● 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 vesicoureteric 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, 30 th 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-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 liver dysfunction. 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
chemotherapy which showed only partial response. Now there is a significant advancement in the newer
targeted therapy which resulted in a good 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 vesicoureteric reflux, a condition in which urine
flows backwards towards the kidneys, increasing the risk of recurrent infections.
With a liver transplant being considered and the risk of infection, needing to be minimized, the urinary
abnormality had to be addressed before transplantation. The child therefore underwent a successful
ureteric reimplantation surgery to reposition the ureter and correct the underlying abnormality. A
temporary stent was subsequently placed to support the urinary system and reduce the risk of further
infections during the transplant process.
Navigating this intricate medical puzzle required seamless collaboration across multiple specialties. A
dedicated expert team at Rainbow Children’s Hospital, comprising Pediatric Nephrologists, Pediatric
Surgeons, Hepatologists, Pediatric Transplant Surgeons, Pediatric Hemato-Oncologists, and Pediatric
Intensivists came together to execute a carefully staged treatment plan to manage the complications,
determine the appropriate sequence of interventions, stabilise the child and prepare him for liver
transplantation. Once the urinary abnormality had been corrected and the child was medically stabilised, the
liver transplant was successfully performed approximately three weeks later.
The child underwent a living donor liver transplant, receiving a portion of his father’s liver, who was
found to be a suitable donor following detailed evaluation. The transplant was performed by Dr.
Mettu Srinivas Reddy, Group Director – Department of Liver Transplantation & HPB Surgery,
Rainbow Children’s Hospital, Chennai along with Dr. Somashekara H R, Senior Consultant –
Pediatric Hepatology & Liver Transplantation, Rainbow Children’s Hospital, Guindy with the
multidisciplinary team of doctors Dr. Prahlad N, Senior Consultant – Pediatric Nephrology & Kidney
Transplant, Dr. Prasanna Gopal, Pediatric Transplant Surgeon, Dr. Nandhini G, Senior Consultant –
Pediatric surgeon and Urologist, Dr. Karthik Narayanan R & Dr. Nataraj P, Consultants – Pediatric
Intensive Care, Dr. Meena Sivasankaran, Consultant Pediatric Hemato-oncologist, and Dr. Sathish
Chander, who led the anesthesiology department. The living donor liver transplant involved
transplantation of the left lateral segment of the donor liver, with the procedure lasting approximately 10
hours. Following the transplant, the child was closely monitored for 8 weeks and after which he continued to
receive disease-directed chemotherapy for LCH. He subsequently completed four additional rounds of
chemotherapy, with follow-up evaluations showing no evidence of LCH and resolution of the recurrent urine
infections.
Speaking on the occasion, Dr. Somashekara H R, Senior Consultant – Pediatric Hepatology & Liver
Transplantation, Rainbow Children’s Hospital, said, “This was an exceptionally complex case because we
were not dealing with a single problem. We had to manage a rare systemic disease with severe liver
involvement, while also dealing with the limitations that the liver dysfunction placed on chemotherapy.
When recurrent infections emerged, we had to identify and correct the underlying urinary abnormality before
the child could proceed to transplant. Each decision had to be carefully coordinated with the next. The
involvement of our hemato-oncology, hepatology and liver transplant, nephrology and urology teams
allowed us to address these challenges together and take the child through treatment in a planned and
coordinated manner.”
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 vesicoureteric 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 vesicoureteric 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.