University of Chicago performs liver-cell transplant to rescue infant
March 13, 1999
On Thursday evening, March 11, 1999, Mujahid Musa, a three-pound premature infant with liver failure, became the youngest and by far the smallest person ever to receive a new form of liver "transplant." Since Musa is too tiny and far too fragile to withstand major surgery, the University of Chicago Hospitals liver transplant team infused about a billion liver cells through a catheter into his portal vein, a blood vessel that leads into the liver, in an innovative attempt to restore his liver function. The goal is to keep him alive long enough to become a transplant candidate.
The cells lodged in his damaged liver and should begin to perform some of the tasks of a healthy liver within two to three days. They could possibly take root there permanently and slowly repopulate the organ with working liver cells, making a transplant unnecessary. More likely, they will function for a few weeks or months, allowing him to gain enough size and strength to become a candidate for a more traditional liver transplant.
"This was the only treatment option for this very tiny child," said Michael Millis, MD, director of the liver transplant program at the University of Chicago Hospitals and a specialist in transplantation of very small children.
Although about a dozen liver-cell infusions have been performed in the United States, it has never been attempted in an infant this small.
The treatment required the cooperative efforts of scientists and physicians around the country. The patient was flown on March 10, 1999 to Chicago from Children's National Medical Center in Washington, DC. The liver cells were flown in the next evening from a bank of frozen cells stored at the University of Pittsburgh. The liver tissue, from which the cells were isolated, had recently been shipped to Pittsburgh from the University of Chicago and one other medical center. One donor was a young girl and the other an elderly women.
Musa was born January 26, 1999, 13 weeks premature and weighing 770 grams (1 lb. 11 oz). His due date was April 25, 1999. His mother, Cheryl Ryder, and father, Abdul-Alim Musa, have two other children--a 21-year-old son and a 21-month-old daughter.
Ryder was undergoing amniocentesis at a Washington hospital when the fetus's umbilical cord was damaged, necessitating an emergency cesarean section. The child, who is still dependent on a ventilator to breathe, recovered well from many of the problems associated with extreme prematurity and the birth emergency--but has increasingly suffered from the consequences of inadequate liver function. The cause of the liver failure is undetermined, but it may have resulted from a persistent viral infection during the pregnancy, possibly compounded by the circumstances surrounding the birth.
While Musa and his mother waited in the pediatric intensive care unit Thursday evening, the thawed and carefully packed cells arrived at the Hospitals at 7:45 p.m. The cells were examined, counted, washed, and prepared in the cellular transplantation laboratory. Just before 10 p.m., Dr. Millis carried the prepared cells on ice to the unit.
Over the next three hours, 300 million cells were infused into Mujahid's liver in three batches of about 100 million cells each. The process was repeated Friday morning and will be repeated another two times in about four days for a total of nearly 1.2 billion cells.
"The first 24 hours are critical in determining if the baby's body will tolerate the hepatocytes," said Dr. Millis, and the following 48 hours will be the crucial period before we know they are working." Mujahid is receiving immunosuppresive drugs to keep his body from rejecting the foreign cells, as if he received a solid organ transplant."
"The name Mujahid means warrior," explained his mother. Because of his unanticipated premature delivery, the parents had not settled on a name when he was born. They came across the name in a book and decided that it was perfect for him. "He has had to fight just to stay alive ever since he was born," said Ryder.
The University of Chicago has been a leader in transplantation since the very beginning, which started at the University in 1904 when Alexis Carrel, MD, developed the surgical techniques to perform organ transplantation. Carrel won the Nobel Prize for Medicine and Physiology for this work in 1912.
Since the 1980s the University of Chicago Hospitals has been the leading center for innovative treatment of children with liver failure, developing a series of new surgical techniques including the use of living donors to improve transplantation of small children.
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