14-year-old becomes youngest patient to receive living donor liver transplant at Cleveland Clinic Abu Dhabi

 

A 14-year-old boy has received a living liver donation from his elder brother at Cleveland Clinic Abu Dhabi, an integral part of Mubadala Health, becoming the youngest patient to undergo the operation in the hospital’s history.

Montasir Elfatih Mohyeldin Taha was diagnosed with biliary atresia in infancy, a condition where the bile ducts outside the liver fail to form during fetal development, not allowing the bile to reach the small intestine where it helps in the digestion of fat. At 10 months, he had to undergo the Kasai procedure, which is done to connect a loop of small bowel directly to the liver so that the bile can drain into it. Montasir’s doctors back home in Sudan knew that it was only a matter of time before he would have to undergo a liver transplant, an inevitable consequence for most children who have this procedure.

Portal hypertension

Earlier this year, Montasir’s symptoms and blood tests revealed that he had started developing liver failure and was suffering from portal hypertension, an increase in the pressure within the vein that carries blood from the digestive organs to the liver, resulting in varicose veins in his esophagus. Seeing the high risk of potential complications, his doctors in Sudan recommended that he undergo a liver transplant at Cleveland Clinic Abu Dhabi.

Dr. Luis Campos, the Director of Liver Transplant and Hepatobiliary at Cleveland Clinic Abu Dhabi, who was part of the interdisciplinary team that cared for Montasir, says this was one of the most complex living donor liver transplant surgeries that they have performed at the hospital.

“There were additional nuances that had to be taken into consideration because of his age, which made it even more challenging. Factors such as height and weight impact the surgery and after-care, and determine the dose of immunosuppressive medication during and after the transplant. There is also a risk of other infectious complications in pediatric liver transplant that do not apply to adult surgeries,” says Dr. Campos.

Multidisciplinary medical team

The multidisciplinary medical team at Cleveland Clinic Abu Dhabi studied the case and evaluated Montasir’s mother and brother for a match in February. After careful discussion with colleagues in the US-based Cleveland Clinic, doctors here decided that his sibling would be a more suitable match.

“My little brother needed me. I was very relieved when I was told that I can help be the cure to his illness. This was one of the easiest decisions that I have had to make,” says Khalifa Elfatih Mohyeldin Taha. “My father passed away six months back and as the eldest son in the family, it was my responsibility to save him.”

Kasai procedure

Dr. Shiva Kumar, the Chair of Gastroenterology and Hepatology in the Digestive Disease Institute at Cleveland Clinic Abu Dhabi, who was also part of the patient’s care team, says one of the biggest challenges during Montasir’s transplant was posed by the young patient’s Kasai procedure.

“While the Kasai procedure is commonly performed to prolong the need for a liver transplant in children, this is a major operation and makes the transplant more challenging to perform,” says Dr. Kumar.

“However, the surgeries of both brothers were successful and without complications. Montasir received a left lobe graft from his brother. This is a smaller portion of the liver than if we were transplanting a right lobe graft. This makes it a safer operation for the donor and helps them recover faster.”

Immunosuppressive regimen

The brothers are on their way to a full recovery. Khalifa is back to his normal life now while the Cleveland Clinic Abu Dhabi care team is monitoring Montasir’s immunosuppressive regimen, which he will be on for the rest of his life.

Khalifa says he could not contain his joy when he was told that the surgery was a success. “The best part of my transplant journey was to see that Montasir’s body had accepted the new organ. My family and I are very grateful to the care team at Cleveland Clinic Abu Dhabi for saving my brother’s life.”

He also hopes that more people consider organ donation. “The feeling of giving a chance to someone to live a normal life is incomparable. Seeing the result of your donation will fill you with contentment.”