations revealed LCH, a rare systemic disorder, with significant involvement of the liver. The extent of liver dysfunction was reflected in the child’s bilirubin levels, which had risen to 10-12 mg/dl, compared with less than 1.5 mg/dL expected at this age.
Given the severity of the liver involvement, the initial focus was on controlling the underlying LCH and improving the child’s condition before transplantation. Chemotherapy was therefore initiated. However, with the liver already severely compromised, the treatment itself had to be carefully adapted. The child was placed on a low-dose targeted chemotherapy regimen, which resulted in an approximately 90-95% response in the LCH.
While this represented a significant response to treatment, the child’s clinical journey became more complex when he began developing recurrent urinary tract infections during chemotherapy. Rather than treating the infections as an isolated complication, the medical team investigated the underlying cause. Evaluation by the pediatric nephrology and urology teams revealed congenital vesicoureteral reflux, a condition in which urine flows backwards towards the kidneys, increasing the risk of recurrent infections.
Adding on to this case, Dr. Mettu Srinivas Reddy, Group Director – Department of Liver Transplantation & HPB Surgery, Rainbow Children’s Hospital, said, “Performing a liver transplant in a 3.5-year-old child with significant liver involvement and multiple associated medical complications requires meticulous planning at every stage. Before transplantation, the child had to be stabilised and the recurrent infections and congenital urinary abnormality had to be appropriately addressed. From the surgical perspective, ensuring that the child was medically optimized and ready for transplantation was critical. The successful transplant was made possible through close coordination between the transplant, pediatric, oncology, nephrology and urology teams, followed by careful post-transplant monitoring and continued treatment for the underlying condition.”
Elaborating on the treatment journey, Dr. Prahlad N, Senior Consultant – Pediatric Nephrology & Kidney Transplant, Rainbow Children’s Hospital, said, “Recurrent urinary infections added another significant challenge to the child’s treatment. Given the need for a liver transplant, it was important to identify the reason behind these repeated infections and address it beforehand. Our evaluation, along with the urology team, identified vesicoureteral reflux. Gross reflux in a immunocompromised child like him, negating reflux. This was done by continuous bladder drainage with a silicon folleys prior and after anti reflux surgery. Permanent Correction of this condition was important to reduce the risk of further infections and ensure that the child was medically optimized before transplantation. Managing these associated problems alongside the primary condition was an important part of preparing the child for the next stage of treatment.”
Further to this, Dr. Nandhini G, Senior Consultant – Pediatric Surgeon and Urologist, Rainbow Children’s Hospital, Guindy, said, “Recurrent urinary infections became an important concern as the child was being prepared for liver transplantation. Further evaluation identified congenital vesicoureteral reflux, where urine flows backwards towards the kidneys, increasing the risk of repeated infections. We performed ureteric reimplantation surgery with stent placement to correct the abnormality and close monitoring. Addressing the urinary condition before transplantation was important to reduce the risk of further infections and ensure that the child was medically stable for the next stage of treatment. The child was subsequently able to proceed with the liver transplant after recovering from the procedure.
About Rainbow Children’s Medicare Limited: Rainbow Children’s Medicare Limited has a network of 26 hospitals across 11 cities, supported by 6 outpatient clinics and 2 exclusive IVF centres, with a total capacity of 2,505 beds. Our Pediatric services operating under the brand “Rainbow Children’s Hospital” includes new-born and pediatric intensive care, pediatric multi-specialty services, pediatric quaternary care (including organ transplantation); whereas our women care services under “Birthright by Rainbow” offers perinatal care services which includes normal and complex obstetric care, multi-disciplinary foetal care, perinatal genetic and fertility care along with gynecology services.
Adding on to this case, Dr. Mettu Srinivas Reddy, Group Director – Department of Liver Transplantation & HPB Surgery, Rainbow Children’s Hospital, said, “Performing a liver transplant in a 3.5-year-old child with significant liver involvement and multiple associated medical complications requires meticulous planning at every stage. Before transplantation, the child had to be stabilised and the recurrent infections and congenital urinary abnormality had to be appropriately addressed. From the surgical perspective, ensuring that the child was medically optimized and ready for transplantation was critical. The successful transplant was made possible through close coordination between the transplant, pediatric, oncology, nephrology and urology teams, followed by careful post-transplant monitoring and continued treatment for the underlying condition.”
Elaborating on the treatment journey, Dr. Prahlad N, Senior Consultant – Pediatric Nephrology & Kidney Transplant, Rainbow Children’s Hospital, said, “Recurrent urinary infections added another significant challenge to the child’s treatment. Given the need for a liver transplant, it was important to identify the reason behind these repeated infections and address it beforehand. Our evaluation, along with the urology team, identified vesicoureteral reflux. Gross reflux in a immunocompromised child like him, negating reflux. This was done by continuous bladder drainage with a silicon folleys prior and after anti reflux surgery. Permanent Correction of this condition was important to reduce the risk of further infections and ensure that the child was medically optimized before transplantation. Managing these associated problems alongside the primary condition was an important part of preparing the child for the next stage of treatment.”
Further to this, Dr. Nandhini G, Senior Consultant – Pediatric Surgeon and Urologist, Rainbow Children’s Hospital, Guindy, said, “Recurrent urinary infections became an important concern as the child was being prepared for liver transplantation. Further evaluation identified congenital vesicoureteral reflux, where urine flows backwards towards the kidneys, increasing the risk of repeated infections. We performed ureteric reimplantation surgery with stent placement to correct the abnormality and close monitoring. Addressing the urinary condition before transplantation was important to reduce the risk of further infections and ensure that the child was medically stable for the next stage of treatment. The child was subsequently able to proceed with the liver transplant after recovering from the procedure.
About Rainbow Children’s Medicare Limited: Rainbow Children’s Medicare Limited has a network of 26 hospitals across 11 cities, supported by 6 outpatient clinics and 2 exclusive IVF centres, with a total capacity of 2,505 beds. Our Pediatric services operating under the brand “Rainbow Children’s Hospital” includes new-born and pediatric intensive care, pediatric multi-specialty services, pediatric quaternary care (including organ transplantation); whereas our women care services under “Birthright by Rainbow” offers perinatal care services which includes normal and complex obstetric care, multi-disciplinary foetal care, perinatal genetic and fertility care along with gynecology services.
Rainbow Children’s Hospital built on strong fundamentals of a multidisciplinary approach with a full-time consultant-led clinical service along with 24/7 commitment in a child centric environment. The company follows a hub-and-spoke operating model where the hub hospital provides comprehensive outpatient, inpatient care, with a focus on tertiary and quaternary services, while the spokes provide 24/7 emergency care, large outpatient services and comprehensive obstetrics, pediatric inpatient and level 3 NICU services. This model is successfully operational at Hyderabad and is gaining traction in Bengaluru. The endeavor is to replicate this approach in Chennai and across the National Capital Region. Subsequently Rainbow intends to expand into tier-2 cities of Southern India.
Rainbow Children’s Hospital embraces a unique doctor engagement model, where doctors work exclusively on a full-time. The doctors work in teams and have 24/7 commitment, which is particularly important for children’s emergency, neonatal, pediatric intensive care services and to support pediatric retrieval services. The Company also operates the country’s largest pediatric DNB training programme in private healthcare, offering post graduate residential DNB and fellowship programmes.