The Telegraph
Saturday , December 22 , 2012
Since 1st March, 1999
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Infection blow to rape victim amid hope
Intestine transplant offer

New Delhi, Dec. 21: The Delhi gang-rape victim began breathing unassisted today, remained conscious and alert, and received fluid food intravenously but her condition remains critical as doctors have spotted signs of infection.

“There are some signs of improvement, some signs of deterioration,” said Badrinath Athani, medical superintendent at the government-run Safdarjung Hospital where the 23-year-old woman is being treated.

“She is breathing on her own without ventilator support and her pulse rate and urine output are within limits,” Athani, flanked by a team of physicians, surgeons and intensive care specialists treating the victim, told reporters this evening.

But doctors have observed a fall in her infection-fighting white blood cells (WBCs) — her count today was about 1,500 cells per cubic centimetre, significantly below the normal range of 4,000 to 11,000 cells per cubic centimetre — and a rise in bilirubin.

“A fall in the WBC count at this juncture is worrying. WBCs help fight infections and she needs strong immune system support while she is under the threat of infection,” a senior member of the medical team said. “The next two days will be crucial.”

Doctors have been giving her antibiotics to prevent the spread of infection from the site of her multiple injuries, pain-control medications, oxygen support and intravenous nutrition — a liquid cocktail of carbohydrates, proteins, fats and other essential nutrients.

Safdarjung Hospital doctors declined to speculate whether she could benefit from an intestinal transplant offered today by a team of doctors at the Sir Ganga Ram Hospital, a private tertiary health care centre in New Delhi.

The victim lost a section of her intestines during Sunday night’s sexual assault and almost the whole of the residual part had to be surgically removed because it had turned gangrenous.

If she recovers, she will need to stay on intravenous nutrition for life — which doctors say brings its own complications — or could be offered an intestinal transplant.

“Our entire focus right now is on managing her critical state; we are not at a stage where we can discuss a transplant option,” Athani said. “She is receiving the best supportive care possible.”

A senior surgeon who has participated in intestinal transplants in the UK said that while the surgical principles are well established and the surgery itself is less sophisticated than a liver transplant, the post-transplant management is complicated.

“There are no clear markers to determine whether an intestinal graft has been accepted or rejected,” said Subash Gupta, a transplant surgeon at the Apollo Indraprastha Hospital in New Delhi.

After liver and kidney transplants, doctors can use liver function tests and kidney function tests to assess the performance of the transplanted tissue.

“After an intestine transplant, patients require repeated biopsies to check on the graft,” Gupta said.

A transplant team at the Sir Ganga Ram Hospital, led by surgeons Samiran Nundy and Naimish Mehta, had performed India’s first intestinal transplant on a 43-year-old man using tissue from a living donor.

But the patient died from sepsis six weeks after a functioning graft.