Montasir Elfatih, liver transplant patient
A 14-year-old boy Montasir Elfatih with his elder brother and donor Khalifa. Elfatih is the youngest patient to undergo a living related donor transplant procedure at the Cleveland Clinic Abu Dhabi,. Image Credit:

Abu Dhabi: A 14-year-old boy who received a portion of his elder brother’s liver has become the youngest patient to undergo a living related donor transplant procedure at the Cleveland Clinic Abu Dhabi, the emirate’s first multi-organ transplant centre.

Despite complexities during the procedure, both the patient — Sudanese teenager, Montasir Elfatih Mohyeldin Taha — and his donor brother, Khalifa, 23, are now doing well.

Congenital liver condition

Taha was diagnosed with biliary atresia as an infant. The condition sees bile ducts outside the liver failing to form during fetal development, and this prevents bile, which helps in the digestion of fat, from reaching the small intestine. At just 10 months, Taha underwent a Kasai procedure, which connected a loop of his small intestine directly to the liver so that bile could drain into the bowel.

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However, patients who undergo Kasai procedures eventually need to undergo liver transplants. Earlier this year, Taha’s symptoms and blood tests began to indicate liver failure, including an increase in pressure within the vein that carries blood from the digestive organs to the liver. This hypertension resulted in varicose veins in his oesophagus.

Seeing the high risk of potential complications, his doctors in Sudan recommended that he undergo a liver transplant at Cleveland Clinic Abu Dhabi.

Most complex case

Dr. Luis Campos, director of liver transplantation and hepatobiliary surgery at the Abu Dhabi Hospital, said Taha’s was one of the most complex living donor liver transplant surgeries 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 aftercare, and determine the dose of immunosuppressive medication during and after the transplant. There is also a risk of other infectious complications in paediatric liver transplants that do not apply to adult surgeries,” Dr Campos explained.

Donor selection

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

Easiest decision

“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,” Khalifa said.

“My father passed away six months ago and as the eldest son in the family, it was my responsibility to save him,” he added. The family flew in to the UAE capital for the transplant procedure.

Transplant complexity

Dr. Shiva Kumar, chair of gastroenterology and hepatology at the hospital’s Digestive Disease Institute, said one of the biggest challenges during Taha’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. However, the surgeries of both brothers were successful and without complications. Taha 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,” Dr Kumar said.

Recovery

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

Need for organ donation

Khalifa said 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 Taha’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 said.

The Sudanese national added that he also hoped more people would consider donating their organs. “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,” he added.