Boy Who Received Unique Transplant Goes Home for Holidays

Newswise - A 2-year-old who has spent his entire life in the hospital will be going home for the holidays, 10 months after a pioneering double transplant operation.

Isiah Wright, of Berwyn, Ill., is the first child in the United States to undergo a successful living-donor liver and small bowel transplant from the same donor. His mother, Vanessa Munoz, donated a segment of her liver and a segment of her small bowel in sequential surgeries at the University of Illinois Medical Center at Chicago.

Isiah will be released from the hospital Dec. 7.

"A dual, two-staged transplant was the only option for Isiah," said Dr. Enrico Benedetti, associate professor of surgery at UIC and division chief of transplantation surgery.

The toddler has been hospitalized since birth due to multiple medical problems.

Due to the complexity of his illness, a previous transplant, and multiple blood transfusions, Isiah had developed pre-formed antibodies that surgeons feared would result in acute rejection of a newly transplanted intestine.

However, pre-formed antibodies do not cause rejection in liver transplant patients. With this knowledge, surgeons first removed a portion of his mother's liver and transplanted it into Isiah on Feb. 3 of this year.

"We knew the liver would filter the pre-formed antibodies from Isiah's blood, but we didn't know how long that might take," said Dr. Mark Holterman, associate professor of surgery and division chief of pediatric surgery.

"To our surprise, his blood was free of pre-formed antibodies within two hours of the operation."

One week later, surgeons removed approximately six feet, or one third, of his mother's small intestine for the second phase of the transplant.

"The preparation, timing and two-step process was crucial to ensure that the transplant would not be rejected acutely," said Dr. Giuliano Testa, director of living-donor liver transplantation surgery at UIC.

"We know that using a living-donor graft is superior to using a cadaveric graft for liver and small-bowel transplantation because the risk of rejection and infection is greatly reduced," Benedetti said.

Since the dual transplant, Isiah has had a slow but steady recovery. He will require speech, occupational and physical therapy due to his long hospitalization. His mother was discharged from the hospital Feb. 16 and has had no complications.

In the past 10 years, living-donor organ transplantation has significantly reduced the mortality of children waiting for livers, and living-donor kidney transplantation for children has become routine.

"Sadly, many families are not aware that living-donation is a viable option for intestine transplantation," Dr. Holterman said. Consequently, the mortality for children waiting for small bowels has remained high.

UIC surgeons have performed more of these surgeries than any other center in the United States and believe this may be the best option for some children currently on the waiting list.

Based on Organ Procurement and Transplantation Network data as of Nov. 26, only seven patients under age 18 have undergone living-donor small bowel transplantation in the United States. Four of these surgeries were performed at UIC.

Isiah's complex medical history

Isiah Wright was born Feb. 8, 2002 weighing 4 pounds 7 ounces. He suffered from gastroschisis, a congenital defect of the abdominal wall in which all or parts of the small intestine and other internal organs are on the outside of the abdomen with no protective sac. The defect occurs in approximately 1 in 10,000 births.

In most cases, it can be repaired with surgery after the child is born, but in a few cases, the amount of damage to or loss of intestine causes further complications. Isiah's bowel did not have a sufficient blood supply and was surgically removed after birth.

Without a small intestine, Isiah could not digest food or absorb nutrients. He required intravenous feeding but his growth was stunted and he became extremely ill.

He was placed on the transplant waiting list in June 2002. After eight months on the waiting list, his liver was also failing as a result of the intravenous feeding.

In January 2003, Isiah's mother began evaluation as a living donor. During the work-up she learned that she was pregnant and was immediately ruled out as a potential donor. His father was found to have an incompatible blood type.

Isiah's maternal grandmother was the only suitable donor. She donated a portion of her small bowel in February 2003.

Several weeks after surgery, Isiah's body rejected the organ. He was treated aggressively with immunosuppression and then developed post-transplant lymphoproliferative disorder, a significant complication of solid organ transplantation. Due to the severity of the disorder, the transplanted organ was removed, and the disorder resolved itself within six months.

During this time, Isiah was cared for by a team of specialists in the pediatric intensive care unit at the University of Illinois Medical Center. His health continued to decline and physicians and nurses struggled to keep him alive.

"This child is extremely resilient and he's a fighter," said Dr. Benedetti.

During Isiah's medical crisis, his mother gave birth to a healthy daughter in August 2003. After recuperating from the delivery, she was again considered as a potential donor.

"After having the surgery myself, I understand now what he's been going through," Vanessa Munoz said. "It's so exciting now because it's real and he's finally coming home."

For more information about University of Illinois Medical Center at Chicago, visit http://www.uillinoismedcenter.org

UIC ranks among the nation's top 50 universities in federal research funding and is Chicago's largest university with 25,000 students, 12,000 faculty and staff, 15 colleges and the state's major public medical center. A hallmark of the campus is the Great Cities Commitment, through which UIC faculty, students and staff engage with community, corporate, foundation and government partners in hundreds of programs to improve the quality of life in metropolitan areas around the world.

Copyright © 2004 Newswise.

This article posted Decembere 16, 2004.