A multidisciplinary team at Children's Memorial Hermann Hospital is the first in Houston and only the fourth in the nation to perform a rare quadruple organ transplant.
Maria Mendez, of Houston, received a new liver, small bowel and two kidneys in a 14-hour operation on November 17, 2006. After almost five months of recovery from the ground-breaking procedure, the young patient has been successfully discharged and is now able to join her family at home.
The surgery was performed by transplant surgeon Luis Mieles, MD, medical director of liver transplantation at the Memorial Hermann's Texas Liver Center and the Intestinal Rehabilitation and Transplantation Center, and a clinical professor at The University of Texas Health Science Center at Houston (UTHSC); Bob Saggi, MD, transplant surgeon at Memorial Hermann's Texas Liver Center, assistant medical director of the Intestinal Rehabilitation and Transplantation Center and a clinical assistant professor at UTHSC; and Hadar Merhav, MD, assistant medical director of Memorial Hermann's Texas Liver Center, transplant surgeon at the Intestinal Rehabilitation and Transplant Center and associate professor at UTHSC. Perioperative anesthesia care was provided by Nicholas C. Lam, MD, and Vladimir Melnikov, MD.
Mendez developed short-gut syndrome at 6 months of age, leading to the removal of most of her intestine, leaving only 4 inches of small bowel and a small portion of colon.
Patients who lose a large portion of bowel must live on total parenteral nutrition (TPN), which involves intravenous feeding through an implanted vascular catheter. While many patients on TPN tolerate it well, intravenous feeding can lead to serious complications, including liver disease.
Mendez developed severe liver disease in December 2005 and was referred to Ruben Quiros, MD, pediatric gastroenterologist at Children's Memorial Hermann and associate professor of clinical pediatrics at the University of Texas Medical School at Houston. During evaluation for transplantation, Quiros discovered that Mendez's kidney function was compromised as well.
"It was nearly a year before we could transplant Maria because of the difficulty of obtaining all four organs and because we were dealing with complicated size and match issues."
Even though she is 14, Maria is the size of a nine-year-old. Her abdominal cavity had not developed normally due to the missing portions of small and large bowel. As a result, she needed the organs of a three-year-old, which were recovered from a donor in the Southeast U.S.
"Maria is an extraordinary case," Saggi said. "Most kids don't make it as long as she did on TPN before developing liver disease."
Because Mendez had virtually no small and large bowel and her abdominal cavity failed to develop normally, she also required complex postoperative care, according to Saggi. Mendez now has been off of TPN for more than a month for the first time since she was 6 months old.
"Without the team effort and infrastructure of Children's Memorial Hermann we could not have succeeded, because the complexity of the surgery is just part of the challenge," Saggi said. "The postoperative care must be perfect as well."
All four physicians attribute Mendez's extraordinary survival to the dedication of her mother, Maria Gonzalez, and the care she provided while raising six other children.
"It is time-consuming and emotionally exhausting to raise a child on TPN," Mieles said. "Most people who have a child with complex health needs find it overwhelming. It is amazing that Mrs. Gonzalez was able to maintain Maria's health with minimal infection.
"This was a very complicated case that required the efforts of a multidisciplinary team," Mieles continued. "The pediatric intensive care unit at Children's Memorial Hermann is one of the best in the nation. We have a team - pharmacists, nurses, nutritionists, social workers and counselors - that woks with us to ensure the success of the surgery and recovery. Maria's new organs are doing well. Without them, she wouldn't have survived another six months to a year."