No foreigner to firsts

Abdullah Alazemi celebrates an early first birthday with his parents.

Eleven-month-old Abdullah Alazemi of Kuwait may be from another country, but "firsts" are not foreign to him. In December, he became New England's first recipient of a multivisceral transplant, an operation in which the stomach, pancreas, liver and small intestine were transplanted from a single donor.

Abdullah was born in December 2003 with severe Hirschsprung's disease, a condition in which the intestine lacks nerves cells that receive signals from the brain to move food through it. This can cause blockages, inability to tolerate feeding, and ultimately, liver failure, which can lead to the need for organ transplantation.

Abdullah's disease progressed quickly, and it was determined that he would need an intestinal transplant to live. So officials in his home country sent the family to Children's Hospital Boston for surgery.

The Alazemi family—who lost another son to this same disease in 1998—arrived in Boston in February 2004 with Abdullah weighing little more than 8 pounds. "We had to make sacrifices, leaving behind our country and our family, but we didn't hesitate for a moment once we knew there was a chance," says Abdullah's father, Ahmed, in Arabic, through Children's translator, Milad Najjar. "In Kuwait, we had given up hope. But Children's gave us new hope."

The hospital's Short Bowel Program, run by Tom Jaksic, MD, surgical director of the program, and Christopher Duggan, MD, director of the Clinical Nutrition Service, helped Abdullah gain weight and get healthy enough to undergo the transplant. He was placed on the transplant waiting list in April in hopes that small enough organs would become available before it was too late.

Then on August 31, Heung Bae Kim, MD, surgical director of Children's newly formed Liver, Intestine and Multivisceral Transplantation Center, got an early morning phone call that would forever change young Abdullah's life—a set of organs had become available. Dr. Kim rushed to procure the stomach, pancreas, liver and small intestines. At the same time, Dr. Jaksic prepared Abdullah for his transplant.

In a complicated six-hour procedure, Dr. Kim's surgical team carefully removed Abdullah's abdominal organs and replaced them with the donor's non-diseased ones. "The organs are really treated as one," says Dr. Kim, explaining that since the baby was so small, it was easier to leave the organs connected for transplant. "In this case, the patient needed the intestine and the liver; the stomach and pancreas came along for the ride." Surgeons only needed to connect the aorta and one vein when reattaching the organs, as opposed to all the blood vessels that would be involved with each organ separately.

"We were pleasantly surprised with how well he did after the operation," says Dr. Kim. "He spent eight days in intensive care, and has been in the hospital for three months. Now he's ready to go home."

Despite a bout of infection and having to take medication to fight graft-versus-host disease, Abdullah has done very well after his complicated surgery. He will stay in the area for the next several months, until his parents feel comfortable with the ongoing care they'll need to provide for him, and until Children's doctors give the nod that he is healthy enough to head back to Kuwait.

Ahmed and his wife, Reem, are thrilled to see their son doing so well. "What makes this hospital great and distinguished is the people here that helped Abdullah everywhere he went," says Ahmed. "In Kuwait, we thought we would lose him, like we lost our first son. But now we have a new beginning."

	For more information on Children's Hospital Boston's Liver, Intestine and Miltivisceral Transplantation Center, call (617) 355-4837.