A 13-year-old boy has made Australian history by becoming the country’s first paediatric intestinal transplant recipient, in surgery performed at The Royal Children’s Hospital (RCH).
The complex, multi-organ operation – a collaboration between the RCH and Austin Hospital – was led by Austin Hospital surgeon Professor Bob Jones last week.
Mohamed El Shazly had intestinal failure due to gastroenterological condition ‘Hirschsprung’s disease’. Since infancy his condition has worsened and he’s spent much of his life as an inpatient at the RCH.
The ten-and-a-half hour surgery gave Mohamed a new liver, small bowel, pancreas and duodenum – and a second chance at life.
Professor Jones said the operation went smoothly.
“Pleasingly, the surgery went very much to plan. We removed Mohamed’s original liver and small bowel, but retained his original pancreas and duodenum. We then transplanted the four donor organs (liver, small bowel, pancreas and duodenum) as one package,” Professor Jones said.
“While Mohamed now has two pancreases and two duodenums, only the new organs will function,” he said.
The team then performed a second procedure days later to completely close the abdominal cavity once swelling had reduced.
For most of his life, Mohamed has been fed via a tube in his veins. Also known as parenteral nutrition, this method of feeding provides essential nutrients and fluid to sustain life and enable growth and development in patients who are unable to eat.
RCH Head of Clinical Nutrition, Professor Julie Bines, says intestinal transplantation offers Mohamed the possibility of achieving nutritional dependence.
“Whilst parenteral nutrition has been keeping Mohamed alive as he waited for a transplant, it is associated with potential life-threatening complications such as sepsis, loss of venous access, metabolic complications and liver disease.
“Not only does intestinal transplantation reduce these risks for Mohamed, we hope he will soon have the ability to satisfy his desire for food and eat just as an average boy does,” Professor Bines said.
RCH Head of Liver and Intestinal Transplantation, Associate Professor Winita Hardikar, says Mohamed is recovering steadily after last week’s operation.
“Mohamed is a courageous, resilient boy. He endured the operation well and is recovering as we’d hoped, but he does have a challenging journey ahead,” A/Professor Hardikar said.
“There is still a high risk the body will reject the new organs and infection is also possible. We need to monitor his progress closely and provide months of high level care before we can declare the surgery a success,” she said.
The RCH has been working in collaboration for some time with Austin Hospital on the development of an intestinal transplantation program.
A/Professor Hardikar said the development of intestinal transplantation at the RCH was a logical progression in meeting the clinical needs and expectations of patients with irreversible intestinal failure and their families.
“The Royal Children’s Hospital has spent the last 17 years building up our expertise in liver transplantation. We have well-trained medical and surgical staff and the ability to deal with complex illnesses. We also had the benefit of learning from the first adult intestinal transplant performed at the Austin Hospital in 2010,” A/Professor Hardikar said.
It was announced soon after the first adult transplant that the next intestinal transplant in Australia would be a paediatric one; however, the RCH waited nearly two years for organs from an appropriate donor to become available.
“Unlike other organ transplants, an intestinal transplant requires organs of equivalent or smaller size than the recipient. That’s in addition to the usual considerations, such as blood type,” A/Professor Hardikar said.
She said Mohamed’s journey has been the culmination of years of hard work from many departments across both the RCH and Austin Hospital.
“The teamwork required to keep Mohamed alive has been phenomenal. The medical, surgical, nursing and allied health support has included gastroenterology, clinical nutrition, intensive care, infectious diseases, interventional radiology and anaesthesia, just to name a few,” she said.
RCH Chief Executive Officer Professor Christine Kilpatrick says the surgery and ongoing complex care of patients with intestinal failure complements the national leadership position of the RCH.
“The Royal Children’s Hospital is already a nationally funded centre for paediatric heart, lung and liver transplantation. We hope to develop an intestinal transplantation program, in collaboration with Austin Hospital, which will have a significant impact on the futures of children with intestinal failure,” Professor Kilpatrick said.
“Importantly, we mustn’t forget that Mohamed has been granted a second chance at life thanks to the generosity of a grieving family. We wish to thank them sincerely, as we do all organ donors, for their selflessness during the most emotional of circumstances,” she said.
Mohamed was one of a number of patients in Australia in desperate need of an intestinal transplant. To register to become an organ donor, visit www.donatelife.gov.au.